The Outbreak and Sequelae of the Increase in Opioid Use in the United States, Canada and Beyond

Many thousands of people are dying of opioid-related overdose in North America every month. Such deaths are taking place in rural, suburban and urban areas. We have only a partial understanding of why this is occurring; where it is occurring with particular force; and what forces shape political, medical, community and interpersonal responses to it. Efforts by the pharmaceutical industry to sell their painkilling products seem to have had a role, but this does not fully address issues of why so many people felt they needed painkillers, nor does it address issues of the illegal distribution of a variety of innovative high-potency products like forms of fentanyl that have helped cause many fatalities. There is considerable evidence that increased opioid use has reinvigorated some heroin markets and has led many people to begin injection drug use—with implications for blood-borne viral and bacterial transmission and disease as well as overdose. Furthermore, opioid users seem to be engaging in high-risk sexual and other behaviors that may also have epidemiologic and medical consequences. Public health citizen activists have gotten involved in terms of naloxone distribution campaigns and syringe exchanges, and efforts have been made both by citizen activists and some government authorities to expand (or initiate) safer injection facilities.

Altogether, then, the increased opioid use is part of many interacting causes and effects that pose many issues for research. Indeed, in many ways, we do not even know what the best questions are to ask in order to understand these phenomena and reduce their harms, much less bring it under control. This suggests the need for transdisciplinary theoretical development which is likely to involve a wide mix of social sciences, behavioral and psychological sciences, epidemiology and the biological sciences; and a need to consider macrosocial, macrocultural, geographical, epidemiologic, economic, community, family and psychological levels of analysis.

This Research Topic, then, aims to elicit a range of innovative and thoughtful papers. Ideally, these will include a combination of theoretical and empirical insight and originality.