A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic

Annu Rev Public Health. 2021 Apr 1:42:95-114. doi: 10.1146/annurev-publhealth-090419-102727. Epub 2021 Nov 30.

Abstract

More than 750,000 people in the United States died from an overdose between 1999 and 2018; two-thirds of those deaths involved an opioid. In this review, we present trends in opioid overdose rates during this period and discuss how the proliferation of opioid prescribing to treat chronic pain, changes in the heroin and illegally manufactured opioid synthetics markets, and social factors, including deindustrialization and concentrated poverty, contributed to the rise of the overdose epidemic. We also examine how current policies implemented to address the overdose epidemic may have contributed to reducing prescription opioid overdoses but increased overdoses involving illegal opioids. Finally, we identify new directions for research to understand the causes and solutions to this critical public health problem, including research on heterogeneous policy effects across social groups, effective approaches to reduce overdoses of illegal opioids, and the role of social contexts in shaping policy implementation and impact.

Keywords: demand; opioids; overdose; policy; social determinants; supply.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics, Opioid / poisoning
  • Analgesics, Opioid / therapeutic use
  • Chronic Pain / drug therapy
  • Epidemics*
  • Humans
  • Illicit Drugs / poisoning
  • Opiate Overdose / epidemiology*
  • Policy
  • Practice Patterns, Physicians' / statistics & numerical data
  • Social Environment
  • United States / epidemiology

Substances

  • Analgesics, Opioid
  • Illicit Drugs