Editor’s Note: Claire E. Sterk, PhD, is the 20th president of Emory University. She is the Charles Howard Candler Professor of Public Health. The opinions expressed in this commentary are her own.
Less than one month ago, just as many of us were gathering to celebrate the holidays with families and friends, the Centers for Disease Control and Prevention released its annual report on the toll of the opioid crisis in 2016. While drug overdose deaths are up a shocking 21% from 2015, the death toll is even higher among 15- to 24-year-olds, with an increase of 28%.
These grim numbers show an escalating deadly crisis that is far from under control and that is taking a particularly brutal toll on our teenagers and young adults. Yet, despite the dire consequences, this public health epidemic is mired in a fragmented and tepid national response. Why?
As a social scientist and university president who has spent decades tackling major public health issues such as HIV/AIDS and addiction, I see a clear and distressing pattern in how our country addresses these crises. Our cultural disposition is to initially place blame and responsibility solely on the afflicted – or addicted – individual.
This accusatory mindset leads to a disproportionate emphasis on criminalizing the behavior, rather than addressing it as a societal problem that we all must own. We stigmatize and shame. We punish and incarcerate. We expect the addicts to find their own solutions. It is their problem, not ours. This approach further contributes to these public health crises spiraling out of control, as we now see with opioids. We only unite in a belated societal call-to-action when a crisis reaches epic proportions.
It is time to break this dangerous pattern.
We witnessed the same initial condemnation of a public health epidemic in the early days of the HIV/AIDS crisis. At the onset, much of the public blamed the individual for his or her diagnosis. Too few amongst us had sympathy, or paused to consider that women and men often had no knowledge of the risk that their partners brought.
No one was spared from the ostracization that came from being HIV positive, whether you contracted the disease sexually, from a lifesaving blood transfusion or in the womb as an unborn baby. Even providing clean syringes to drug addicts to help prevent the spread of AIDS was frowned upon. The intense fear of being labeled HIV positive prevented many from getting tested and treated.
Both with HIV/AIDS and opioid addiction, the result is not just loss of opportunity and life. It is also the erosion and dissolution of entire communities – from lost wages to unaffordable health care costs and broken families. In my native country, the Netherlands, as well as in other European countries, the response to opioid addiction is pointedly different.
In the Netherlands, addiction is seen from the start as a mental health issue that requires education, outreach, treatment and sustained collaborative action. Officials seek to rehabilitate and heal drug abusers, not to discard them. The culture supports a collective effort in which everyone plays a role in turning the tide from the beginning.
Shamefully, during the crack epidemic, we never took collective ownership to solve the problem because the crisis didn’t spread beyond a narrow segment of society. Instead, there was an overemphasis on criminalization of crack addicts, which filled up our prisons.
Even though there is finally a long-overdue national awakening to our opioid epidemic, the financial and social impact of a crisis that has been brewing unchecked is daunting. A 2017 White House report by The Council of Economic Advisers estimates that the yearly cost of the epidemic is in excess of $500 billion.
But what keeps me up at night is the long-term impact the crisis could have on our youth. A 2016 study by Columbia University’s Mailman School of Public Health found that the risk of becoming dependent on opioids such as Vicodin and Percocet jumped an alarming 37% among 18-25 year-olds between 2002 and 2014. A 2015 Betty Ford Foundation study found that close to 16% of the young people surveyed reported using pain pills not prescribed to them, while over 37% admitted not knowing where they would go for help if they overdosed.
An entire generation is growing up believing that prescription pills are more often than not the go-to remedy for all ills. The line has blurred between legal and illegal use.
We must recognize these driving societal forces, as well as delve more deeply into the growing root causes of depression, stress and hopelessness fueling this epidemic, especially among America’s young adults. They are our future.
When we treat addiction from the very beginning as an illness rather than a crime, we can then take a more comprehensive and collaborative approach. At Emory University, we are working with businesses, government and public health agencies, particularly in the Southeast, to bring together stakeholders across the region to share ideas and combine efforts.
As we did with the Ebola crisis, we are sharing research and lessons learned with the Centers for Disease Control and Prevention. We are on the ground in locations in Kentucky and Georgia, working directly with communities affected by the epidemic. And at our student health center, we are implementing a system of care for our students that takes a holistic approach to the problem. Because of our unique role in society, universities can – and must – be leaders not only in education and research, but in helping build a national consensus around how we address public health crises.
That consensus begins with an understanding that what our society lacks in the early stages of a public health epidemic is a collective willpower. As long as the problem is “theirs” and not “ours,” we will waste precious time, resources and, most importantly, lives in criminalizing instead of stemming the crisis.
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Just as we finally came together to bring the HIV/AIDS epidemic in the US under control, we are now slowly making a paradigm shift in our societal commitment to fight the opioid epidemic.
But when this crisis abates, we must step back and face our initial base instinct to adopt an “us-versus-them” mentality when it comes to public health issues. We cannot wait until a public health crisis has caused monumental damage and touched every segment of our society until we make it our own.