The opioid crisis: What we should learn from the AIDS epidemic

January 03, 2019

NEW YORK (January 3, 2019)--There are important lessons to be learned from the successes and failures of the AIDS response that could inform our response to the opioid epidemic, according to a new paper by researchers at the Columbia University Mailman School of Public Health. Decades of HIV research have demonstrated that the existence of an effective biomedical treatment is rarely, in and of itself, sufficient to combat an epidemic, suggesting that both a social as well as a biomedical response to the opioid crisis are necessary in order to be effective. The paper is published in the New England Journal of Medicine.

"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," says Silvia Martins, MD, PhD, associate professor of Epidemiology at Columbia Mailman School.

Over 2 million Americans had an opioid use disorder in 2016. The rate of opioid overdose deaths has increased by 500 percent since 1999.

"Even as efforts are under way to scale up access to medication-assisted treatment for opioid use, it is vital not to assume a position of 'if we build it, they will come,'" says Caroline Parker, PhD candidate in the Department of Sociomedical Sciences. In the case of HIV/AIDS, "the benefits of scientific progress have been unequally distributed, with growing ethnic and sexuality-related disparities. This failure of equity should draw our attention to the importance of social factors in shaping who benefits from effective biomedical therapies."

To improve the population health impact of opioid use medication-assisted treatment (MAT), the researchers provide a five-point action plan: "As millions of dollars are appropriated at the state and federal levels for the opioid crisis, we face a choice. Committing those resources exclusively to biomedical solutions is likely to reproduce the sharp disparities that we have seen with HIV, but learning from the failures and successes of our response to HIV can help us leverage support to ensure that the opioid response benefits all sectors of society," says Martins.
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Co-authors are Jennifer Hirsch and Charles Branas, Columbia Mailman School; and Helena Hansen, New York University.

Columbia University Mailman School of Public Health  

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.  

Columbia University's Mailman School of Public Health

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