By Elise Meyer
In October 2017, Northwestern Pritzker School of Law hosted a roundtable to discuss the opioid epidemic in Chicago and its surrounding counties. The full-day roundtable brought together law enforcement, physicians, lawyers, local government, and public health officials, among individuals from other disciplines and backgrounds. Arising from the discussion, Northwestern published a white paper as an official report providing readers with evidence-based, Chicago-specific policy proposals from the diverse set of convened experts relating to the complex opioid epidemic. The Northwestern Public Health Review will be summarizing the contents of the white paper in a series of blog posts, tracking the white paper’s three-point plan: (1) prevention, (2) harm reduction, and (3) recovery.
Today, we focus on prevention. In the context of the opioid epidemic, prevention can be thought of as counteracting the risk factors of developing a substance-use disorder (SUD). Prevention requires addressing the socioeconomic factors that lead to SUD as well as decreasing the opioid supply – both illicit and prescribed.
As a general matter, “[t]he root causes of health include both the social determinants of health and structural inequities, or societal systems that unjustly benefit one population more than another.” Researches have determined that the root causes of SUD are no different – SUD is a physical brain disease that, like any other disease, social determinants can exacerbate (or help). Thus, addressing social determinants of SUD will work to prevent future development of SUD.
Three socioeconomic areas warrant attention, according to the white paper: (1) stress, (2) lack of opportunity, and (3) mental health. Trauma, especially post-traumatic stress disorder (PTSD), and discrimination are two major areas of stress that often lead to SUD. Prevention of substance abuse and slowing the opioid epidemic therefore involves addressing causes of trauma and discrimination as well as encouraging stress management techniques. It also includes rectifying racial and economic inequalities by, for example, investing in economic development of marginalized communities and dismantling barriers to accessing healthcare. Finally, in the majority of SUD patients, mental health issues are co-occurring. Prevention involves destigmatizing mental health and SUDs, encouraging the building of social networks, and – perhaps most importantly – establishing mental health services in impacted communities.
According to a recent issue brief by the Chicago Urban League, “[b]lack people make up approximately 32% of the population in Chicago but account for nearly half (48.4%) of all opioid deaths.” Therefore, remedying socioeconomic harms suffered by black communities – including trauma, “discrimination stress,” mental health issues, and lack of opportunity – is especially poignant as a prevention strategy in responding to the opioid epidemic in Chicago. Studies indicate that those living in disadvantaged neighborhoods, like Chicago’s South and West sides, experience increased levels of PTSD, which, as mentioned above, is directly linked with development of SUD. Yet the City of Chicago has cut the budget for mental health services by hundreds of millions of dollars, closing down public mental health clinics, even “while mental health coverage expanded under the Affordable Care Act.”
The second prong of a prevention plan in Chicago is curbing the opioid supply, which the white paper notes can be achieved through better prescribing practices, law enforcement efforts, and litigation against big pharma. Law enforcement strategies can target prescribers who accept monetary bribes, facilitate drug take-backs, and increase community outreach. And while the opioid epidemic in Chicago is mostly an issue of heroin , the white paper also discusses ways to change opioid prescription practices and emphasize pain management alternatives. Such a shift requires changes to healthcare polices to allow coverage of alternatives and education programs for those with prescription privileges. Successful litigation against big pharmaceutical companies will also limit the opioid supply. A settlement or court order could inhibit false advertising, raise awareness of the deceptive marketing strategies used, and force companies to pay the government an award of damages to be put toward efforts seeking to curb the opioid epidemic.
As the opioid epidemic flourishes in Chicago and the surrounding counties – according to the Chicago Department of Public Health, in 2015, “[t]he rate of overdose deaths involving opioids in Chicago…was 50% higher than the national rate” – interdisciplinary engagement at every level of the opioid response becomes more and more imperative. Stay tuned in the coming weeks for more on solutions forwarded by such an interdisciplinary group on harm reduction and recovery – and if you can’t wait until then, read the full white paper here.
Elise Meyer is the Schuette Clinical Fellow in Health and Human Rights at Northwestern Pritzker School of Law where she supports the Access to Health Project.