The prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.

The opioid epidemic in the United States has had a devastating impact on millions of people as well as on their families and communities. The increased prevalence of opioid misuse, use disorder and overdose in recent years has highlighted the need for improved public health approaches for reducing the tremendous harms of this illness. In this paper, we explain and call for the need for more systems science approaches, which can uncover the complexities of the opioid crisis, and help evaluate, analyse and forecast the effectiveness of ongoing and new policy interventions. Similar to how a stream of systems science research helped policy development in infectious diseases and obesity, more systems science research is needed in opioids.

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