Epidemiology is the study of disease from a population perspective. As an epidemiologist, the disease you have focused on most is the opioid epidemic. Is studying a drug epidemic the same as studying, say, a measles epidemic, for example? How is it different?
Many of the tools we use to study drug epidemics are similar to those used to explore other diseases, like measles. Take for example the host-agent-environment framework, which helps us map out what factors cause and exacerbate disease. When it comes to the opioid crisis, we can think of the ‘host’ as patients who take opioid medications and people who use other types of opioids, like heroin. The ‘agent’ is the opioid product. The ‘environment,’ speaking broadly, is the policy, social, or immediate context in which drug use takes place. All three factors come together, often in complex ways, to either increase or mitigate harms, like HIV infection and overdose.
You’re Canadian and received your training at the University of British Columbia. How does your perspective, coming from a country that guarantees hospital access and physician services, impact your approach to studying the opioid epidemic?
Being Canadian has informed my approach to studying the overdose crisis in a number of ways. Take for example the for-profit nature of much of American health care. What we know from decades of research is that any health care system in which a primary goal of some actors is to maximize profit can also have the unintended consequence of maximizing harms to patients. In the United States, highly aggressive marketing by manufacturers of opioids resulted in rapid increases in opioid prescribing, and near exponential growth in overdose deaths over the past two decades.
We published studies last year showing that even small-dollar payments to physicians, like free meals at marketing events, increases opioid prescribing, which in turn is associated with higher overdose deaths at a county-level. As a Canadian, my view is that health is an inherent human right. Even the most marginalized in our society, including people who use drugs, deserve access to high-quality, evidence-based treatment and care, regardless of one’s ability to pay. The overdose crisis is just one example of what happens when profit takes precedence over the health and safety of patients.
Do you think COVID-19 is creating space in the United States for more open-minded consideration of our health care model, especially in the face of the obvious health disparities suffered by Black and Latino Americans during the pandemic?
In the addiction treatment arena, the COVID-19 pandemic has forced federal and state regulators to implement a number of policies that may increase equitable access to treatment. Take for example relaxed federal rules around buprenorphine (an FDA approved medication for opioid use disorder), which can now be initiated over telemedicine versus mandating an in-person assessment. My research team recently demonstrated that buprenorphine is less readily available in segregated minority communities across the U.S. So these innovations in telemedicine and federal policy changes are important, and could help address the massive racial/ethnic disparities we see in access to evidence-based addiction treatment.