The Emergence of an Epidemic

The opioid crisis has roots deep in history, including social, cultural, and economic factors and trends that have driven the current epidemic. In this chapter, the authors describe the history of opioid use and its evolution to the current day. The modern epidemic has been spurred by the early marketing of pain medications as “nonaddictive,” increased availability of both prescription and illicit opioids in the United States, and perceptions that drug misuse and addiction are individual “moral failings” versus a broader understanding of addiction as being driven by broader social and environmental factors such as community resilience and social cohesion. The chapter suggests several opportunities to improve efforts to end the epidemic, including working with clinicians and community leaders to change health system procedures and to adopt policies that support communities in efforts to address the social determinants of health.