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The Opioid Crisis

Things aren’t always what they seem. That was one message here.

The panel surveyed its audience as we sat in the Hilton Cleveland Downtown, views of the skyline and Lake Erie just beyond the door: How many of us have been affected by opioid dependence, through friends, neighbors, or family members? Almost everyone raises a hand. Professionals are elbow to elbow in this room.

“This audience is the face of addiction,” William Denihan said. “It’s mostly Caucasian, between 25 and 40, and suburban.” He is chief executive officer of the Alcohol, Drug Addiction, and Mental Health Services Board of Cuyahoga County, a position that occasions an intimate familiarity with the demographics of opioid abusers.

The story of opioid addiction often follows a familiar trajectory. Someone has an injury or undergoes surgery and is prescribed an opioid painkiller in a larger than necessary quantity, leading to a period of opioid abuse, then dependence. Once the pill supply runs out, the person turns to cheaper and more readily accessible drugs such as heroin—sometimes cut with fillers and with fentanyl, which is 50 times more potent. Treatment is typically precipitated by arrest, drug court, and probation. With the average detox stay of just 30 days and few if any auxiliary services—research says it takes 5 years of abstinence to achieve an 80 percent sobriety rate (compared to alcohol or other drugs, at 2 years)—relapses abound, with rates routinely exceeding 90 percent.

But this isn’t a new problem, and unless we acknowledge the past, argued Andrea Boxill, deputy director of the Governor’s Cabinet Opiate Action Team, we can’t move forward. It’s the demographic of the affected population, she said, that makes this seem new.

Opioid addiction isn’t as far removed from the Federal Reserve’s typical subject matter as some might imagine. The Cleveland Fed’s community development focus on both workforce issues and healthy communities prompts us to seek more knowledge about how opioid dependence affects our District states’ communities and employment realities.


Denihan, a speaker on the panel discussing the opioid crisis, laments the size and scope of the epidemic: “This is not a crisis, this is a tsunami.” A healthy community is a vibrant community, he argued, and an unhealthy community does “not [provide] stability for economic development.”

Photo highlights:

Research highlights:

  • In 2013, the estimated total societal cost of prescription opioid abuse in the United States was $78.5 billion, with lost productivity and lost production costs in the workforce comprising $20 billion, or about one-fourth, of that total.
  • There were 3,050 documented overdose deaths in Ohio in 2015, the last year for which complete data are available.
  • Of those people who say they need treatment but don’t get it, 49 percent cite a lack of or inadequate healthcare coverage, while only 29 percent aren’t ready to stop using.
  • Private health insurance claims related to opioid dependence increased by 3,203 percent from 2007 through 2014.

Post-event Q&A

Some questions posed by audience members didn’t get answered during the Policy Summit. Here, they do get answered.

Has racial bias and segregation contributed to a gentler response to the opioid crisis than the one to the crack epidemic in the 1980s/1990s? Is this an opportunity to rethink treatment/punishment of drug offenses?

Mark Singer

Mark Singer, Leonard W. Mayo Professor, Case Western Reserve University: In the United States, to understand addiction, we have tended to use a combination of two models: the disease model and the moral model. Most of us are familiar with the disease model that sees addiction as a medical problem/disease. Treatment is needed to overcome the addiction, and there are specific diagnoses for drug use disorders. The moral model sees the individual as being responsible for his or her addiction and the circumstances surrounding it: It’s the person’s fault and they need to be punished for their failure to lead a socially acceptable life. This model is often used for people we don’t have much empathy for and who are not part of our day-to-day lives: the “others.”

The crack addiction epidemic of the 1980s and early 1990s was seen very much as a moral model issue. Inner city residents had little political sway; those in power could easily dismiss them as moral failures and punish them with incarceration for being addicted. Families, neighborhoods, and the social fabric of our inner cities suffered enormously as children were left without parents, violence raged, and guns and shootings were commonplace, especially among youths.

Our current opioid crisis is being viewed more sympathetically than the crack crisis, in part because the victims are not seen as the “others.” These individuals are across the socioeconomic spectrum and are often relatives and friends of people who make political policy or are influential in electing them. With the current opioid epidemic comes the possibility of changing this way of viewing addiction from a moral, punishing model to a medical, disease model.

What is needed is a coordination of medical, social, educational, and employment services. This is a model that has been used successfully in many European countries: the harm reduction model. As its name implies, the harm reduction model focuses on minimizing the harms related to use for the person, others, the community, and society. In the harm reduction model, whenever possible, jail or prison is avoided, and the individual receives an array of services instead. It treats people with dignity and as valued human beings who have a problem.