Why Substance U in Public Health?

​​​​​​​Substance use prevention, harm reduction, treatment and recovery are important public health priorities. The number of people who die from substance use and related consequences is significant. This is particularly relevant given that there are effective public health responses to prevent, treat, and reduce harm. People who die or are affected by substance related issues have family, friends, colleagues and come from all ages and socioeconomic backgrounds. Pain is an important root-cause factor for understanding and addressing substance use. 

Pain

Pain is a complex and pervasive public health issue which if untreated, or ineffectively treated, can lead to serious and fatal individual, familial, and economic consequences. [1] Pain is a near universal human condition and serves an important function. Pain alerts us to danger, harm, injury, and disease. [2] Yet, pain can be persistent or dysfunctional which may lead to adverse health outcomes such as suicide. [1] Severity of pain is typically categorized based on the duration of its presence. The three primary categories are (1) acute (time-limited and less than 1 month), (2) subacute (present for 1-3 months), and (3) chronic (greater than 3 months). [3] Chronic pain can be high impact defined as having pain on most days or every day during the past 3 months which interferes with daily functions. [3]

Physical and emotional pain are interconnected.[4] It is well established that people who experience Adverse Childhood Experiences (ACEs) have greater odds of developing conditions such as heart disease, cancer, suicidal ideation, substance use.[5] Pain associated with historical trauma is important to consider particularly for populations that have repeatedly experienced inequities in care due to discriminatory structural barriers. [6]

Solutions

In Arizona, some of our health leaders called for changing the paradigm for treating pain from the biopsychosocial to the sociopsychobiological model which considers the primariness of our social contexts to our health and wellness. [7] The authors argue if we use a multidisciplinary team-based approach to educate patients about pain and offer whole person treatments that address the sociopsychobiological factors, we can improve patient health and reduce costs. [7]

The social determinants of health (SDOH) are "the conditions in which people are born, live, learn, work, play, worship, and age" which affect health and quality of live and exacerbate inequities. [8] SDOH include economic stability, health care access and quality, education access and quality, neighborhood and built environment, and social and community context. These are conditions which have the potential to be modifiable. As such, HealthyPeople 2030 has increased its focus on these determinants.[8]

In 2016 the Surgeon General issued a first-ever Surgeon General's report on alcohol, drugs, and health. This report offers communities, practitioners, and policy makers concrete strategies for implementing evidence-based strategies and tactics to address substance use, misuse, and addiction. 

Sources:

[1] Dowell D, Ragan K, Jones C, Baldwin G, Chou R. CDC clinical practice guideline for prescribing opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;2022(71(No. RR-3)):1-95. doi:http://dx.doi.org/10.15585/mmwr.rr7103a1 

[2] Santiago V. Painful truth: The need to re-center chronic pain the functional role of pain. J Pain Res. 2022;15:497-512. doi:https://doi.org/10.2147/JPR.S347780  

[3] Zelaya C, Dahlhamer J, Lucas J, Connor E. Chronic pain and high-impact chronic pain among U.S. adults, 2019. 2022. Published online 2022. Accessed January 27, 2023. https://www.cdc.gov/nchs/products/databriefs/db390.htm 

[4] De La Rosa J, Brady B, Ibrahim M. et al. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: Prevalence, functional impacts, and opportunities. Pain. 2023; ():10.1097/j.pain.0000000000003056. DOI: 10.1097/j.pain.0000000000003056​ 

[5] Felitti V, Anda R, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults The Adverse Childhood Experiences (ACE) study. Am J Prev Med. 1998;14(4):245-258. doi:10.1016/s0749-3797(98)00017-8  

[6] Stanford S, Raja K, Pegna S, et al. Identifying the root causes of drug overdose health inequities and related social determinants of health: A literature review. Published online 2021. https://www.naccho.org/programs/community-health/injury-and-violence/overdose/health-equity-drug-overdose-response  

[7] Mardian AS, Hanson ER, Villarroel L. et al. Flipping the pain care model: A sociopsychobiological approach to high-value chronic pain care. Pain Med. 2020; 21(6): 1168-1180. doi: 10.1093/pm/pnz336 

[8] Office of Disease Prevention and Health Promotion. HealthyPeople 2030. Accessed April 9, 2023. ttps://health.gov/healthypeople/priority-areas/social-determinants-health 

Last reviewed: 2/8/2024