Applying a Social Determinants of Health Approach to the Opioid Epidemic

Abstract

Ohio is one of the hardest-hit states in the United States when it comes to opioid overdose deaths. Confronted with over 4,000 opioid overdose deaths in 2017, the Ohio Department of Mental Health and Addiction Services launched the Community Collective Impact Model for Change (CCIM4C) initiative to encourage 12 Ohio counties to think more deeply about primary prevention. By moving upstream and taking a look at the causes of the opioid crisis, the counties involved in the CCIM4C initiative were able to expand the range of potential partners and potential solutions, moving from emergency response alone to broader efforts to support social connection, economic security, and other social determinants of health. Each county brought together a wide array of partners, including local employers, community colleges, health care organizations, faith leaders, youth-serving organizations, first responders, librarians, school board members, public health officials, parks and recreation staff, and people with lived experience. This article focuses on the efforts of three counties—Ashtabula, Lorain, and Lawrence—to take on the community conditions that increase the risk of unhealthy substance use and addiction. It describes what they learned as they went beyond a sole focus on preventing opioid overdoses and deaths—as critically important as that is—to transforming their communities to support health and well-being in the first place.

Intersecting substance use treatment and harm reduction services: exploring the characteristics and service needs of a community-based sample of people who use drugs

“…Yet, only onethird of programs offered any parenting, childcare, or pregnancy services. Lack of integration of these services highlights a missed opportunity to address social determinants of health that strongly influence overdose risk and overall health and stability among this highly vulnerable population [36,37]. Increasing grant funding for wrap-around services, as was done via the Ryan White HIV/AIDS Program [38], improving insurance coverage of social services via bundled payments [39], and leveraging flexible funding streams, such as those allocated to states in the aftermath of opioid litigation, [40] may be avenues to assist programs in integrating client social services.…”

Applicability of Artificial Societies to Evaluate Health Care Policies

“…13 In addition to health factors, opioid misuse is influenced by the social and physical environment surrounding individuals, including housing status, socioeconomic status, employment, and educational attainment. 14 Many people who misuse opioids require social support and connections to other social services in addition to health care, provided in an integrated and easily accessible way. A full description of the simulation lies beyond the limits of a single article, but we exemplify the principles of the needed steps.…”

“…People who misuse opioids disproportionately experience other comorbidities such as HIV infection, cardiovascular conditions, pulmonary conditions, and mental health issues 13 . In addition to health factors, opioid misuse is influenced by the social and physical environment surrounding individuals, including housing status, socioeconomic status, employment, and educational attainment 14 . Many people who misuse opioids require social support and connections to other social services in addition to health care, provided in an integrated and easily accessible way.…”

Reward Deficiency Syndrome (RDS): A Cytoarchitectural Common Neurobiological Trait of All Addictions

“…The medical establishment is encouraging the belief that alternatives with no risk or side-effects, and moderate-quality evidence supporting effectiveness, are inferior to drugs with highquality evidence in chronic pain patients. However, a recent JAMA report provides strong evidence that non-opioid treatment such as NSAIDs fare better than chronic prescription of opioids [79,80].…”