Reviews: Treat the opioid epidemic as a public

Treat the opioid epidemic as a public health crisis

The opioid crisis continues to devastate families and communities, especially in North America, but also increasingly in Sweden, Norway, Ireland, and England and Wales. This is in part due to doctors’ over-prescription: in the United States, for example, 240 million opioid prescriptions were dispensed in 2015, nearly one for every adult in the general population. Illegal opioids are also increasingly available.

With greater availability, overdose deaths are rising. In the United States, 399,230 people died from opioid overdose between 1999 and 2017, while in Canada, more than 10,000 people died between January 2016 and September 2018, and in Australia, more than 1,000 people die each year. There’s an economic cost to this human tragedy, too–in the United States, for example, the opioid crisis led to the loss of 12 billion work hours between 1999 and 2015, ultimately costing the country 702 billion in lost real output.

This report looks at the magnitude of the opioid crisis across OECD countries, describing its impact on health care systems, social services, and law enforcement as well as the crisis’ impact on specific groups. Three out of four opioid deaths involve men, while prisoners are far more likely than the general population to abuse opioids. Pregnant women and mentally ill people are also more likely to be at risk.

What needs to be done? The report recommends that opioid use disorders (OUDs) be considered a chronic health condition and primarily addressed as a public health issue. This should guide the design of health policy responses, but also social policy and law enforcement strategies. For example, medicationassisted therapy, complemented with psychosocial support, could be supported both by the health sector and law enforcement, facilitating the connection of low-level offenders with health care. Likewise, health care networks can offer more recovery and reinsertion opportunities to OUD patients by having good communication with employment or housing support services. More closely monitored prescription by doctors and use of alternative chronic pain management options are also key to addressing the crisis.

OECD (2019), Addressing Problematic Opioid Use in OECD Countries, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/a18286f0-en

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Watching your basic behaviour

Forgetting to file your taxes on time. Not cleaning up after your dog when it leaves a mess on a public street. Driving above the speed limit. Why do we behave in certain ways and not others? Why are certain polices effective, eliciting desired behaviours and improving people’s lives, while others fail to do so?

Behavioural science has shown that our choices and actions are all influenced both by context and our own biases and that a more nuanced understanding of human behaviour can lead to better policies. Policymakers who want to achieve impact should consider what actually drives the decisions and behaviours of citizens rather than relying on assumptions of how they should act. And they can draw on behavioural insights (BI) to do so. Grounded in rigorous research from behavioural economics and the behavioural sciences, BI can help public bodies understand citizen needs and why citizens behave as they do, as well as allow them to pre-test policy solutions. By integrating BI into the policymaking process, governments can better anticipate the behavioural consequences of a policy and, ultimately, design and deliver more effective policies that improve the welfare of citizens.

This report provides concrete guidance on how to apply BI more systematically and responsibly. Its toolkit helps policymakers work through the “BASIC” (Behaviours, Analysis, Strategies, Interventions and Change) methodology and apply BI to any policy problem from start to finish. By understanding how and under what circumstances BI can be applied to cause behaviour change, policymakers are far more likely to design and deliver effective policies.

Although the report is geared to policymakers who have limited or even no experience with BI, it will also be of interest to confirmed BI practitioners and points readers who are ready to go further towards a wealth of resources.

OECD (2019), Tools and Ethics for Applied Behavioural Insights: The BASIC Toolkit, OECD Publishing, Paris, https://doi.org/10.1787/9ea76a8f-en