Structural Determinism Amplifying the Opioid Crisis: It's the Healthcare, Stupid!

Abstract

The article paints a picture of a healthcare system that not only has been slow to deliver appropriate treatments but also stands as a structural determinant of this crisis. Structural determinants create barriers that stop or slow the remediation of social determinants while perpetuating others. This paper argues that the healthcare system has failed those struggling with OUD and co-morbidities and is itself a structural determinant that creates barriers to effective behavioral health services. In some ways (such as poor preventative care and over-prescribing) the healthcare system justifiably can be viewed as a cause of the opioid epidemic. However, its true failing is the way it has amplified the crisis, seemingly unable or unwilling to identify appropriate points of intervention or deliver the necessary services. The root causes of the opioid epidemic must be treated with improved education, better surveillance, and generally improving the social determinants of health. However, the U.S. healthcare system is responsible for many of the symptoms of the opioid crisis and several of barriers to effective solutions. The article examines some of healthcare’s flaws relevant to the opioid crisis, critically examining access and benefit stratification, the changing role of Medicaid, and problems associated with fragmentation of care and the lack of wraparound services. It also provides a brief overview of the extreme healthcare-related structural determinants present in our jails and prisons.

Keywords: Opioids, Substance Use, Addictions, Health Care Policy, Medicaid, Standard of Care, Health Insurance, Prisons, Drugs, Overdose

JEL Classification: K14, K32