Summary/Abstract

Reflections on the absence of the application of the biopsychosocial epidemiological model for addictive disorders in public policy.

Content

“The prestige of government has undoubtedly been lowered considerably by the Prohibition law. For nothing is more destructive of respect for the government and the law of the land than passing laws which cannot be enforced. It is an open secret that the dangerous increase of crime in this country is closely connected with this.” ~ Albert Einstein - My First Impression of the USA, 1921

As I reflect on my period of isolation several years ago in my home in Walpole Maine due to the social distancing recommended by the CDC to lessen the spread of the Corona Virus (COVID-19), I find myself looking at the global, national and state level epidemiological data for opioid use disorder persistently released by academia, the World Health Organization, the Center for Disease Control, The American Medical Association, the National Institute of Health and the United Nations and wonder why politicians are either unaware or have ignored the decades of research published regarding the field of biopsychosocial epidemiology. They have failed to incorporate that research in new legislation and policy, understanding the human, economic and social ramifications to the opioid epidemic that has been ravaging society nationally and internationally for the last decade. The opioid epidemic is by definition a pandemic.  Although COVID-19 poses a serious elevated threat to human life, the incidence of reported mortality data is highly correlated to advanced age and those with preexisting medical conditions, i.e. cardiovascular, respiratory, diabetes, obesity, hypertension. These are the usual suspects that alone claims hundreds of thousands of lives per year. Pharmaceutical companies have fast tracked the development of vaccines and future outbreaks of this virus will eventually be capable of being contained with a vaccine and pharmacotherapies and the panic reaction will slowly subside, as with influenza, and become part of everyday preventative healthcare. However, the systemic genocide and cultural cleansing of the population afflicted with an opioid use disorder will remain each year and will continue to claim hundreds of thousands of lives globally. There is no vaccine nor a single or a cocktail of medications to either contain, cure or prevent the continuing escalation of this pandemic. 

An argument for a parallel theoretical application could be made as from a biopsychosocial epidemiological model for addictive disorders which are communicable to those most susceptible. Cassel, a noted social epidemiologist, puts forth a “central hypothesis is that the ‘social environment’ alters host susceptibility by affecting neuroendocrine function. His list of relevant psychosocial factors includes: dominance hierarchies, social disorganization and rapid social change, marginal status in society, including social isolation, bereavement, and, acting as a buffer to all of the above, the ‘psychosocial asset’ of ‘social support’. In Cassel's view, these psychosocial factors, considered together, explain the puzzle of why particular social groups are disproportionately burdened by otherwise markedly distinct diseases, e.g. tuberculosis, schizophrenia and suicide. Shifting attention from ‘specific etiology’ to ‘generalized susceptibility’—while acknowledging that what disease a person gets is dependent on prior exposures —Cassel ultimately concludes that, in his own words, the most ‘feasible’ and promising interventions to reduce disease will be ‘to improve and strengthen the social supports rather than reduce the exposure to stressors. The biological component is understood by applying the empirical data results from a decade of research on the role of epigenetics in addictive disorders. The host is then predisposed genetically to have less resistance to the stressors and therefore a higher susceptibility to addiction.

Perhaps if society would adjust its lens and alter its perception of this disorder and abandon the archaic philosophy rooted in 18th century moralism that has promulgated this misguided ideology which has cast “addicts” into a secondary deviant subculture akin to lepers in biblical times, we could then move forward to address the opioid pandemic as an urgent healthcare issue rather that a moral or criminal issue. This discriminatory, non-science based practice has been a primary causal factor in the persistent escalating mortality rates and the mass incarceration of millions for the past fifty years.