Medicine is not going to be enough. That was the first lesson that the world learned when Acquired Immune Deficiency Syndrome (AIDS) raged across cultures in the 1980s. Though its cause was learned to be Human Immunodeficiency Virus (HIV) its transmission was social. In some undeveloped countries, unprotected sex, infidelity, and sometimes even rape were points of pride. In wealthier nations, risky behavior in sub-cultures was touted as freedom.

Yet the illegal opioid epidemic has a much wider footprint. More people died last year from fentanyl and heroin use than died of AIDS during its mortality peak in the 1990s. According to estimates, the rate of opioid overdose deaths has increased by 500 percent in the last 20 years and up to 2,000,000 people had an opioid use disorder in 2016.

A recent paper in the New England Journal of Medicine outlines 4 action items they believe can help, at least with medication-assisted treatment, and then one that seems like fitting the issue into their political beliefs.

1. Identify the cultural, social, economic, and structural barriers to care for the 80 percent of people with opioid use disorders that currently receive no treatment. During the AIDS epidemic, some did not seek treatment until it was too late. And awareness campaigns about protection were either not reaching them or were ignored. Decades ago there was also an issue with health care access. However, health care is now mandatory, and free for poor people, there are no economic barriers, meaning the issue will be social. People don't want to admit they have a problem, or don't think they do.

2. Address stigma and discrimination against people with opioid use disorder. The authors recommend decriminalizing substance use disorders, although using drugs is not illegal. Only possession and things like driving while impaired are.  No one gets jailed for being addicted to an opioid. More germaine is training key community actors, such as police and churches, rather than just focusing on changing individual attitudes. 

3. Mobilize family and community support networks to help improve healthcare engagement. Leverage the resources and social networks that facilitated HIV treatment and adherence to improve access to medication-assisted treatment. This could be more difficult than during the AIDS epidemic. Treatment for people with addiction by families requires non-stop attention and few companies can afford to provide paid leave from work to care for a relative who is addicted to heroin.

4. Recognize that community activism is crucial to making medication-assisted treatment widely available just like engaging society and stakeholders was central for expanding access to antiretroviral therapy. 

The authors also try to blame a lack of socialized health care in the U.S., as if that makes people take recreational drugs. They believe that if hospitals or insurance companies make a profit people will take fentanyl, or that pharmaceutical marketing is somehow causing people to take heroin.  Or that there is eroding economic opportunity at the same time the Federal Reserve keeps raising interest rates because unemployment is too low and the economy is booming.

"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 at Columbia University. 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."