Beyond Judgment: Empathy as the Antidote in the Opioid Crisis

A place where individuals can inject drugs with either in-person or virtual supervision may sound like a dystopian reality, but in actuality, it may be the key to solving one of our nation’s most prominent public health issues. 

This is not a narrative of surrender, accepting a loss in America’s war on drugs, but rather a progressive adaptation, understanding that old strategies may not be effective and rallying for a more tangible response.  

Opioid addiction is now one of the most complex and prominent public health issues ever to exist, with opioid overdose becoming the leading cause of injury death in the U.S.

The opioid epidemic is fueled by a multitude of factors ranging from overprescription by providers and an ever-growing mental health crisis to a lack of community support. The opioid crisis is not a standalone epidemic but a syndemic, intricately woven with mental health challenges exacerbating both issues. 

A syndemic refers to the conjunction of multiple epidemics at the same time which worsens outcomes. Substance use disorders often are intertwined with other mental health conditions and a lack of resources or treatment for either leads to worsening of both. 

Stigma plays a huge role in accessing resources, with social perception often viewing opioid addiction as a moral failing rather than a health condition. 

This social stigma also creates barriers to treatment, as individuals may be reluctant to seek treatment due to possible discrimination or a lack of accessible resources. Addiction and mental illness go hand in hand, and this stigmatized illness leads to social isolation and exacerbates mental health challenges as a support system can be lacking. 

These attitudes can lead to a lack of empathy, preventing compassionate outreach and forcing a nuanced approach to addressing the root issue of opioid addiction. 

An empathetic approach starts with changing language and perception, forgoing outdated labels like the word “addict” and instead using “individual who uses opioids.” 

These subtle language changes set the basis for changing the perception of opioid addiction being an illicit activity but rather a complex health issue. 

Criminalization of opioid use is a primary contributor to this stigma as an association with legal repercussions, can lead to a lack of reporting for overdoses and a fear of seeking support due to possible legal, social, or employment consequences. 

The U.S. has had harsher punitive action for individuals who use opioids, leading to increased fear of seeking help from social services such as the police or medical personnel. 

This mass incarceration and relentless cycle of punitive action means limited rehabilitation support and contributes to an ever-growing cycle of addiction. Though opioid addiction does not strictly affect a particular group of individuals, certain structural factors make the epidemic worse in certain areas. 

Opioid addiction rates and punitive charges are disproportionately high within urban communities that are already facing higher rates of mass incarceration. Opioid addictions are more prevalent in sex workers, individuals experiencing homelessness, and individuals with a history in the justice system.

Discrimination within our healthcare system and socioeconomic inequality contribute to a lack of access to treatment and often perpetuate higher rates of opioid use in these marginalized communities. 

To combat this multifaceted issue, a collaborative approach is needed on the fronts of public health and policy change through legal reform. 

Harm reduction acknowledges the complexity of this issue and strives to find practical solutions to prevent opioid overdose and prioritize community and individual well-being by providing resources. 

Altering circumstances that surround drug use by providing safe places to use, tests to confirm drug safety and accessible naloxone is essential in changing the tides of the opioid epidemic. 

Though harm reduction proves effective in places like Europe, the U.S. fails to fund these services due to the highly stigmatized perception of opioid use. 

Contrary to the idea that providing individuals with a place to do drugs would lead to more drug use, the opposite is observed. 

A recent study conducted at a supervised injection site found that 90% of individuals who use safe-use sites would be using a public site such as a public restroom, park, or parking lot if they did not have access to the site.

Implementing these safe-use sites would lead to decreased public issues as proper discarding practices can be used and limit public exposure to individuals using opiods. 

From a financial perspective, hypothetical models demonstrate harm reduction practices such as safe-use sites could generate millions of dollars in savings with minimal annual costs.

The benefits of harm reduction are apparent from a public health and economic perspective but are not widely implemented due to this social stigma. 

Empathetic responses are the basis of fostering a compassionate society that breaks down these preconceived barriers and works to implement lasting change. 

By acknowledging the humanity of individuals who are affected by opioid addiction, it lays the groundwork of developing prevention programs and treatment strategies. 

As a Global Health Graduate student in San Francisco, I find the contrast between academic perception and our city’s opioid crisis both striking and disheartening. 

Despite San Francisco being a national epicenter for drug use and facing a severe housing crisis, some peers approach topics regarding opioid addiction with internalized stigma. 

Debates arise about why funding should be given to harm reduction services for individuals struggling with addiction compared to a myriad of other growing and neglected public health issues. 

Our role is to resist applying our moral hierarchy to public health epidemics. Instead, we must approach these issues with empathy, understanding the multifaceted challenges, and implementing strategies that improve well-being. 

This is not a plea for moral redemption but a call for realism. We must acknowledge the intersectionality of social determinants, health factors, and the need for harm reduction. 

Let’s engage in destigmatizing conversations, challenge preconceptions, and develop comprehensive public health strategies collaboratively. 

Only through collective empathy and understanding can we hope to create positive change and contribute to the well-being of our community.