US Pharm. 2019;44(3):2.

The triumphs and tribulations emerging from the HIV/AIDS epidemic response can guide an informed reaction to the opioid-use crisis, according to theories posed by researchers from the Columbia University Mailman School of Public Health. Decades of HIV research, they contend in a paper published online in January in the New England Journal of Medicine, shows that an effective medical treatment alone is rarely enough to battle an epidemic. A social as well as a biomedical response to the opioid crisis, the researchers say, is required.

Silvia Martins, MD, PhD, associate professor of Epidemiology at Columbia, highlights the apparent futility of the medically focused strategy in the fight against the growing opioid-use crisis. “Despite the effectiveness of medication-assisted treatment for opioid use disorders, the mortality rate for opioids has surpassed that of the AIDS epidemic during its peak in the early 1990s—a time when there was no effective treatment for HIV/AIDS.”

Sufficiently weighing social factors, argues Caroline Parker, PhD candidate in the Department of Sociomedical Sciences, is key. “Even as efforts are under way to scale up access to medication-assisted treatment for opioid use, it is vital not to assume a position of ‘if we build it, they will come.’”

In the case of HIV/AIDS, Parker adds, “The benefits of scientific progress have been unequally distributed, with growing ethnic and sexuality-related disparities. This failure of equity should draw our attention to the importance of social factors in shaping who benefits from effective biomedical therapies.”

To improve the population health impact of opioid-use medication-assisted treatment (MAT), the Columbia researchers provide a five-point action plan:

1. Identify the cultural, social, economic, and structural barriers to care for the 80% of people with opioid-use disorders who currently receive no treatment.

2. Stop considering only one person at a time and address the structural drivers of the crisis, such as profit-driven healthcare, insufficient regulation of pharmaceutical markets, and eroding economic opportunity.

3. Address stigma and discrimination against people with opioid-use disorder through legislation to decriminalize substance-use disorders and through training key community actors, such as police and churches, rather than just focusing on changing individual attitudes.

4. Mobilize family- and community-support networks to help improve healthcare engagement. Leverage the resources and social networks that facilitated HIV treatment and adherence to improve access to MAT. Develop policies that recognize and compensate people for caring for people living with opioid-use disorder.

5. Recognize that community activism is crucial to making MAT widely available, just as engaging society and stakeholders was central to expanding access to antiretroviral therapy.

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