What can the AIDS epidemic teach us about the US opioid crisis?

What can the AIDS epidemic teach us about the US opioid crisis?
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Evaluating the successes and failures of the AIDS epidemic response could inform the response to the US opioid crisis, according to a new paper.

The Columbia University Mailman School of Public Health has assessed the AIDS epidemic response and developed an action plan using this knowledge to inform action on the current US opioid crisis.

Silvia Martins, MD, PhD, associate professor of Epidemiology at Columbia Mailman School said: “Despite the effectiveness of medication-assisted treatment for opioid use disorders, the mortality rate for opioids has surpassed that of the AIDS epidemic during its peak in the early 1990s–a time when there was no effective treatment for HIV/AIDS.”

Recommendations for acting on the US opioid crisis

To improve the population health impact of opioid use medication-assisted treatment (MAT), the researchers provide a five-point action plan:

The researchers recommend a five-point action plan to improve the population health impact of opioid use medication-assisted treatment (MAT).

1.Identify the cultural, social, economic, and structural barriers in caring for the 80 percent of people who have opioid use disorders but who receive no treatment. Caroline Parker, PhD candidate in the Department of Sociomedical Sciences, added: “As the HIV/AIDS epidemic has taught us, the existence of effective medical treatment does not mean that people who need treatment can and will obtain it.”

2. Address the structural drivers of the US opioid crisis, rather than consider one person at a time. The drivers include profit-driven health care, insufficient regulation of pharmaceutical markets, and eroding economic opportunity.

3. Address stigma and discrimination against people with opioid use disorder through legislation. This would include decriminalising substance use disorders, train key community actors, such as police and churches, rather than just focusing on changing individual attitudes. Parker explains: “It is critical to directly engage affected families and communities in policymaking and changing legislation to stop the criminalization of substance use disorders.”

4. Improve healthcare engagement by mobilising family and community support networks. Leverage the resources and social networks that facilitated HIV treatment and adherence to improve access to MAT. Develop policies that recognise people for caring for people living with opioid use disorder and compensate them.

5. Recognise the importance of community activism in making MAT widely available, just as engaging society and stakeholders was crucial for expanding access to antiretroviral therapy.

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