(By Alison Carney, Queen’s University)
The radical increase in Canada’s opioid-related mortality rate has resulted in preventative and treatment strategies becoming more accessible to public health authorities. According to statistics, the annual death rate attributed to opioid use increased by 463% between 2000 and 2013. Opioid-related mortality is now the first leading cause of accidental death, with one death occurring every eight hours. With these alarming statistics at hand, this paper outlines the complexity of the current national opioid crisis and uses a Social Ecological Framework to propose a multifaceted solution through a health promotion lens.
Opioids are substances that target the pain relief circuits of the brain. They act by binding to neuronal receptors and promoting the release of dopamine and endorphins in the body. An acute effect of opioid use is a rush of pleasure or euphoria. Symptoms of withdrawal include nausea, diarrhea, irritability, and restlessness. Naturally occurring opioids include morphine and codeine, but the opioid abuse epidemic is certainly not limited to these common substances. Recently, counterfeit opioids, such as fentanyl, have been circulating the streets and landing in the hands of drug users. Fentanyl is an example of a powerful synthetic opioid that is 100 times more potent than morphine. Teslin Russell, an 18-year-old Ottawa teen, passed away on December 31 2016 due to her consumption of counterfeit opioids laced with fentanyl. The sudden loss of this flourishing teen exemplifies a crisis that is increasing exponentially.
Academic literature outlines solutions to opioid addiction and abuse. Kolodney et al. (2015) emphasizes the importance of a multidimensional and long-term prevention approach that addresses the chronic relapsing nature of opioid dependence. This study suggests a need for treatment strategies at the primary, secondary, and tertiary levels. Abstinence oriented interventions such as detoxification and relapse prevention, maintenance treatment, and harm reduction measures such as needle exchange programs are among the solutions proposed. This platform shows promise as it considers the complex nature and longevity of opioid dependence.
While existing strategies proposed by public health authorities tackle specific aspects of the problem, a feasible solution must use an approach more broad in nature. Bronfenbrenner’s Social Ecological Model (1979) is a useful framework to conceptualize the underlying mechanisms and risk factors associated with the opioid abuse epidemic. As a whole, the theory identifies a reciprocal deterministic relationship between the individual and their environment. According to Conn and Marks, “environmental contexts interact with the individual to promote healthy behaviours or create risks of maladaptive ones such as substance misuse” (p. 185). This framework is comprised of five major levels of influence including the individual level, the microsystem of close family and friends, the mesosystem or organizations of involvement, the exosystem or community level, and the macrosystem or societal cultural level.
Through the Social Ecological Model, it is possible to imagine an approach to the opioid crisis that incorporates all facets of influence to an individual’s recovery. Beginning globally at a macrolevel, leaders and government officials may address current policies and regulations regarding the issue. This level adheres to national or provincial characteristics including laws and regulations as well as the actions of leaders. More proximally, at the exolevel, the attitudes and beliefs of community members and leaders can be adjusted through media messages and the use of modeling. For example, mass media campaigns in the 1990s used advertisements and television shows to bring about change in the rates of drinking and driving, which lead to a prompt decrease. The mesosystem level includes organizations in which an individual is involved, such as school, the workplace, or even religious affiliations. Implementing treatment and prevention programs at this level will aim to target risk or affected populations. At a more personal level, the microsystem includes members of a person’s family or close friend group. Families can positively influence individuals by providing support and healthy communication surrounding issues of drug use. The individual is at the core of each of the levels of the Social Ecological Model, with their internalized attitudes, beliefs, experiences and health. The individual influences his or her surroundings as much as his or her surroundings influence the individual. Moreover, all of the levels of the model elicit an impact on the individual.
In conclusion, the complex nature of the current opioid-use crisis sees no single solution. Rather, it demands a multifaceted approach as prescribed in the Social Ecological Model. That is, the implementation of numerous interventions through various levels of society are necessary in the attempt to reduce the rate of opioid-related mortality and prevent future tragedies such as the recent loss of teenage victim, Teslin Russell.
Bronfenbrenner U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Google Scholar
Conn, B. M., & Marks, A. K. (2017). An ecological approach to understanding adolescent prescription drug misuse. Journal of Adolescent Research, 32(2), 183-204. doi:10.1177/0743558415589369
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574. doi:10.1146/annurev-publhealth-031914-122957