Cook and Worcman Health and Justice (2019) 7:13 Health and Justice https://doi.org/10.1186/s40352-019-0095-8 RESEARCH ARTICLE Open Access Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia Amy Kyle Cook1* and Nicola Worcman2 Abstract Background: Public opinion polls have consistently shown Americans prefer treatment over arrest policies for opioid users. As the opioid epidemic remains a major health problem in the United States, it is important to determine the type of treatment policies the public would support. Theoretically, government should take into consideration the opinion of its constituents when deciding how to act. As such, the 2018 Virginia Commonwealth Public Policy Poll determined levels of support for the expansion of community-based treatment in one’s community. Results: Overall, the results showed 80% of Virginians (n = 788) supported the expansion of community-based treatment centers in their neighborhood, 69% supported the use of housing in their community, while less than half supported the provision of clean needles to IV drug users so they do not use dirty needles that could spread infection. Multivariate analyses revealed education, sex, and political party affiliation are significant factors in predicting support for the expansion of services. Conclusions: Given the lack of progress made by the government in reducing the supply and demand of drugs over the course of the war on drugs, it is time to move away from punitive policies to responsible and pragmatic approaches that include the expansion of community-based treatment. Keywords: Opioids, Public opinion, Community-based treatment, Recovery housing, Needle exchange Background opioids at $78.5 billion annually, including increased costs Opioid use disorder remains a major health problem for health care, treatment, lost productivity, and criminal worldwide with 70% of the burden of disease attributable justice system involvement (Florence, Luo, Xu, & Zhou, to the use of opioids (United Nations Office on Drugs and 2016). Moreover, drug related deaths were attributed to a Crime [UNODC], 2017). The United States is responsible loss of .28 years in life expectancy (Dowell et al., 2017). for 25% of drug related deaths worldwide, mostly from the Globally it was estimated that 17 million years of life use of opioids (UNODC, 2017). In the United States in lost were attributable to drug use in 2015 alone 2017, there were over 72,000 fatal drug overdoses with over (UNODC, 2017). 47,000 the result of opioids (National Institute of Drug The impact of drug abuse has far-reaching conse- Abuse [NIDA], 2019). The effects of those numbers are quences in the lives of Americans. A recent public opin- profound considering more people die from the misuse of ion poll showed that 30% of respondents felt drug abuse opioids than do from car accidents or violence (UNODC, was a cause of trouble for their family (Gallup, 2018). 2017). Economists have estimated the United States’ When asked about the extent of the heroin problem in economic burden of both the dependence of and fatal their area, 47% of respondents reported heroin was a overdoses from heroin, prescription opioids, and synthetic very serious or somewhat serious problem with an add- itional 17% reporting it to be at crisis levels. Similar * Correspondence: [email protected] trends emerge with respect to prescription opioids. A 1L. Douglas Wilder School of Government and Public Affairs, Virginia number of public opinion polls show that addiction to Commonwealth University, 1001 W. Franklin Street, Richmond, VA 23284, USA prescription pain medication is a serious or major prob- Full list of author information is available at the end of the article lem nationally (CBS News Poll, 2018; Gallup, 2018; © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Cook and Worcman Health and Justice (2019) 7:13 Page 2 of 12 Kaiser Family Foundation, 2016; Marist Poll, 2017;AP- the coordination of any number of health and social ser- NORC Poll, 2018; Pew Research Center, 2017)with20to vices needed to meet client’s needs to encourage change of 54% of Americans knowing someone who has suffered behavior in the community (UNODC, 2014). Importantly, from opioid addiction (American Psychiatric Association, treatment services need to be available, accessible, 2017;CBSNewsPoll,2018; Marist Poll, 2017;Statand affordable and evidence-based to deliver quality care for all Harvard T.H. Chan, School of Public Health, 2016). More- people in need of support to help them reduce or stop the over, roughly 20 to 25% of Americans reported knowing use of alcohol and other drugs (UNODC, 2014). Given that someone who died from prescription opioid use (Kaiser drug use is also associated with increased healthcare prob- Family Foundation, 2017; Marist Poll, 2017;StatandHar- lems, particularly for people who inject drugs (PWID), vard T.H. Chan, School of Public Health, 2016). expanding prevention and treatment opportunities and Public opinion polls have also compared preferences for access is critical. treatment to criminal justice system responses. When Currently, the United States offers a broad range of faced with the choice to either increase access to treat- services based on evidence-based-programs designated for ment or impose stricter punishments and enforcement, people who use drugs; however, availability and access to Americans prefer policymakers increase access to treat- treatment for drug use remains a challenge. According to ment by 58% and 26%, respectfully (APA, 2017). Similarly, Substance Abuse and Mental Health Services Administra- the preference of treatment over arrest for prescription tion (2018), 20.7 million people in the United States were opioids and heroin use was found in other polls (Cook & estimated to need substance use treatment, yet only 2.5 Brownstein, 2017; Pew Research Center, 2014). Despite million received treatment. Some of the reasons for not the vast attention dedicated to the current opioid crisis, receiving treatment include not being ready to stop using, 43% of Americans believe the country is headed in the a lack of healthcare coverage, not being able to afford the wrong direction as opposed to only 20% who feel the cost of treatment, believing seeking treatment would have country is headed in the right direction in addressing the a negative impact on employment, stigma from others, opioid crisis; 37% were not sure (APA, 2017). Further- not knowing where to go for treatment, and not finding more, 37% of Americans feel the nation has lost ground in the type of treatment wanted (SAMSHA, 2018). Globally, making progress with the drug problem (Gallup, 2017). only one out of six people with drug use disorders has While the reasons are unknown as to why Americans access to treatment (UNODC, 2014, 2017). reported feeling the country is headed in the wrong dir- ection or that insufficient progress has been made in Recovery housing coping with the drug problem, it is important to con- Recovery housing or recovery residences are peer-run sider the observe public support for the expansion of sober living environments that support individuals in community-based treatment options. The following sec- their recovery from addiction or co-occurring mental tions discuss various programs through which communi- health and substance use disorders (National Association ties can utilize best practices to address the ever- Recovery Residences, 2012; Reif et al., 2014). Residents growing substance abuse crisis as a public health prob- living in recovery homes receive a variety of services lem. These include community-based treatment, recov- such as case management, therapeutic recreational activ- ery housing, and needle-exchange programs. ities, and peer support in order to improve functioning with the ultimate goal of integration back into the com- Community-based treatment munity (Reif et al., 2014). Safe and stable living environ- Community-based treatment refers to comprehensive out- ments are important to the recovery process especially patient health care and psychiatric services offered in the for individuals with substance use disorders who need community (United Nations Office on Drugs and Crime more structured care, typically after release from an [UNODC], 2014). Based on a bio-psycho-social approach, inpatient facility (Reif et al., 2014). Often times those community-based treatments are designed to help people released from jail or prison are also in need of safe and with substance use problems develop the skills to manage stable living environments to continue recovery efforts. their addiction in the community using a continuum of Blue and Rosenberg (2017) describe recovery housing as care model that reduces the need for residential and custo- an essential component to the recovery process and dial services where possible (UNODC, 2014). According to without it, they contend recovery from addiction is UNODC (2014), community-based treatments are the most unlikely, particularly given the challenges associated with cost-effective method addressing drug use and dependence low recovery capital. Low recovery capital