Epidemic Or Evolution
by S. Todd Stolp MD
©February 6, 2020
It strikes me that calling trends in opiate dependency and polypharmacy overdose deaths an “opiate epidemic” is a misnomer, akin to calling the Industrial Revolution an epidemic. While the term may effectively rivet pubic attention on the problem, characterizing the drug dependency and overdose crisis an “epidemic” undermines a deeper public understanding of it.
An epidemic is often sparked by a newly emerged infectious disease, usually a bacteria or virus. As such, mitigations are usually focused on the single agent that is placing communities at risk. Effective initial solutions may include the isolation of infected individuals, so they do not expose the general population to risk of infection. Or perhaps a vaccine to prevent infection or an antibiotic to treat those who are already infected. On the other hand, it is virtually impossible to isolate our populations from the knowledge of and exposure to pain relievers, and because drug dependency evolves over a lifetime, simple solutions are elusive.
The newly emerging threat in an epidemic is external to society. In contrast, like the Industrial Revolution, the drivers of drug dependency and overdoses are intrinsic to the evolving structure of society. The causes are complex and are, at least initially, deliberate. Research confirms that socioeconomic and educational disparity, unemployment, global policies, cultural incongruity and a health care system that is focused too much on profit have all been major contributors to the evolving problem over the past century.
This raises the question of timeline. As the years and decades pile up, it begins to become apparent that many of the trends we see have occurred before. Before your next breath, note that this is not cause – nor call for – despair. But it does remind us to learn from past experience and past mistakes, if not by our own generation then by earlier ones. From Prohibition in the 1920s, to the Rolling Stones Mothers Little Helper in the ‘60s, to crack cocaine in the urban U.S. in the ‘80s, to methamphetamine in the ‘90s, and now prescription and non-prescription pain relievers and opiates, the trend has been indolent and relentless over generations.
Because the drug dependency and overdose problem is imbedded in our social fabric, the solution is necessarily complex. To make criminal justice interventions the only solution to the drug dependency and overdose crisis would be like building a more robust fire department in response to climate change. Both strategies are destined to fail unless vigorously partnered with public health research and interventions that work upstream to limit the factors that incubate criminal behavior and modify human behaviors that contribute to climate change.