APHA Press book serves as guide to US opioid crisis, offers solutions
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* Mark Barna

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/54/2/5.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/54/2/5.1/F1)

The U.S. opioid epidemic has claimed lives and harmed communities at an alarming rate. A new APHA Press book offers evidence-based interventions that public health professionals can use to address the crisis, which claimed over 80,000 lives in 2021.

“Responding to the Opioid Epidemic: A Guide for Public Health Practitioners” is authored by leaders in the field. The book’s 24 chapters share a range of approaches to the problem, from broad programs within the continuum of care to granular discussions on a single aspect of care. Topics include health disparities, prenatal opioid use, peer recovery, harm reduction and ways to use funds from lawsuits against opioid drug companies.

“We want people to pick up this book and, rather than read it from front to back, find the chapters that most inform what they’re doing in public health,” Martha Waller, PhD, MA, co-editor of the book and senior program developer at Pacific Institute for Research and Evaluation, told *The Nation’s Health*.

Three phases mark the recent history of opioids in the U.S., according to co-editor William Wieczorek, PhD. In the 1990s, opioid-based prescriptions became available for pain relief, the most popular being oxycodone. The products were highly effective but also addictive, causing demand to explode. “Pill mills” emerged that sold opioid-based products to anyone who could pay for them.

From 2008 to 2012, as leaders tightened drug prescriptions, people who had begun using opioids as patients lost access. Some of them turned to drugs such as heroin and counterfeit opioids, said Wieczorek, president and CEO of Pacific Institute for Research and Evaluation. Phase 2 geographically expanded the illicit opioid market from cities to suburban neighborhoods. Overdose deaths increased as counterfeit drugs flourished.

Meanwhile, illegal drugmakers began using more fentanyl, an inexpensive synthetic opioid 50 times more potent than heroin, in the drugs they created for sale. Phase 3 begins in the mid-2010s with skyrocketing use of fentanyl, causing record overdose deaths.

“One of the challenges now is that people taking illicit drugs don’t believe they have any exposure to opioids or fentanyl,” Wieczorek told *The Nation’s Health*. “But now we know things like methamphetamine and cocaine often have enough that people who haven’t been exposed to opioids can literally overdose in a single episode.”

A study released in February found that 70% of all drug overdose deaths in 2022 involved illegally manufactured fentanyl. Reflecting continuing changes in the epidemic, the research found that most of the deaths involved smoking, with many users switching from injecting the drugs to inhaling them.

A connecting thread throughout the new book is the necessity of a continuum of care for opioid users, which involves promotion, prevention, harm reduction, treatment and recovery. Both upstream and downstream causes need to be addressed to solve the problem, Wieczorek said.

“You can never treat yourself out of a chronically relapsing illness like addiction,” he said. “You have to think about prevention as well and also putting systems in place so that people can get treatment.”

For more information on “Responding to the Opioid Epidemic,” visit [www.aphabookstore.org](http://www.aphabookstore.org).

*   Copyright The Nation’s Health, American Public Health Association