The opioid crisis: a contextual, social-ecological framework

Abstract

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.

A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations

“…Interventions that used MI (e.g., motivational interviewing, motivational enhancement therapy [MET]) were the next most common. This is consistent with research supporting CBT, CM, and MI/MET as evidence-based treatments for a variety of SUDs (Carroll & Onken, 2005;Miller, Yahne, & Tonigan, 2003;Prendergast, Podus, Finney, Greenwell, & Roll, 2006) J o u r n a l P r e -p r o o f Given a robust body of literature documenting the importance of using an ecological framework in addressing individual, interpersonal, and environmental factors impacting substance use (DeJong & Langford, 2002;Jalali, Botticelli, Hwang, Koh, & McHugh, 2020), a need also exists for additional research that examines interpersonal and environmental strategies for prevention and early intervention to reduce substance-related problems among SGM individuals A gap in the literature exists regarding the benefits of culturally adapted substance-use interventions for SGM populations. While many of the studies included in this review focused on interventions that incorporated elements intended to be responsive to the needs and perspectives of SGM individuals, only nine studies directly compared tailored and nontailored versions of an intervention (Carrico et al, 2018;Carrico, Gómez, et al, 2015;Morgenstern et al, 2007;Reback et al, 2019;Reback & Shoptaw, 2014;Shoptaw et al, 2008;Shoptaw et al, 2005;Starks et al, 2019); all but two (Morgenstern et al, 2007;Starks et al, 2019) focused on methamphetamine use.…”

Data Needs in Opioid Systems Modeling: Challenges and Future Directions

“…3 Consequently, opioid misuse has seized the attention of scholars, researchers, health professionals, and politicians, 4 resulting in calls for a broad public health approach to reducing opioid misuse, disorder, and fatal and nonfatal overdoses. 5 The opioid crisis is multifaceted and dynamic, 6,7 involving a wide range of societal entities including pharmaceutical companies 8 ; healthcare systems 9 ; insurance companies 10 ; law enforcement agencies and criminal justice systems 11 ; social welfare and foster care systems 12 ; employers, individuals, and communities 13 ; and local, state, and federal public health agencies. 14,15 The rapidly changing dynamics of this crisis make it a particularly challenging problem to understand in its entirety.…”

Economic Evaluation in Opioid Modeling: Systematic Review

“…1,2,4,5 The opioid crisis is characterized by multilayered dimensionality, with many moving interconnected parts ranging from the individual to societal level. 6 Opioid-related illness has significant economic costs for healthcare systems and society. Costs to the US economy of the opioid epidemic-including healthcare, mortality, criminal justice activities, family assistance, and productivity loss-were estimated at $631 billon total over the 4-year interval 2015 to 2018.…”