John had excruciating back pain so his doctor quickly prescribed him opioids.
Over-Prescribing Pharmaceutical companies marketed prescription opioids to physicians who treat chronic pain patients without highlighting the risks of addiction.
John needed more and more opioids to function but his doctor wouldn't prescribe them, so he turned to heroin.
Increased access to substances Higher availability of heroin has driven increased use. Nearly 80% of people who use heroin reported using prescription opioids first.
John cannot stop using heroin but doesn't feel like he can tell his family. He is sure he will be punished if he is caught using substances so he does not seek treatment.
Criminalization Fewer than 20% of Americans want a friend, colleague, or neighbor who is addicted to opioids. Over half of those in prison have substance use disorder.
John tries to quit but his withdrawal symptoms are so severe he winds up in the ER where doctors call him a "junkie." The doctors do not believe buprenorphine, a medication to treat Opioid Use Disorder (OUD) , is effective due to stigma and are not licensed to prescribe it.
Social isolation Nearly a quarter of emergency, family, and internal medicine providers believe their practice would attract undesirable patients if they treated OUD.
Ashamed, John withdraws from family and friends and decides not to seek help.
Insufficient treatment capacity Isolation and loneliness ripples out to the family and friends of the person with an opioid use disorder. Shame and stigma prevent families from seeking support.
John watches a news segment about the opioid epidemic and the commentator disparages the use of medications to treat OUD. There is no mention about medication being a valid, evidence-based treatment option.
Gaps in evidence-based treatments Local news coverage in states with high opioid overdose rates highlighted more negative consequences of medications for OUD, and fewer than 40 percent of news stories about the medications mentioned they were underused.
John's family notices he is isolating himself and reaches out. John's family encourages him to seek treatment. He begins to use medication and joins a recovery group where he finds community. As John starts his recovery he faces the constant threat that he may not be able to afford his medication and struggles with his insurance company.
Lack of help-seeking Many state Medicaid programs require prior authorization for buprenorphine-naloxone medications. In many states, Medicaid also does not cover residential treatment. Only 60% of employer-sponsored health plans cover Medication for Opioid Use Disorder (MOUD).