It is no secret that the United States is dealing with a full-blown national opioid misuse epidemic. In recent years, opioid overdoses have claimed the lives of more than 100,000 people each year. This national epidemic has resulted in a mobilization of resources and the development of a crisis management paradigm that emphasizes a strong public health approach. Social workers are major stakeholders in almost every aspect of responding to the opioid epidemic—from advocating for better policies, to individual and family support, as well as roles that fall between these two, such as work with prison populations.
The public health paradigm includes overarching policy considerations that are the foundation for responding to national health crises. Chief among these considerations is a commitment to ensuring that health care administrators and practitioners adhere to health equity principles and practices, all of which are associated with population health models that include social determinants of health concepts. While health equity and population-based approaches are essential, the most fundamental and immediate needs are for evidence-based prevention and treatment programs for opioid use disorder (OUD) and substance use disorder (SUD).
OUD Prevention Models
Several promising models for preventing opioid and substance use disorders include:
Preventing at-risk adolescents from developing opioid use disorder:
Developing and testing interventions that target risk factors such as trauma, mental health problems, peer pressure, or family history of substance use among adolescents.
Syringe services programs:
Providing sterile injection equipment, safe disposal of used syringes, testing and treatment for infectious diseases, and referrals to health and social services for people who inject drugs.
Initiating buprenorphine-based medication-assisted treatment (MAT) in emergency departments:
Starting patients who present with opioid overdose or withdrawal on buprenorphine—a medication that reduces cravings and withdrawal symptoms—in the emergency department and linking them to ongoing care.
Medication-Assisted Treatment in criminal justice settings and upon release:
Offering MAT to incarcerated individuals with opioid use disorder and ensuring continuity of care after release to reduce relapse and overdose risk.
Limited Availability of SUD and OUD Treatment
The number of people with opioid use disorder exceeds the treatment capacity across the country. In 2017, more than 450,000 individuals with OUD were unable to access treatment. The data are reinforced by related 2021 statistics that show only 22% of people aged 12 or older with an opioid use disorder received medication treatment.
Given the continuing high opioid use and the paucity of treatment options, the Office of National Drug Control Policy’s (ONDCP) strategy has recommendations that include expanding access to high-impact, harm-reduction tools, such as naloxone, and connecting more people to treatment.
Briefly stated, MAT is used in combination with addiction counseling and behavioral therapies. MAT is seen as one of the more effective methods for treating opioid use disorders. There are three drugs the FDA has approved for the treatment of opioid dependence: buprenorphine, methadone and naltrexone. All three of these treatments have been demonstrated to be safe and effective in combination with counseling and psychosocial support. It is recommended that all of those who seek treatment for an OUD be offered access to all three MAT options.
Racial Disparities
Much of the national dialogue about the OUD epidemic has focused on white populations. This is despite the fact that opioid-related deaths have grown at a higher rate among people of color than among non-Hispanic white people.
During 2020, the rate of Black American drug overdose deaths greatly increased, more than any other racial or ethnic group in the country. More ominously, the proliferation of fentanyl in the Black community played a major role in the rise of overdose deaths. A CDC report showed that Black Americans died from fentanyl overdoses more than from any drug in 2021, at far higher rates than white or Hispanic people. According to experts, this upsurge of overdose deaths in the Black community is rooted in racial disparities in opioid policies and the service delivery system.
Families and Children
Disparities in drug policies are not limited to inequities based on race. The opioid crisis has had a significant impact on families and children. The national opioid crisis affects every aspect of service providers, including child welfare, courts, treatment providers, public health, and medical providers. The consequences of opioid-related childhood trauma are also severe in adolescence. Overdose death rates—highest for opioid drugs—have recently increased among adolescents (aged 15–19).
Social Workers’ Stakeholder Role
Substance abuse can have a serious impact on a family. Social work roles in responding to the opioid epidemic include drug policy, legislative advocacy, behavioral health treatment, and family support services. As trained and credentialed treatment providers, social workers are well-informed about SUD and OUD intervention and modalities to refer clients to appropriate treatment options.