insurance companies, who are often more likely to fund painkillers
than alternatives like physiotherapy. Our modern lifestyles also play a
role, with rising chronic pain associated with increases in obesity and
office-based work.
One of the best ways to slow an epidemic in its early stages is to
reduce the number of people who are susceptible. For drugs, this
means improving education and awareness. ‘Education has been
very important and very effective,’ said Pacula. Strategies that reduce
the supply of drugs can also help early on. Given the multitude of
drugs involved in the opioid epidemic, this means targeting all
potential routes of exposure, rather than one specific medication.
Once the number of new users peaks, we enter the middle stage
of a drug epidemic. At this point, there are still a lot of existing users,
who may be progressing towards heavier drug use, and potentially
moving on to illegal drugs as they lose their access to prescriptions.
Providing treatment and preventing heavy use can be particularly
effective at this stage. The aim here is to reduce the overall number
of users, rather than just preventing new addictions.
In the final stage of a drug epidemic, the number of new and
existing users is declining, but a group of heavy users remains.
These are the people who are most at risk, having potentially
switched from prescription opioids to cheaper drugs like heroin.[79]
But it’s not as simple as cracking down on the illegal drug market in
these later stages. The underlying problem of addiction is much
deeper and wider than this. As Police Chief Paul Cell put it, ‘America
can’t arrest its way out of the opioid epidemic’.[80] Nor is it just a
matter of taking away access to prescription drugs. ‘There’s an
addiction problem, and not just an opioid problem,’ Pacula said. ‘If
you don’t provide treatment when you’re taking away the drug, you’re
basically encouraging them to go to anything else.’ She pointed out
that drug epidemics also come with a series of knock-on effects.
‘Even if we get the issue of misuse of opioids under control, we have
some very concerning long term trends that we haven’t even started
dealing with.’ One is the effect on drug users’ health. As people move
from taking pills to injecting drugs, they face the risk of infections like
hepatitis C and . Then there is the wider social impact – on