Three Questions: Prof. Marissa King on How the Opioid Epidemic Spreads
The sale of prescription opioids has risen sharply since 1999, and the number of fatal drug overdoses attributed to the drugs has more than quadrupled. We asked Yale SOM’s Marissa King, an expert in social networks who has studied the spread of drug addiction, what is driving the crisis and how it can be addressed.
Is it useful to think of the prescription drug abuse crisis as an epidemic?
Thinking of prescription drug abuse as an epidemic is helpful in two regards. First, the word “epidemic” carries with it a sense of urgency, so it draws attention and resources to the problem. But, somewhat unintentionally, “epidemic” also highlights social transmission. While the prescription drug abuse isn’t contagious in the usual sense, it is socially contagious.
What are the relationships that cause the epidemic to spread? Is it patient-to-patient, doctor-to-patient, doctor-to-doctor?
Both “patient”-to-“patient” and doctor-to-doctor transmission play a role. The majority of people who misuse prescription painkillers get them from a friend. But those pills initially come from physicians. Much of my recent work has focused on how physicians influence one another to prescribe inappropriately. Victoria Zhang and I have found that physicians frequently influence one another to deviantly and negligently overprescribe.
What kinds of interventions have been proven effective addressing social epidemics?
On the physician side, the most appropriate intervention depends on whether physicians are deviantly or inadvertently overprescribing. The notion that accidental or inadvertent overprescribing could be a big contributor to the epidemic has largely been missed. Based on our work on benzodiazepines, physicians who are complicit in prescribing to patients for non-medical use tend to cluster in dense cabals with other deviant prescribers. Interestingly, these physicians are pretty responsive to social pressure to curb inappropriate prescribing. This opens up the possibility of leveraging social networks to improve prescribing.