SOC213 Module 7 Final draft
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Southern New Hampshire University *
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Apr 3, 2024
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The contemporary social problem I would like to focus on is opioid use disorder (OUD), along with opiate related deaths in the Commonwealth of Virginia and comparing it to both the United States and a global scale. Opioid use is becoming a grave issue in Virginia as well as the United States. Opioid use can lead to addiction, also leading to death; however, it can be treated and is a mental health condition. Symptoms for opioid use disorder are strong desires for opioids,
inability to reduce or control use, use while interfering with major obligations and/or social functioning, and increased dosage over time, developing a tolerance.
“
The
data from 2021
revealed that nearly 150,000 people in Virginia had an opioid use disorder, 127% higher than 2020 estimates, with at least six Virginians dying of an opioid drug overdose every day on average. The calculator revealed that the overall cost of the epidemic in 2021 was more than $5 billion, which is 43% higher than 2020 estimates. On an individual level,
the financial impact of the opioid epidemic amounted to $588 per Virginian on average”(Trani, 2021). There is an opioid crisis in the United States and a devastating public health emergency. Since 2000, there have been 400,000 opioid-involved deaths
in the U.S., contributing to a historic decline in the U.S. life expectancy. Accidental overdoses are now the leading cause of death for people under 50 years old. “The societal cost of OUD and fatal opioid overdoses was estimated to be over $1 trillion in 2017
. The crisis has led to an increase in children in foster care, a rise in the incarcerated population struggling with OUD, and many more grandparents raising grandchildren” (Welcome to the Brandeis, n.d.).
The experience for opioid use is different for everyone and often there is a combination of psychological and social factors that contributes to why a person may be struggling. The social determinants of opioid use can be influenced by age, ethnicity, gender, and socioeconomic status. The most impacted age group for opioid related overdose deaths in Virginia is 25 – 34-
year age group (Mdrecovery, 2023). Despite having substantial opioid deaths in this age group, opioid use disorder can start at any age. In 2019, Black males had a greater percentage of fatal opioid overdose in Virginia; however, women
have a higher utilization rate than men, especially in deprived areas. Fentanyl and heroin deaths occurred more frequently in white males 25 – 34-
year of age. Other social determinants that may influence an individual to become dependent on opioid are social status (peers they interact with daily), family members, or medication prescribed for a condition. In Virginia, 3.47% of the population reported opioid misuse in the last
month, and 1.84% reported and Opioid Use Disorder.
“Worldwide, about 296 million people (or 5.8% of the global population aged 15–64 years) used drugs at least once in 2021. Among them, about 60 million people used opioids. About 39.5 million people lived with drug use disorders in 2021
(2)
. Most people dependent on opioids used illicitly cultivated and manufactured heroin, but the proportion of those using prescription opioids is growing” (World Health Organization, n.d). “Worldwide, about 600 000 deaths were attributable to drug use in 2019. Close to 80% of these deaths are related to opioids, with about 25% of those deaths caused by opioid overdose. According to WHO estimates, approximately 125 000 people died of opioid overdose in 2019. Opioid overdoses that do not lead to death are several times more common than fatal overdoses” (World Health Organization, n.d). Social determinants of Opioid Use Disorder on a global level include economic instability, subpar education, housing, stress, hunger, education, provider availability, and health coverage. Another social determinant of the opioid crisis is COVID-19. “Those with substance use disorders (SUD) are more likely to be exposed to the virus and have higher hospitalization and mortality rates due to COVID-19. In one study, the odds of exposure to COVID-19 for those
with SUD was 8.7 times higher than those without SUD, with those with OUD at highest risk. Another study found that those with SUD were at increased risk for hospitalization, ventilation use, and mortality compared to those without SUD. Minorities have been especially hard hit by the convergence of SUD and the pandemic” (3Wang, 2020).
“Opioid use is a global issue, and there are both similarities and differences in the way it is addressed across different countries and regions. According to a study published in the journal Current Treatment Options in Psychiatry, there is a strong tendency for consolidation of drug treatment strategies in favor of more systematic, structured, and balanced approaches to regional and national drug policies” (Vasilev, Milcheva, Vassileva, 2016). The difference between local and global social variables in relation to opioid use are as follows:
Local Social Variables
Local factors include experience, personal characteristics, and behavior. These might involve an individual’s socioeconomic status, mental health, access to healthcare, and history of substance use.
Local social networks, family dynamics, and peer influences play a significant role. Lack
of family support can impact an individual’s vulnerability to opioid misuse.
Local communities contribute to the opioid crisis. Factors such as community norms, social cohesion, and neighborhood safety influence substance use patterns.
Local healthcare infrastructure affects access to pain management, addiction treatment, and harm reduction services.
Global Social Variables
Global factors include the production, distribution, and availability of opioids worldwide.
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Global policies and regulations shape opioid prescribing practices, drug trafficking, and control measures.
Global economics disparities affect opioid use.
Global media coverage influences public perception of opioids.
International awareness campaigns educate the public about opioid risks and safe practices.
Global efforts to combat drug trafficking and enforce drug laws impact opioid availability
and misuse.
Local variables focus on individual and community contexts, while global variables encompass broader societal, economic, and regulatory aspects.
The similarities between local and global social variables in opioid use is social-ecological framework.
Social-Ecological Framework
Social-ecological framework was developed to understand the multivariable risk factors of opioid misuse.
Local factors include interpersonal relationships, community conditions, and social stigma.
Global factors encompass government regulations, economic conditions, medial influence, and advertising campaigns.
Globalization
Increased access to prescriptions
Social-cultural aspects of globalization play a role in opioid misuse.
People with opioid use disorder are often stigmatized and discriminated against due to stereotypes and biases. These biases can lead to unfair treatment and discrimination against
people who use substances and can also undermine health-seeking behaviors. For example, people with opioid use disorder are often seen as criminals, poor employees, and lacking morals. This population is sometimes referred to as “drug abusers,” which carries an implicit association with physical, sexual, or emotional abuse. Such language can be harmful, inaccurate and can further stigmatize people with opioid use disorder. “It is important to recognize that opioid use disorder is a medical condition that requires treatment, and that people with this disorder should not be judged or discriminated against” (WebMD, n.d). Increasing awareness will help people with opioid use disorder get the care they need.
My preconceived notions come from ignorance. Because I have a tolerance for certain opioids and take them as prescribed, my assumption is everyone is doing the same. I never thought there was an addiction risk because opioids are legal and commonly prescribed. I also had a preconceived notion that only white America had a prescription opioid addiction and could
easily get access to them. However, these notions are inaccurate. The symbolic interactionists theory will see drug use arising from an individual’s interaction with people who engage in drug use. This sociological theory will help me to limit and analyze my bias with opioid use disorder by first identifying the problem, understanding the issue, and not use bias and assumptions. I will also limit my bias by not feeding into stigmas, racial inequality, the misconception of prescription opioids being exempt from addiction risk and having empathy.
The opioid crisis has had profound effects both locally and globally. The symbolic interactionist sees the local impact of opioid misuse arising from social interactions. People learning how to use drugs and develop attitudes that justify drug use based on their interactions with others. The symbolic interactionist sees opioids having diverse cultural meanings worldwide. They also highlight how cultural norms, beliefs, and rituals shape drug use patterns.
Opioid use disorder has had a significant impact in the Commonwealth of Virginia. Opioid deaths increased 5% from 2021. Approximately 79% of these overdose deaths involved fentanyl, fentanyl analogs, and tramadol. In 2021, “there were 22,398 drug overdose emergency department visits” (Drug Overdose, 2023). In 2022 opioid misuse led to a spike in 792 new HIV
cases and 5,331 new cases of hepatitis C. The opioid crisis has had far-reaching consequences across the globe. “In 2019, approximately 600,000 deaths worldwide were attributed to drug use, with nearly 80% of these deaths related to opioids. About 25% of those deaths were caused by opioid overdoses” (World Health Organization, n.d.). The opioid crisis has a “high incidence of non-medical use of tramadol and increasing use of codeine-based cough syrup” (Understanding, n.d.). In Asia and Oceania, there is an uptick in fentanyl use and manufacturing of synthetic opioids. The Middle East has an increase in tramadol usage and Europe’s main opioid concern is heroin with an increase in fentanyl use.
“Opioid use disorders affect over 16 million people worldwide, over 2.1 million in the United States, and there are over 120,000 deaths worldwide annually attributed to opioids” (Dydek, Jain, & Gupta, 2022). Opioid use disorder differs locally and globally in the number of overdoses. “Opioid overdoses are by far the most common in the United States, with death rates several times higher than those in countries with the next highest rates – such as Canada, Sweden
or Russia” (Ritchie, 2018).
The opioid crisis has led to hundreds of thousands of deaths in the US and poses a risk of dissemination worldwide. Globalized countries have witnessed a reorganization of healthcare practices, including greater opioid prescriptions. As the nature of the opioid epidemic continues to evolve, the lack of a unified surveillance database, the complexity of the health care system, systemic biases, underinvestment in evidence-based treatments, and ineffective drug laws have
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contributed to the crisis
. Opioid use disorder may have inherent underpinnings related to globalization, particularly socio-cultural aspects. Factors like increased access to prescriptions and feelings of despair due to cultural erosion and educational gaps play a role. Understanding these dynamics is crucial for effective prevention and intervention strategies. The opioid crisis has had far-reaching effects, both locally and globally. From a biological perspective, both local and global impacts of opioid misuse share certain similarities such as genetic susceptibility, and neurobiological effects. Locally and globally, there are risk factors such as chronic pain, mental health conditions, and previous substance misuse. The number of fatal overdose patterns has risen significantly in the United States and in other countries. The underlying biological mechanisms and risk factors remain remarkably consistent.
The similarities of opioid misuse locally and globally from the biological perspective is the staggering number of deaths over the past decade. Other similarities are the number of prescriptions written, access to healthcare and but not limited to health insurance.
The federal government has made a successful attempt to fight the opioid crisis by investing $2 billion into a program called Helping to End Addiction Long-term Initiative (HEAL
Initiative) in 2018. The program supports science-based solutions to the opioid crisis. “
As of July 2022, NIH had invested $2 billion in HEAL, funding some 600 research projects nationwide” (American Psychological Association, n.d.). HEAL is designed to make a correlation between chronic pain and addiction. HEAL uses an all-hands on deck approach and brings together community members, scientists, private sector, and various levels of government which focuses on ending the opioid crisis. However, the FDA’s contribution to the opioid crisis failed. “
The FDA’s regulatory failures with respect to opioids have not gone unnoticed. In 2017, the President’s Commission on Combatting Drug Addiction and the Opioid Crisis found that the
opioid crisis was caused in part by “inadequate oversight by the Food and Drug Administration,” and the National Academy of Sciences (NAS) publicly called on the FDA to overhaul its opioid policies” (
Kolodny, 2020). Through all of this, the FDA has not changed its practices – labeling and approving opioids.
An extremely beneficial way to help combat opioid use disorder is creating referral programs through law enforcement agencies. This program would be Virginia Police Assisted Referral Program (VPAR). This program would allow people to voluntarily go to their local police station and request assistance. The program would train officers to de-escalate situations involving non-criminal opioid crisis, a communication loop with local substance abuse/addiction counseling agencies and mental health agencies, referrals for screenings, education, and treatment, equip officers with business cards containing information and referral numbers. The result is everyone goes home during a non-criminal call, provides appropriate connections (substance abuse agency, social services), education, and clear communication to the communities. Implementing VPAR would include mandatory training for all officers, supervisors, and command staff. Referral cards would be created as well as business cards. The officer would have to document the referral in the police report. The referrals may trigger assessments and/or home visits, the agency worker may contact the police department’s emergency dispatch center for assistance. VPAR’s goal is to create a partnership with substance abuse agencies, mental health agencies, community programs and social services. Another goal of VPAR is for citizens to view police officers in a positive manner and in the role of first social responders as well as law enforcement officers.
In conclusion, the opioid crisis has far-reaching effects locally and globally. Combating opioid misuse, on both scales, is an extremely difficult challenge. Through the lens of the symbolic interactionist, addiction is not solely a biological or chemical issue but a social construct. VPAR is a start to addressing this public issue.
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References
Trani, O. (n.d.). The opioid epidemic cost Virginians $5 billion in 2021, New Data Shows
. VCU News. https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-
in-2021-new-data-shows Mdrecovery. (2023, May 15). Virginia heroin and Opioid Addiction Statistics
. Maryland Recovery. https://www.marylandrecovery.com/blog/heroin-and-opioid-addiction-in-
virginia
Welcome to the Brandeis Opioid Resource Connector
. Brandeis Opioid Resource Connector. (n.d.). https://www.opioid-resource-connector.org/ World Health Organization. (n.d.). Opioid overdose
. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose#:~:text=Worldwide
%2C%20about%20296%20million%20people%20%28or%205.8%25%20of,lived%20with
%20drug%20use%20disorders%20in%202021%20%282%29. Vasilev, G., Milcheva, S., & Vassileva, J. (2016, July 9). Opioid use in the twenty first century: Similarities and differences across national borders - current treatment options in psychiatry
. SpringerLink. https://link.springer.com/article/10.1007/s40501-016-0089-2 WebMD. (n.d.). Dealing with the stigma of opioid misuse
. WebMD. https://www.webmd.com/mental-health/addiction/stigma-opioid-misuse
Drug overdose and Related Health Outcomes
. Drug Overdose Data. (2023, December 4). https://www.vdh.virginia.gov/drug-overdose-data/ World Health Organization. (n.d.). Opioid overdose
. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose Understanding the global opioid crisis. (n.d.-b). https://www.unodc.org/documents/scientific/Global_SMART_21_web_new.pdf American Psychological Association. (n.d.). The federal government just made a $2 billion investment to address the opioid crisis. here’s how it works
. Monitor on Psychology. https://www.apa.org/monitor/2022/10/opioid-crisis-federal-initiative Kolodny, A. (2020, August 1). How FDA failures contributed to the opioid crisis
. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/how-
fda-failures-contributed-opioid-crisis/2020-08
3 Wang, Q.Q., Kaelber, D.C., Xu, R., Volkow, N.D. (2020). COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United
States. Molecular Psychiatry, 1–10.
Dydek A.M., Jain, N.K., & Gupta, M. (2022, January 28) Opioid Use Disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553166
Ritchie, H. (2018, March 16). Opioids, cocaine, cannabis and illicit drugs. Our World in Data. Sullivan, T. J. (2016). Introduction to social problems (10th ed.). Pearson.
World Health Organization. (2021, August 4). Opioid overdose. https://www.who.int/newsroom/fact-shee
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