The Importance of Prevention in Addressing the Opioid Crisis

As our communities, healthcare systems, and government agencies join in the effort to reverse the epidemic of opioid overdoses and solve the opioid crisis, it is not enough to focus all our resources on treating people who are already addicted to opioids. Keeping people who do not have an opioid use disorder from becoming addicted is an equally important task. Addressing overprescribing of pain medications through improved pain management and prescription monitoring has been one important prevention approach; and as illicit opioids like heroin and imported fentanyl become more prevalent, reducing the supply of those substances through law enforcement efforts is also crucial. But reducing the demand for opioids by addressing the reasons people turn to them and become addicted in the first place is just as vital and fundamental to ensuring that a new drug epidemic does not follow once the opioid crisis is contained.

Two people talking with Prevention overlay

Research on preventing drug use by addressing vulnerability factors that increase the risk for substance use disorders is an important component of the National Institutes of Health (NIH) HEAL (Helping to End Addiction Long-termSM) Initiative. Specifically, the HEALthy Brain and Child Development (HBCD) study being partially funded by HEAL will examine how the human brain develops in the transition from infancy into early adolescence. Evaluating the effects of fetal drug exposures, adverse environments, genetics, mental illness will provide knowledge to help us understand how these risk factors operate in conferring vulnerability for substance use disorders.

Abundant research by NIDA-funded investigators over the past few decades has shown that positively altering a child’s life trajectory by reducing various risk factors, strengthening protective factors, and increasing access to resources can reduce or delay later drug use as well as minimize other adverse outcomes like criminality or other mental illness. Risk factors addressed by early childhood interventions can include poor self-regulation, aggression, or insecure attachment to parents. Those addressed in family and school prevention interventions at all ages through the teen years include lack of parental supervision, exposure to drugs at home or at school, and stresses from poverty, neglect, or abuse.

Prevention programs can take many forms, but all in one way or another address these risk factors and/or bolster factors like self-control, peer relationships, or other age-appropriate skills. These forms of resilience may make all the difference in the young person’s life when faced with the opportunities and temptations to begin smoking, drinking, or using drugs when they are adolescents, despite whatever adversity they may have experienced when younger. Effective prevention can even begin as early as the prenatal period: For example, an intervention in which trained nurses visit and provide guidance to first-time mothers during their pregnancy and in the first two years of their child’s life was shown to be effective at improving various cognitive and behavioral outcomes into adolescence, including reduced substance use and involvement with the juvenile justice system.

The stresses of impoverished environments negatively impact brain development, but a striking finding from prevention research is that interventions can protect against or reverse some of these neurobiological impacts. For example, a family-focused intervention with poor families in rural Georgia protected against poverty-associated neurobiological changes to brain areas involved in learning and stress reactivity. And maltreated children in foster care who received a prevention intervention for preschoolers were better able to regulate stress, as measured by cortisol levels.

Because risk factors for drug use are common to other behavioral problems, most prevention interventions do not focus solely on preventing drug use or on preventing a single type of drug use. A wide range of problems can be addressed or averted by addressing core risk or protective factors. A few programs, however, such as a middle-school intervention called PROSPER, have shown specific benefits at preventing nonmedical use of prescription drugs.

An important research priority is finding out how to widen the adoption and effective implementation of evidence-supported prevention programs. The menu of such interventions is diverse, but few of the options are widely used. Part of the problem is that high-quality intervention programs are costly, and communities may be reluctant to invest the needed resources when the payoff may be years or more in the future. However, studies have strikingly shown that many programs more than pay for themselves. Like other investments—saving for retirement, for instance—primary prevention of substance use and addiction requires long-term thinking and balancing the short-term costs in money and time against the long-term benefits of a healthier society down the road.

The HEAL initiative will also prioritize research on developing interventions targeted towards the transition from late adolescence into adulthood, the age where there is the largest increase in initiating opioid use. NIDA will be funding research to create an evidence base for new strategies and interventions to prevent opioid initiation and opioid use disorder (OUD) in older adolescents and young adults in healthcare, justice, and other settings.

In a new Commentary, Targeting Youth to Prevent Later Substance Use Disorder: An Underutilized Response to the US Opioid Crisis, in the American Journal of Public Health, colleagues at NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control (CDC) highlight the importance of research on primary prevention for helping to address the opioid crisis. Such research will provide us not only with scientific solutions to address the current opioid crisis but will provide us with the knowledge and tools to protect us from future drug crises.

Dr. Nora Volkow, Director

Here I highlight important work being done at NIDA and other news related to the science of drug use and addiction.

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 Family intervention program

I run an NGO that focuses on Teens ,we were going to schools to talk to Teens about the dangers of getting involved in illicit drugs, but I found out that most of them that are addicted come from a dysfunctional home, so I now channeled most of my energy talking to parents, helping them unlearn and relearn stuffs about parenting, helping in international parenting, reuniting them with their teens there by making the home more conducive for the teen.

 An ounce of prevention is indeed worth a pound of cure!

Regarding the opioid crisis, we have a systemic problem derived from a vast segment of our population that said "Yes" to illegal, recreational drugs. NIDA is correct to emphasize prevention. For a behavior that is risky and detrimental to one's health and well-being, "Why?"

It's nonsense to blame the medical community for the opioid crisis because there is no extra profit from 'over-prescribing' and over-producing pills. Profits derive from the R&D production to fulfill finite, pain-management requests. Instead, our vast and extant drug culture capitalized on the situation. Not the other way around!

So why the lure for drugs? What a concept! I think much stems from our society's lack of guidance and focus. We are aimless and clueless about who we are and how we should behave. We think marijuana is harmless, and it is not. We are whipsawed by political agendas that focus on the negatives of the world, 'bad events' are generally what feed the ever intensified news media, we fret and clamor over global warming like the world is going to end, etc,etc.

In other words, there's lure to live for now figuring the future is doom anyway. Popular entertainment, especially the music industry, indirectly promotes the lifestyles of drug use as glamorized, innocuous, romantic and appealing despite the wrecked lives and suicides that result.

De-popularizing drug use like we once did with tobacco (remember those "Smoking is glamorous" posters) might help. A holistic approach to this gigantic problem is warranted. From top to bottom.

 SUD prevention

With more than 40 years of clinical experience I agree w/ escalating prevention strategies. However, based on both my clinical and teaching experience here are a few additional observations:
when we examine our anthropological record, some of our species are quite enamored w/ agents that alter, mood, mind, and motor. And during adolescent development we find a keen interest in experimentation despite available evidence about harm. And you know that the earlier the exposure significantly enhances risk over decades to come.

 Hoping to be part of the solution and not part of the problem.

I am 11 years clean and just finished my bachelor's degree in Psychology. I am starting my master's in Theology this fall. My mission is to work with teens and young adults who are struggling with (i) active addiction and chronic relapse, (ii) poor self-image, (iii) struggling with spiritual and metaphysical questions, (iv) mental disorder, and (v) hopelessness. I have been reposting Dr. Volkow's monthly blog post on my WordPress blog site. My focus is on recovery, spirituality, and creativity. I provide all proper copyright and publication notices and credits and do not edit the original. Keep up the great work at NIDA. Steven Barto

 Costly? Evidence Based?

You bring up costly drug intervention programs at a time when a million NON VIOLENT Americans are incarcerated on drug charges? (source / REALLY?
At a cost of about $25,000 each how much does that cost our nation?

One million times 25,000... That's $25,000,000,000.00 every year.
Why are a MILLION Americans locked in a cage for non violent drug charges?

How much "high quality TREATMENT" and PREVENTION would $25 BILLION buy?

How much does HIV treatment cost our nation?
Meanwhile there are STILL states that do not have needle exchange programs when we KNOW that sharing syringes is how deadly diseases are spread!

Opioid epidemic? Is heroin killing Americans?
NO, lack of regulation, based on our failed drug policies, is what's killing Americans.

How much do we pay the DEA? MORE BILLIONS.
Yet it's IMPOSSIBLE to stop drugs from finding those who want to use them.

So prevention, YES. But don't pretend that high quality programs are too "costly" as we WASTE tens of billions of dollars every year on a failed drug policy which is POLITICALLY based, not science based.

Why is there no "opioid epidemic" in Holland, where heroin is GIVEN to those who are hooked?
Take away the crime, spreading of diseases and death from overdoses and all you have left is a health issue.
THAT is evidence based.

Want to stop drug abuse? Look at the current DRUG POLICY.
The best thinking of policy makers has created this epidemic. Think about THAT!

 Negative advertising

Negative advertising against recreational drug use could go a long away. I mentioned those "Smoking is Glamorous" posters that featured images of folks smoking who were shall we say, not so glamorous looking. My college classrooms were plastered with those posters, and I must say it worked.

We are doing nothing of the sort now. Our society is mostly cluess with regards to the utterly devastating effects on us as individuals, as well as society as whole. For instance, there is nothing glamorous about about the violence and homicides that results from the drug trade, nothing glamorous about families who deal with addiction sometimes pouring their life savings into saving a family member, nothing glamorous about life-long struggles to stay sober, nothing glamorous about being addicted and becoming homeless and living in the streets, and of course nothing glamorous about the suicides that result.

These should all be talking points in grade school, colleges, on national radio and tv and in the halls of congress. How many trillions of dollars have already been squandered down a rat hole? Just imagine: we could have afforded universal health care with that kind of money, could have bridged the wealth gap considerably, etc etc, And the grand irony is those who are addicted despise those drugs. They are trapped, virtually enslaved.

This whole illegal, recreational drug disaster must be reckoned with before it destroys us. It's bad, really bad, yet our nation hardly seems to notice.

 Negative Advertising

People laugh at negative advertising.
All the things you mentioned,
the violence and homicides that results from the drug trade, (a DIRECT RESULT of our nation’s drug policy)
families who deal with addiction sometimes pouring their life savings into saving a family member, (the TRILLIONS that this nation has chosen to waste in an effort to stop people from getting high could buy a LOT of treatment)
life-long struggles to stay sober (Which is a HEALTH ISSUE, not a legal issue, yet our nation makes MONEY by making it a legal issue, which compounds the problem)
being addicted and becoming homeless and living in the streets,
and of course nothing glamorous about the suicides that result (none of which would happen if our nation treated this as a HEALTH ISSUE, not a legal one).

You are looking at the result of an epic FAIL by the national embarrassment that is called “America’s war on drugs”.
ONLY IN AMERICA! We started the war on drugs (idiotic notion) then we imposed our will on the rest of the world.
THAT is the source of all the suffering you mention.
It’s the way we treat drug USERS.
The harm is not in the drug use itself, it is made dangerous and “taboo” policy (Which appeals to ANY teen BTW)
by those who make MONEY from the drug war. That’s where the harm comes.
Think about it.

 Negative Advertising would go a long way

I have to agree, when I was a kid, "Joe Cool" was on every billboard, tough guys and gorgeous gals in movies and on TV smoked, even Santa had his pipe. All the cool kids smoked. But, then those ads were gone, and the CDC flooded our homes with frightening health commercials for cigarette users. Our little children were terrified for our neighbor who smoked. Advertising works, absolutely. We need to get the Vaping ads off social media just like we did cigarettes and we need strong anti-drug commercials aimed at our elementary and middle school children, who view 'burnout' as a stupid thing, when teens cannot finish a sentence.

 The "War on Drugs" does not cause people to become addicted

I can partially agree with Rich that we need to invest more into addiction treatment, yet I staunchly disagree that legalization of recreational drugs is the solution to this enormous problem. The price for law enforcement is minor in comparison to the total costs. Many hundreds of billions of dollars over the years were spent merely on the purchase of drugs! Then the cost of rehab for substance abuse disorders has also cost us hundreds of billions. Then lost productivity has also cost us hundreds of billions, Etc. Besides, legalization of the particularly 'hard' drugs like heroin or cocaine will surely lead to even more addiction. And that's exactly what we don't want!

After marijuana legalization in Colorado for instance, crime, especially violent crime actually rose!
Besides, nobody is being arrested and imprisoned merely for using drugs or becoming addicted. Those who transport and deal in illegal drugs are the ones targeted by law enforcement.

The problem is that a vast segment of our society sees illegal recreational drugs in a positive light. It's 'cool', it's popular, it's the fun thing to do. We are being inundated with 'positive advertising' for the last half century. Songs on the radio for instance with verses such as "She's gonna like cocaine", or "Mary Jane will kill the pain" plaster our society incessantly.

One horrible result of Americans saying "Yes" to drugs is a virtual holocaust this has caused in Latin America. Maybe that angle should be used for negative advertising also.

 Advancing Parenting

Intervention, treatment, rehabilitation, healing, and recovery have been around for many decades and yet there are still multitudes of hurting children and adults. Legendary comedian Moms Mabley quipped, "If you always do what you always did, you will always get what you always got."

Let's take a lesson from Ms. Mabley, Jonas Salk, the public health community, and the Centers for Disease Control and try primary prevention for a a new kind of parenting education. One that reaches everyone, everywhere, all the time.

 My response to MM

Thank you for commenting on my post.

Working backwards from your post, Latin America is a direct result of OUR country imposing OUR will on them.
WE, the USA actually arms many of those Latin American countries who are being torn apart by OUR drug laws!
If you think anyone is going to see a PSA about a village wiped out, then quit using, you’re kidding yourself.

As you said, prohibition makes things “taboo”. Taboo is appealing. Even some music is a push back against prohibition. And look where prohibition has gotten us. EPIDEMIC. It didn’t work in the 20’s and we didn’t learn.

COLORADO- Has become the “Mecca” for cannabis users. The population swelled after legalization, OF COURSE there was more crime. There’s also $800,000.00 A DAY in cannabis taxes made. Significantly raise the population in the town where YOU live, you think there could be more crime?

Opinions are opinions, here is a FACT. I’ve been to Holland several times. Cannabis is legal so it’s not “taboo”. It’s treated like alcohol and there is no hysteria like we’ve seen here for 80 years!

FREE HEROIN IS GIVEN TO USERS. Yet they don’t have 1/10th the opioid “epidemic” deaths we have here in the USA, How do you explain that?

FACT: Those who decide to use are going to use. We have to CHOOSE between prohibition vs Treating drugs as a HEALTH issue. Only when we do, the overdose deaths END. Disease spreading ENDS. Robbing for drug money ENDS.

 Rich makes some thoughtful points, but....

Thanks Rich. Your comments offer much to think about.

To dissuade people from trying or using recreational drugs, I was thinking more along the lines that might be analogous to the efforts and concerns we have for say, plastic pollution. That is, people do become concerned when they realize the plastics they use may eventually harm aquatic creatures. People do listen and take action.

Similarly, if EVERYONE was aware to an equal degree that buying and using illegal recreational drugs directly contributes to an ongoing, virtual holocaust in Latin America, national public opinion would turn very unfavorable towards drug use.

And it's not the police and military committing the atrocities, but instead, the drug gangs and cartels who kill others indiscriminately, including innocent people caught in the middle- such as the 43 kidnapped school children whose remains were later discovered burned and discarded in a landfill.

We Americans need to be honest with ourselves. People will listen since we can not be part and parcel to a holocaust!

Regarding Colorado crime (and elsewhere), note that violent crime did not disappear as marijuana legalization proponents promised. I personally suspect that the deadly violence so often associated with drugs is not because of their illegality, but because some users (or abusers) change mentally. They lose their inhibitions, empathy for life and sometimes develop warped perspectives that render them more prone to violent behavior imho.