摘要：The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis’ trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions. The accepted wisdom about the US opioid crisis singles out opioid analgesics as causative agents of harm, with physicians as unwitting conduits and pharmaceutical companies as selfish promoters. 1 Although invaluable for infection control, this vector model 2 of drug-related harm ignores root causes. Eroding economic opportunity, evolving approaches to pain treatment, 1,3 and limited drug treatment have fueled spikes in problematic substance use, of which opioid overdose is the most visible manifestation. By ignoring the underlying drivers of drug consumption, current interventions are aggravating its trajectory. The structural and social determinants of health framework is widely understood to be critical in responding to public health challenges. Until we adopt this framework, we will continue to fail in our efforts to turn the tide of the opioid crisis.
