Understanding the Disproportionate Impacts of the Current Opioid Epidemic
In the late 1990s, pharmaceutical companies convinced the medical community that opioids would relieve pain without causing addiction. This messaging led doctors to prescribe opiates widely. Before conclusive evidence emerged demonstrating the addictiveness of opiates became widely misused and abused. Over the next twenty years, millions of Americans would have their lives significantly impacted by these substances (“Opioid Overdose Crisis”). However, the opiate epidemic’s devastating impacts on health and society have not been felt evenly.
The opioid epidemic has become especially intense in certain geographic areas such as Ohio, West Virginia, and other parts of Appalachia. These areas share a common theme: widespread poverty due to a shifting labor market. Unemployment, lack of social mobility, limited resources, and financial security are common features of these areas, and these socioeconomic factors are correlated with opioid misuse and abuse (Blumenthal and Seervai). It has become clear, then, that poverty is a major driving force of the opioid epidemic. A wealth of research in recent years has supported this notion. One study examining this connection found that “lower-income individuals, including those on Medicaid and the uninsured, are more likely to misuse opioids and have opioid use disorder than the general U.S. population” and that individuals living under the poverty line were twice as likely to have an opioid disorder than individuals living 200% above the poverty line. This same study also found the following:
“Poverty, unemployment rates, and the employment-to-population ratio are highly correlated with the prevalence of prescription opioids and with substance use measures. On average, counties with worse economic prospects are more likely to have higher rates of opioid prescriptions, opioid-related hospitalizations, and drug overdose deaths” (Ghertner and Groves).
Retrieved from https://aspe.hhs.gov/sites/default/files/private/pdf/259261/ASPEEconomicOpportunityOpioidCrisis.pdf
Moreover, a recent photo essay depicting opioid users shows many of them in conditions of poverty. The images display opioid users injecting themselves with substances as they live underneath bridges. The images make it clear that these are individuals in economic distress. Based on these images, the typical opioid addict is an impoverished white person from a struggling neighborhood, rather than an affluent American from a prosperous neighborhood (Nachtwey). The concentration of the epidemic amongst the impoverished mirrors the late stages of the first American opioid epidemic, where opiate addiction occurred primarily amongst low-income Americans. Therefore, parallels exist between the current opioid epidemic and the opioid epidemic that occurred in the late 19th and early 20th century.
Image taken from a recent photo essay of a woman injecting herself with opioids in the cold. Retrieved from https://time.com/james-nachtwey-opioid-addiction-america/
Poverty serves as a driving factor for the opiate addiction for numerous reasons. Notably, poverty increases stress and anxiety: these conditions can arise in people in poverty as they struggle to find work, provide for their families, and pay their bills. Additionally, poverty can cause people to lose hope in their lives and their ability to move up the social ladder. In this mental state, these individuals are more likely to turn to substances because opioids can provide a form of short-term relief. Poverty also leads to less social support and access to healthcare. The dearth of a community to hold these individuals accountable and offer them support, along with a lack of adequate resources to combat substance misuse, makes those in poverty more vulnerable to the impact of opioids (“Understanding the Relationship Between Poverty and Addiction”).
The ongoing opioid epidemic has profoundly impacted the United States, but those in poverty have carried the burden of the crisis. Given that poverty is a driving factor of the disproportionate impacts of the epidemic, solutions must work upstream. This means that policies should be put in place that address the drivers of poverty — education, job opportunities, and healthcare, to name a few. By mitigating poverty, we can ameliorate the opioid epidemic and the inequities it has caused.