Why do people start using heroin and other drugs? Why do people transition from prescription pain pills to heroin? Are occasional relapses inevitably part of recovery from drug addiction or can they be avoided? What drives someone to use and abuse OxyContin or other opioids after years of non-use? What gets people to stop using?
These are just some of the questions Bentley Associate Professor of Sociology Miriam Boeri is asking as part of a three-year, three-city research study funded by the National Institutes of Health.
The “Suburban Opioid Study” will focus on suburban populations of opioid and heroin users including interviews with users and former users in and around Boston, New Haven, Conn., and Atlanta. With Boeri as co-principal investigator along with a colleague at Southern Connecticut State University, Bentley will receive $142,025 of the $341,565 grant, the first NIH grant to a Bentley faculty member.
One goal of the study is to “map” patterns of opioid drug use and abuse to users’ life histories, and look for patterns and correlations. Another goal is to compare these patterns by race, ethnicity, and gender. Data from 180 interviews (60 at each of the three research locations) will be analyzed to try and understand which life experiences tend to lead to drug use and recovery. A better understanding of the social context of opioid use will improve intervention and treatment options.
An urgent need and spiraling costs
Boeri’s research is timely, as what many public health professionals, politicians and community leaders are calling an opioid epidemic rages nationwide. In Massachusetts, the Department of Public Health estimated an average of four deaths a day from opioid overdoses in 2015. For 2016, the total number of opioid-related deaths is estimated at more than 3,400, up from 700 just four years before.
Nationally, the 21st Century Cures Act enacted in 2015 by Congress and the Obama administration committed at least $500 million to combat a crisis reflected in more than 19,000 opioid overdose deaths nationwide in 2014. In addition to the cost in human life, researchers have estimated the total economic burden of the prescription opioid epidemic (excluding illegal drugs) at $78.5 billion.
The unemployment connection
With so much at stake, Boeri says, it’s important to ground our approaches to intervention and treatment in the “real-life experiences” of heroin and other opiate users, whether they’re struggling with addiction to prescription or illegal drugs. Understanding how, when and why people cycle between the use and abuse of legal drugs such as Percocet and illegal drugs like heroin is key to combatting addiction. “Drug addiction depends on the social context, on what your individual life is like,” ” Boeri says. “It’s not as simple as brain chemistry alone.”
Based on earlier research in the field, Boeri says that a common factor in the cycles and patterns of drug abuse and addiction is unemployment. Even users who experience long periods of sobriety often return to drug use after a job loss, she says. Other common factors that seem to drive addiction and/or returns to drug use are divorce, the death of a loved one, physical or mental health crises, and chronic untreated mental health conditions like depression, anxiety or post-traumatic stress disorder.
Conversely, people seem to transition out of periods of addiction when their social needs are met and their underlying psychological problems are addressed. “Depression and other mental health challenges can be treated in ways so that people don’t need to self-medicate with potentially deadly drugs,” Boeri says, “and so can pain management, even for long-term chronic pain.”
Images showing one model of how Boeri's study will map individuals' drug use patterns as part of overall life histories.
Crime, punishment and treatment
Boeri has extensive experience conducting interviews with illegal drug users and former users and in training research assistants to do so to identify the patterns of use and abuse. Given the stigma of drug use, she engages in fieldwork to build rapport and engender trust, and respects the anonymity of her research participants. Her earlier work, published in numerous peer-reviewed articles and in her book Women on Ice: Methamphetamine Use Among Suburban Women (Rutgers University Press), established much of the methodology she’ll be using for the Suburban Opioid Study.
Boeri’s work to date points to the need to treat drug abuse based on individuals’ life histories rather than primarily as a criminal justice issue. “Those who successfully transition out of addiction,” she says, “have something that went ‘right’ in their lives: a new job, a stable social network, finding religion, a new marriage, the treatment of a mental health condition.” Punitive legal interventions may not be as powerful a motivating factor as these other types of life events and support systems.
Boeri compares the U.S. approach to European models, such as in Portugal, where the response to drug use isn’t based on a “war on drugs” but rather on a public health-focused “dissuasion” approach. Boeri’s forthcoming book, Hurt: Chronicles of the Drug War Generation (University of California Press), examines the impact of the punitive, criminal justice approach to addiction on the Baby Boomer generation in particular.
Bentley’s Health Thought Leadership
The current National Institutes of Health grant is due in part, Boeri says, to the support of Bentley’s Health Thought Leadership Network, whose director Danielle Hartigan provided a statement of institutional support for the grant application. Boeri said the institute’s grant reviewers cited the existence of the network favorably in their decision to award the grant. It’s unusual for such a large NIH grant to go to a co-principal investigator at a business university, where one might not typically expect to see health-related research taking place. Boeri hopes this funding inspires more collaborative research focused on health issues at Bentley University.