This article, in a slightly edited form, first appeared on Pain News Network on January 18, 2020.

The Atlantic recently published an article, “The True Cause of the Opioid Epidemic,” by Olga Khazan that shares an underreported description of the complexities of the opioid crisis. The article acknowledges the opioid epidemic is a multi-faceted problem. Yet most of the media remains focused on the large volume of opioids that have been prescribed and appears to ignore the fact that the supply exists only to fill a demand created by deeply rooted, unaddressed problems.

As Pain News Network reported, experts believe that economic despair has created an environment in which drug abuse thrives. Poverty and hopelessness, more than overprescribing, are the seeds of the opioid crisis.

Changing How We View People With Addiction

But those factors are only part of the issue. The prevalence of mental health disorders, the lack of immediate access to affordable treatment of addiction, and inadequately treated or undertreated chronic pain—along with poverty and despair—have caused and sustained the continuing drug crisis.

One of the challenges in beginning to solve the crisis is to change how we view people with the disease of addiction. Rather than providing them with access to affordable care, we stigmatize and criminalize them. This creates recidivism rather than rehabilitation. This affects people who use drugs for the wrong reasons as well as people who use opioids for severe chronic pain.

Debunking the Myths About Why Opioid Addictions Develop

Many people make another false assumption. They claim that opioid addictions develop because of exposure to the drugs. That is untrue. Genetic and environmental factors determine who will become addicted. Exposure to an opioid or any drug of abuse is necessary for the expression of the disease—but, by itself, it is insufficient to cause it.

Most Americans have been exposed to an opioid at some point. In fact, the average person experiences a total of nine surgical and non-surgical procedures in a lifetime. An opioid is administered during most of these procedures. Then, following most of the procedures, opioids are prescribed. But the lifetime risk for developing an opioid addiction is less than one percent of the population.

If exposure alone were responsible for addiction, then the 50 million Americans who undergo an operation annually, or most Americans who undergo the nine procedures in a lifetime, would develop an addiction.

Commonly, people who investigate and discuss opioid overdose deaths believe that the deaths are exclusively due to the disease of addiction, but here again, they are mistaken. An estimated 30 percent or more of overdoses are believed to be suicides. Why do some people choose to intentionally overdose? One driver is the despair that develops from undertreated or inadequately treated pain. People in pain are almost three times as likely as the general population to commit suicide. They often use drugs rather than violent acts to end their lives. In addition, current efforts to curb opioid prescribing have pushed many people to the streets to purchase illegal, and more lethal, drugs. This is even true for some people without a substance abuse disorder who are seeking pain relief.

Despite a more than 30 percent decline in opioid prescriptions, there has been a continued surge in drug overdose deaths. Now we are seeing a shift in the reasons why people are dying from overdoses. Since 2018, the number of overdose deaths from methamphetamines has exceeded the number of deaths from prescription opioids. This underscores the fact that the problem is less about the supply of opioids and more about the demand for relief of psychological or physical pain.

Clearly, America’s drug crisis involves more than overprescribing of prescription opioids—and this helps explain why the interventions that have been introduced have not succeeded. Understanding the actual causes of the problem may help us find real solutions. It also would change the focus from people in pain who find more benefit than harm in opioids to those who clearly are at risk of harm from opioids.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.