The Opioid Crisis: A Sociological Perspective

This is an edited transcript of the webinar, The Opioid Crisis: A Sociological Perspective, presented by Sophie Nathenson, PhD. 

Learning Outcomes

After taking this course, participants will be able to: 

• Describe the social context of the opioid crisis.
• Identify three societal-level contributing factors of the opioid crisis.
• Identify two aspects of a holistic, population health approach to addressing the crisis.

The Sociological Perspective

Let's start by covering the sociological perspective and what sociology entails. Sociology is the study of society as a whole, classified as a social science, focusing on human behavior, similar to psychology. However, in sociology, the focus lies in examining differences between groups rather than individuals. Individuals are grouped together based on various social factors, such as age, race, gender, and socioeconomic status. The objective is to compare these groups in terms of behavior, prevalence of illnesses, and other aspects that shape an individual's life course.

Thus, sociology delves into analyzing social factors and aspects of social life and status, as well as structural factors inherent in communities and societies. Medical sociology places special emphasis on understanding social and structural determinants of health outcomes—identifying how community characteristics and social status contribute to potential differences in health outcomes. This field differentiates between upstream factors, focusing on prevention, midstream factors dealing with illness management, and downstream factors, which involve emergency approaches to illnesses.

The population health perspective is essential in this regard, as it assesses the health of a group and examines health behaviors, such as the use of opiates, from a broader population standpoint.

Rather than solely focusing on understanding why an individual may use, our aim is to identify factors associated with the prevalence of addiction and overdose within a society. Thus, we approach health behaviors within a social context, considering not only individual factors but also broader influences such as social norms, community, family, relationships, and the environment where individuals live, work, engage in recreational activities, and socialize. This perspective allows us to explore the impact of social and structural factors on our position in society and our social status, encompassing elements like race, gender, socioeconomic status, and power imbalances, which affect our access to resources.

Structural factors involve examining societal systems. When comparing different societies or communities and analyzing the prevalence of issues like addiction and overdose, significant differences prompt us to explore the underlying reasons for these variations. In doing so, we broaden our scope to consider the systems and structure of societies. This includes evaluating aspects such as the healthcare system, educational system, industries present in the society, media influence, cultural dynamics, and the overall economic structure, including income levels and wealth distribution. Employment and unemployment rates, educational attainment, and access to education among various groups also play a crucial role in this comprehensive analysis.

In terms of culture and the social environment, that also includes norms, how people are socializing, the degree of social isolation, and where people come together. That's another aspect of a society that could influence health outcomes. At the most top-down or broadest level, factors such as political instability, policy, and laws, are interconnected and can trickle down and affect behavior and collective wellbeing. 

The Opioid Crisis

Now, shifting our focus to the opioid crisis, it was officially declared a national public health emergency in 2017, encompassing both the misuse of prescription opioids and illegal drugs derived from opium, such as heroin.

This crisis has been labeled as the deadliest in American history, with the United States accounting for only 4% of the world's population but experiencing 27% of global drug overdose deaths. However, it's essential to acknowledge that these statistics may change over time. Research and social surveys indicate that pain levels in the United States are comparable to countries like France and Italy, despite the fact that the U.S. consumes a staggering 80% of the world's opioids. This suggests that opioid consumption is not merely linked to pain prevalence or chronic illnesses where opioids are medically necessary for pain management. Rather, there may be underlying societal factors contributing to the crisis. See Katz (2017) for further details.

Trends Over Time

Analyzing trends over time reveals drastic changes in the opioid crisis. Between 1980 and 2008, there was a 600% increase in opioid overdoses, and from 1997 to 2017, the number increased fivefold. Notably, during the pandemic years, from April 2020 to April 2021, drug overdose deaths increased by 28.5%. You can start to think about the context and what may have contributed to this significant rise, such as the social and economic impact of the pandemic.  

When we study populations, societies, and countries, we encounter differences. When we analyze statistics, for example when we look at rates of addiction, overdose, depression, suicide, or suicidal ideation, we can be mislead unless we take into account these real differences between groups.  For example, while overall statistics might indicate improvements in certain areas, specific vulnerable groups might still be experiencing increasing rates. This variation among social groups is a core concern in medical sociology, as it emphasizes that diseases, illnesses, and addictions are not distributed evenly across a population; there are distinct patterns and societal factors at play.

Significant variation is observed not only between states in the U.S. but also between counties within those states and as mentioned, among different countries. Such disparities suggest that societal factors play a substantial role in the opioid crisis. If rates were the same across all states and countries, for example, it might imply that individual factors alone are responsible. However, the substantial variation prompts us to explore how societies are structured, what individuals are exposed to within these societies, and the access to resources available, all of which may contribute to the differences that are observed.

Data Limitations

Research and surveys provide valuable insights into the opioid crisis. Self-reported data, when individuals rate their own health, tends to be reasonably accurate and aligned with objective measures obtained in healthcare settings. However, it is essential to acknowledge the limitations inherent in data collection and analysis in social science research.

Overdose rates, for instance, can be subject to miscoding or misattribution when entered into data systems, leading to potential misinterpretations. For example, an accidental overdose might be categorized as a suice. Non-fatal overdoses are often missing from national surveys, which primarily focus on fatal overdoses, potentially overlooking critical information about near-miss incidents that could provide information about underlying factors and prevention strategies.

Measuring opioid use, especially non-medical use and diversion, poses significant challenges. Household surveys can suffer from low response rates, making it difficult to obtain a comprehensive picture of opioid use within households. Furthermore, national drug lab data might not be fully representative, particularly concerning drugs sold in the social markets or the "black market".  Harm reduction efforts are challenging to quantify. The criminal justice system also poses difficulties when attempting to collect data from arrestees or prisoners due to their vulnerable status. Even hospitalization data might not be captured uniformly or in a standardized manner, which can affect our understanding of the crisis's scope and severity. Finally, assessing access to drug treatment can be hindered by potential under-coverage in insurance data, preventing us from gaining a fully accurate picture of treatment availability and utilization.

While data sources play a pivotal role in comprehending and addressing the opioid crisis, it is vital to approach them with caution, taking into account their potential limitations and biases.

How Did We Get Here?

Understanding how we arrived at the current state of the opioid crisis requires examining the significant changes in statistics over time and the events that contributed to this complex issue.

In the 1980s, there was a notable downplaying of opioid addiction. A report, which was not robust in its scientific basis, was circulated among medical professionals and physicians, indicating that opioids were not labeled as an addictive substance. In the 1990s, a problem was identified: patients were experiencing pain, but it was not always adequately measured or addressed. In response, healthcare professional associations deemed pain as the fifth vital sign, emphasizing its importance and promoting its measurement. In the 2000s, aggressive marketing strategies, educational initiatives, and promotions targeted physicians in a specific and calculated way. There was overpscribing, in part potentially related to patient satisfaction (Fenton, Bertakis, & Franks, 2012). Patients might have demanded opioids for pain relief, and if patient satisfaction was a key outcome for physicians and the healthcare system, it may have played a role in the overprescribing of opioids.  Key 

From Prescription to Illicit

Apart from changes within the healthcare system, various social and economic factors also contributed to the opioid crisis. The opioid crisis can be traced back to both prescription drugs, and also illicit drugs obtained through that social channel. There is both diversion use by healthcare professionals and recreational use. For example, there was a big spike in heroin use because people who were addicted to opioids but ran out of a supply or money for their prescription, would be kind of pushed into buying it through social channels in order to access a similar or same high with heroin. There is a close connection between opioids, prescription drugs, and heroin. A study by Cicero et al. (2014) showed that 75% of heroin users had used analgesics, and that painkiller users were 40% more likely to be addicted to heroin.  In 2017, the CDC found that there was almost equal distribution of opioids from healthcare channels and social channels. Simply addressing the healthcare side of the opioid crisis would not be enough.

Diversion Risks and Signs

According to SAMHSA (Substance Abuse and Mental Health Services Administration), approximately one in 10 healthcare workers may be abusing drugs, though it's important to recognize that this figure might be an undercount due to the challenges of obtaining accurate data in this context.

Fentanyl has been particularly problematic in terms of diversion, as it has caused the most deaths. Detecting opioid diversion within healthcare systems has revealed that this problem exists across different levels and disciplines, not limited to individuals with the most direct patient interactions. It occurs throughout the hierarchy in healthcare.

Several indicators may suggest diversion within a healthcare setting. These include controlled substances being removed without proper authorization, compromised containers that appear tampered with, the use of substitute drugs on patients who were previously prescribed opioids, and verbal orders that have not been appropriately verified. Self-prescription, improper handling or disposal of waste, and instances where health professionals are unusually administering medications can also be red flags indicating potential diversion activities.

Signs of Misuse and Addiction
 

Signs of misuse and addiction can be categorized using the three Cs: Control, Craving and Preoccupation, and use despite negative Consequences.

Regarding Control, there is a loss of control. Indicators may include reporting of stolen or lost medications, seeking early refills, seeking drugs from sources, experiencing withdrawal symptoms, and being unable to control their use of opioids.

Craving and Preoccupation involve increased requests for specific drugs and increased pain without a worsening of disease. This may be related to increased tolerance. In addition, an indicator of craving and preoccupation include dismissing non-opioid pain management methods.

Use despite negative Consequences refers to over-sedation, reduced daily activities and functioning, and experiencing relationship issues due to opioid use.

Social-Ecological Model of Risk Factors

From a sociological and psychological perspective on addiction and overdose, a social-ecological model of risk factors is used. This model encompasses multiple levels of influence.

The broadest level considers aspects of society as a whole. The community level looks at the characteristics of specific communities, such as neighborhoods or cities. Interpersonal factors relate to socialization and relationships within an individual's social circle. Addiction and overdose are multifactorial. At the individual level, these various factors include sociological, psychological, genetic, and environmental factors, to name a few, that come together to contribute to this issue.

Individual and Interpersonal Risk Factors

We cannot simply focus on a single risk factor and address it, as these factors not only contribute independently but also overlap and influence each other, making it difficult to isolate one. Therefore, we will begin by examining individual and interpersonal risk factors.

At the individual level, various factors play a significant role. Socio-demographics, including personal social standing, stress levels, and past or current traumas, all have an impact. Additionally, genetics, family history, pain levels, withdrawal symptoms, and self-stigma, which may be internalized from social environments and norms, are crucial factors to consider.

Self-stigma can lead individuals to judge themselves and believe that seeking help is frowned upon, affecting their willingness to seek assistance. Moreover, their determination level and the presence of other addictions, such as cross-addictions, where individuals may switch from one substance or behavior to another, can complicate the situation.

Moving to the interpersonal level, the influence of family and peers becomes prominent. For adolescents, peer influence can be even more powerful than that of the family. Access to substances can also be influenced by social circles, and the ability to seek and distribute drugs can depend on the level of access one has within their social group.

We also need to consider the influence of family history, particularly when it comes to use among family members and friends. Additionally, the nature of your relationships and associations, especially in romantic relationships, can significantly impact opioid use. Oftentimes, drugs serve as social lubricants within these contexts. Later on, we'll explore studies featuring personal stories of drug users to shed further light on this aspect.

Key literature in this area includes Jalali et al. (2020) and Cragg et al. (2019).

Community and Societal Risk Factors

As we expand our perspective, it becomes evident that differences exist between communities in terms of opioid use and addiction rates. Some communities experience high levels of opioid use, while others have much lower rates. This disparity calls for researchers and health professionals to delve into the underlying reasons behind these variations. Understanding these nuances can either satisfy your curiosity or pave the way for your potential involvement in community work focused on prevention.

Access to treatment plays a pivotal role at the community level. For instance, in the state where I reside, we face one of the highest addiction rates but struggle with limited access to treatment options. This creates a challenging situation for those seeking help. However, it's worth noting that there are also many individuals in recovery, largely due to the prevalence of addiction in our community.

Norms and culture within communities are crucial factors to consider. If drug use is normalized within a community, it can contribute to higher rates of addiction. Let's say a large employer in a community shuts down, leaving large numbers of people out of work.  If drug use is the norm in that community, using drugs may not be perceived of deviant behavior in certain social groups within that community, and drug use may increase. In addition, school and work environments can play into this; whether there is an awareness of the issue and whether or not steps are being taken to address it. Prescribing patterns and prescriber perceptions and attitudes can play a role, as can the quality and level of care in a community. In fact, there are differences according to social status and race when it comes to prescriptions for pain medication.

Societal risk factors include economic conditions, supply, government programs, education, advertising, media, stigma, discrimination and prejudice, law enforcement, and policing. In terms of economic conditions, the distribution of wealth in a society can put a strain on everyone, particularly the most vulnerable. For example, during the pandemic essential workers were working while many other businesses were shut down.  This created a strain on individuals and families. Some children had no access to education during the pandemic. Some teachers told me about half their students had access to the Internet, while half did not.  This is not a complete list of community-level factors but the types of things to consider when examining differences around opioid use and addiction.

Gaining a deeper understanding of these community-level factors can pave the way for resource allocation further upstream. By doing so, we have the potential to prevent opioid addiction or at least address the issue at a population level. While individual interventions play a critical role and can be successful, we need to address the issue comprehensively. Individual interventions may not have the capacity to influence an entire population, especially considering the less than ideal ratios of individuals in need versus the number of available counselors, therapists, behavioral health specialists, and substance abuse and prevention experts.

Documented Variation

Looking at the documented variation in state and country-level statistics, the lowest prevalence of opioid addiction was found in Nebraska, according to the 2017 research (Hedegaard, Warner, & Minino 2017), while West Virginia had the highest rates.

It's important to note that rural areas tend to be more vulnerable to opioid addiction, and there are spikes in these regions that correlate with economic opportunities and changes. In rural areas, the level of investment in the community and the availability of industries can result in shifts in the social demographics, with people potentially leaving the community in search of better opportunities. Moreover, the concept of "deaths of despair" has emerged, referring to deaths that are attributed, either through research or perception, to the profound sense of hopelessness and lack of individual opportunities. These deaths are not caused by illness or natural causes but are driven by the absence of a positive future vision. See Dasgupta, Bletsky, and Ciccarone (2018) for further reading on this topic.

Indeed, disparities in health outcomes based on race and social status are evident across various health issues, including opioid addiction. There is a significant correlation between race and socioeconomic status, which plays a role in shaping the prevalence of addiction within different communities. Gender differences also contribute to the variations seen in opioid addiction rates. The prevalence of mental illness and physical pain can also vary from one community to another, adding further complexity to the issue. All of these factors combined serve as evidence of the intricate web of factors influencing addiction within a community.

The War on Drugs
 

Let's delve into the topic of the "war on drugs." This initiative was launched with the positive intention of combatting drug issues in communities across America. 

The approach of the war on drugs led to increased arrests, but it did not necessarily reduce access to street drugs. Moreover, it influenced the culture, perception, and stigma surrounding drug use and addiction. The focus on punitive measures rather than preventive or supportive efforts may have contributed to the perception of drug use as a moral failing, stigmatizing individuals struggling with addiction.

Unfortunately, the war on drugs didn't fully recognize the role of trauma, both past and new traumas, that individuals experience in society. If the initiative had been framed as a war on addiction, it might have called for investment in addressing underlying community-level issues and potentially reduced the driving force behind people seeking drugs. In addition, it exacerbated the stigma around drug use.

This is not intended to prescribe specific policies or take a political stance. Instead, our focus is primarily on the research on various policies and actions related to drug use and addiction. People hold diverse attitudes and opinions about the root causes of drug use and the characteristics of drug users. These viewpoints, coupled with the considerable size of the drug industry and the prison industrial complex, all contribute to the context in which drug policies are formulated. 

Significance of Root Causes

It is essential to recognize that the relationship between various factors is not linear or one-to-one based purely on availability. Simply addressing one factor, such as prescribing behavior, may not lead to the desired outcome.

A striking study caught my attention, where a 13% drop in prescriptions from 2012 to 2015 was followed by a surge in overdose rates (Dasgupta et al., 2018). This finding challenges the notion that reducing prescription rates alone can effectively combat the opioid crisis. 

When access to prescription opioids decreased, some individuals may have turned to social channels to obtain drugs. This shift in behavior may have led to a greater intermixing of drugs, such as heroin, resulting in more severe health issues for those engaging in recreational use or those who have addiction.

Understanding the contributing causes behind the variations in opioid prevalence based on location and social status is important. This involves looking beyond opioids alone because addiction does not occur in isolation. A multitude of factors, such as socioeconomic conditions, mental health issues, access to treatment, and cultural norms, interact to influence addiction rates. Ignoring all these driving forces and just zeroing in on the opioids alone may not be a successful approach. 

Deaths of Despair
 

The term "deaths of despair" was coined by researchers Case and Deaton (2015) to describe what they observed in their research. They researched people with high mortality rates from suicide, drug overdose, and related causes. The researchers delved into the mental and emotional states of these individuals and found a common thread of hopelessness and economic strain.

This is deeply tied to community-level factors. The sense of hopelessness and lack of opportunity can be associated with mental health issues and economic challenges that individuals face within their communities. Income inequality emerges as a powerful indicator of various social problems, not just in specific regions but across the globe. Researchers have consistently found links between income inequality and a range of social issues, such as decreased social trust, increased rates of teen pregnancy, dangerous adolescent behaviors, and interactions with the criminal justice system. Another key study on this topic is Ezell et al. (2022).

Micro, Meso, Macro Levels
 

Indeed, examining the micro, meso, and macro levels can provide valuable insights into the levels of prevention for addressing opioid addiction. At the micro-level, individual factors such as occupation and job conditions play a significant role. Certain jobs may be more prone to causing physical injuries, while others may have different rates of mortality and injury. Changes in prescribing practices can also have an impact, potentially leading to the illicit use of opioids.

At the meso-level, the focus shifts to the immediate environment of individuals. Limited recreational opportunities may lead some individuals to use opioids as an escape from their reality.

Zooming out to the macro-level, community-wide and societal factors become prominent. The level of investment or divestment in a community can have far-reaching consequences, and economic distress within these communities is often linked to higher mortality rates, particularly in rural areas. These factors can impact mental illness as well. 

The interplay of micro, meso, and macro-level factors creates a framework for understanding the complex nature of opioid addiction and its connection to broader community and societal dynamics.

Levels of Prevention

Levels of prevention can be categorized into primary prevention, secondary prevention, and tertiary prevention, each addressing different aspects. Primary prevention focuses on going upstream and addressing factors at the big-picture level, far from the emergency situation. This includes community education, policy changes, and initiatives to reduce stigma surrounding addiction.

Moving on to secondary prevention, the focus shifts to more immediate interventions. This includes measures like needle exchanges, medication-assisted treatment and safe houses, and proper disposal of unused opioids.

At the tertiary level, the emphasis is on providing support and care for individuals. This involves fostering empathy and caring, introducing evidence-based interventions, establishing psychosocial support structures, and facilitating access to support groups.

Role of Stigma
 

Stigmatizing attitudes towards individuals with opioid addiction can be found not only in the general public but also among law enforcement, health professionals, and emergency services professionals. These negative attitudes can impact how referrals are made and how the issue is addressed, hindering access to care and support.

Health professionals working with individuals facing addiction can experience frustration, disillusionment, burnout, and irritation due to the challenges they witness. Witnessing traumatic experiences, such as domestic violence or deaths resulting from drug use, can take a toll on those in helping professions.

One aspect of stigma is the different assumptions made about prior behaviors of individuals dealing with addiction, such as promiscuity. It's important to recognize that not everyone engaging in drug use necessarily exhibits specific prior behaviors, debunking the misnomer that such behaviors are a prerequisite for addiction.

Stigma has been called the "net absence of empathy" (Ezell et al., 2021), which is an interesting perspective.

Direct Experience v. Role Playing
 

There is research that compares the perspectives of people who use drugs and their experiences (direct experience) and those of behavioral health professionals. Behavioral health professionals may be in a role-playing position, meaning they have to envision the experience of someone who uses drugs or has an addiction, because they do not have a direct experience with drug use themselves. These perspectives are not about any specific individual therapist but rather about broader trends observed in qualitative research comparing groups. It highlights the need to understand the perspective of people who use drugs (prescribed and illicit), and how that relates to empathy.

Behavioral health professionals often examine the causes and conditions that led to addiction in an individual, and some may have personal experience with addiction, which can be beneficial in their work. However, there may also be presumptions based on known risk factors and evidence from research. While it is important to understand the research, each individual has their own unique circumstances which may or may not align with research. While we know from research that economic conditions may drive addiction rates, an individual may not attribute their use of drugs to their economic situation. It's important to look beyond the research on risk factors to look at each person's direct experience, to find out why they are using drugs or struggling from addiction. What are they saying? What is their reasoning or explanations for their circumstances?

One factor that is sometimes downplayed is sensation-seeking, where they seek the psychic or bodily high, or the increased sensations that come with certain behaviors, in terms of relationships and sexual contact. Coping with social and environmental circumstances is another factor, where drugs may be used to facilitate social and romantic relationships.

One poignant finding from direct experiences is that drug use may not always be a premeditated decision. Many individuals do not actively seek drugs; instead, they find themselves in social circumstances where drug use becomes a part of their lives. For example, a person may start using drugs due to the influence of a romantic partner, where pressure or romantic feelings cultivate a sense of trust that can impact behavior. Drug use may also be driven by addressing physical pain.

Sociology of Empathy

From a sociological perspective, empathy challenges the notion that opioid use and addiction are solely the result of predisposition or deviant behavior. Empathy goes against the belief that "it's those kinds of people" who would be involved in opioid use or that it would be "unfathomable." Instead, understanding empathy from a sociological lens allows us to recognize the influence of social norms and circumstances on individuals' behaviors.

By building empathy, we can better comprehend the complexities of addiction and the factors that lead individuals to use opioids. This includes acknowledging the impact of trusting relationships. In a relationship where there is trust, you may be more likely to engage in riskier behaviors. You may not have interest in mountain climbing, but you may do it with a partner if it is important to them. Empathy-building is crucial for behavioral health professionals to establish a more effective therapeutic relationship and to avoid compassion fatigue and burnout.

Moreover, as attitudes among professionals start to shift through empathy and understanding, it can lead to more informed advocacy for policy changes that align with the needs and experiences of those experiencing addiction. We know racial disparities exist in terms of administering and prescribing drugs, and empathy is related to reducing these differences in treatment.

Beyond the Opioid Crisis: A Holistic Approach

Taking a holistic approach to addressing the opioid crisis involves several key steps. 

There should be an expansion of funding and the scope of funding available to tackle the crisis. This funding should not be limited solely to specific interventions or programs targeting opioid users, but rather should consider the broader factors contributing to addiction. 

Acknowledging and addressing social and structural determinants of opioid addiction can be done through policy changes and community organizing. 

Empathy-building plays a crucial role in successful recovery. Behavioral health professionals should continue to develop their ability to understand and empathize with those facing addiction, while also addressing compassion fatigue and maintaining appropriate boundaries while still being able to understand backstories. Creating a supportive environment where seeking help is destigmatized will contribute to more individuals accessing treatment and support.

By adopting a holistic approach that combines evidence-based practices with empathy and an understanding of social determinants, we can better connect the opioid crisis to the broader context of the population being served. 

Why Integrate a Sociological Perspective?

The sociological perspective is crucial when examining addiction, including opioid addiction, as it offers valuable insights into understanding the trends and complexities of this issue at the population level. Addiction is not solely an individual problem; it is deeply influenced by social and cultural factors, and the sociological perspective allows us to recognize and explain these influences.

By taking a sociological approach, we can better comprehend why certain trends in opioid use and addiction change over time, including factors related to initiation and continued use. It acknowledges the significant impact of culture, social norms, social position, geography, and disparities in shaping addiction patterns.

Understanding the social and economic conditions surrounding addiction can help guide research and inform policy development. Through sociological research, we can evaluate the effectiveness of various policies in real-time and retrospectively, allowing for adjustments and improvements in intervention strategies.

Stigma awareness is another crucial aspect addressed through the sociological perspective. By reducing stigma and recognizing contextual factors, we can move beyond seeing addiction as merely an individual choice.

The Mental Health Professional's Role

The role of mental health professionals and behavioral health workers in addressing opioid addiction is essential, and adopting a sociological perspective can further enhance their effectiveness. Understanding the individual within their social and societal context is something we do and this is validation that it is good practice.

Empathy-building and inquiring about personal factors contribute to forming a strong therapeutic relationship and gaining insights into the unique challenges of each individual. Practicing cultural humility allows professionals to set aside assumptions and approach each patient with sensitivity to their cultural background and experiences.

Providing education on non-pharmacological interventions is valuable, as it opens up alternative approaches to managing mental and emotional pain. Integrating these interventions alongside other approaches can have an impact.  

Prioritizing self-care and stress management is vital for mental health professionals dealing with the demands of their work and personal lives. Stress in the workplace and society at large can take a toll on professionals. While there are interventions that need to happen on a larger scale in society and workplaces, engaging in self-care practices on an individual level can be empowering and beneficial for mental health professionals in managing their own well-being and maintaining their capacity to provide effective care to their clients.

Summary

In conclusion, mental health professionals and behavioral health workers play a crucial role in addressing opioid addiction. By integrating a sociological perspective into their practices, they can better understand the complexities of addiction, provide empathetic care, and consider the social and contextual factors that influence an individual's relationship with opioids. Prioritizing self-care further enhances their ability to support people with addiction and promote a holistic approach to addressing the opioid crisis.

References

Bolinski, R., Ellis, K., Zahnd, W. E., Walters, S., McLuckie, C., Schneider, J., Rodriguez, C., Ezell, J., Friedman, S.R., Pho, M., & Jenkins, W. D. (2019). Social norms associated with nonmedical opioid use in rural communities: a systematic review. Translational Behavioral Medicine, 9(6), 1224-1232.

Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.

Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821-826.

Cragg, A., Hau, J. P., Woo, S. A., Kitchen, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2019). Risk factors for misuse of prescribed opioids: a systematic review and meta-analysis. Annals of Emergency Medicine, 74(5), 634-646.

Dalphonse, L., Campbell, D. A., Kerr Jr, B. J., Kerr, J. L., & Gadbois, C. (2023). More than an opioid crisis: population health and economic indicators influencing deaths of despair. Sociological Inquiry. 10.1111/soin.12546

Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: no easy fix to its social and economic determinants. American Journal of Public Health, 108(2), 182–6.

Davis, M. A., Lin, L. A., Liu, H., & Sites, B. D. (2017). Prescription opioid use among adults with mental health disorders in the United States. The Journal of the American Board of Family Medicine, 30(4), 407-417.

Drwecki, B. B., Moore, C. F., Ward, S. E., & Prkachin, K. M. (2011). Reducing racial disparities in pain treatment: The role of empathy and perspective-taking. Pain, 152(5), 1001-1006.

Dwyer-Lindgren, L. Bertozzi-Villa, A., Stubbs, R. W., Morozoff, C., Kutz, M. J., Huynh, C., Barber, R. M., Shackelford, K. A., Mackenbach, J. P., van Lenthe, F. J., Flaxman, A. D., Naghavi, M., Mokdad, A. H., & Murray, C. J. L.(2016). US county-level trends in mortality rates for major causes of death, 1980–2014. JAMA, 316(22), 2385-2401.

Ezell, J. M., Olson, B., Walters, S. M., Friedman, S. R., Ouellet, L., & Pho, M. T. (2022). A sociology of empathy and shared understandings: contextualizing beliefs and attitudes on why people use opioids. Rural Sociology, 87(3), 1053-1087.

Ezell, J. M., Ompad, D. C., & Walters, S. (2021). How urban and rural built environments influence the health attitudes and behaviors of people who use drugs. Health & Place, 69, 102578.

Fenton, J. J., Bertakis, K. D., & Franks, P. (2012). Satisfied to death: a spurious result? — reply. Archives of Internal Medicine, 172(14), 1110-1114.

Hedegaard, H., Warner, M., & Miniño, A. M. (2017). Drug overdose deaths in the United States, 1999–2015. NCHS data brief, no 273. National Center for Health Statistics. 

Jalali, M. S., Botticelli, M., Hwang, R. C., Koh, H. K., & McHugh, R. K. (2020). The opioid crisis: a contextual, social-ecological framework. Health Research Policy and Systems, 18, 1-9.

Katz, J. (2017, August 10). Short answers to hard questions about the opioid crisis. The New York Times. https://www.nytimes.com/interactive/2017/08/03/upshot/opioid-drug-overdose-epidemic.html

Rigg, K. K , & Monnat, S..M. (2015). Urban vs. rural differences in prescription opioid misuse among adults in the United States: informing region-specific drug policies and interventions. International Journal of Drug Policy, 26(5), 484–491.

Ruckert, A., & Labonté, R. (2017). Health inequities in the age of austerity: the need for social protection policies. Social Science & Medicine, 187, 306-311.

Savage, S. R., Kirsh, K. L., & Passik, S. D. (2008). Challenges in using opioids to treat pain in persons with substance use disorders. Addiction Science & Clinical Practice, 4(2), 4.

Salmond, S., & Allread, V. (2019). A population health approach to America's opioid epidemic. Orthopedic Nursing, 38(2), 95.

The Joint Commission, (2019, April). Quick Safety. Drug diversion and impaired healthcare workers. Issue 48. https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_drug_diversion_final2pdf.pdf

Vitali, A., & Siemaszko, C. (2017, August 10). Trump declares opioid crisis national emergency. NBC News. https://www.nbcnews.com/storyline/americas-heroin-epidemic/trump-declares-opioid-crisis-national-emergency-n791576