From Health Policy to Stigma and Back Again: The Feedback Loop Perpetuating the Opioids Crisis

Abstract

Why is it that the United States seems to have little resilience in the face of such crises? Why aren't those at risk being diagnosed earlier through preventative care? Why are so many of those suffering with OUD denied any care or are unable to find adequate treatment, coordinated care, or recovery services? An earlier article concentrated on flaws in the healthcare system, arguing that healthcare itself was a structural determinant of the continuing crisis.10 Specifically, that article was critical of access and benefit stratification, the failure of some states to adopt Medicaid expansion (or having done so to make enrollment dependent on burdensome administrative or work requirements), persistent problems associated with fragmentation of care, sub-optimal care coordination, and the lack of wraparound services." This Article seeks to provide additional context for those structural determinants. Furthermore, this analysis extends to identifying causes that are upstream (for example, social determinants) or downstream (for example, exceptionalism) from those identified healthcare structural determinants. These causes and effects include the limitations of our federal structure, social and structural determinants, and the implications of stigma-reinforcing policymaking. Together they conspire to create a feedback loop fueled by inadequate goals, strategies, and tactics.