Opioids and the Social Construction of Social Problems
According to a recent report by the Centers for Disease Control and Prevention (CDC), deaths due to heroin and synthetic opioid overdoses quadrupled in the U.S. between 1999 and 2015, with a dramatic rise occurring between 2010 and 2015. In 2010 there were just over 3,000 deaths due to heroin overdose, rising to nearly 13,000 in 2015.
The authors attribute this increase to “increased heroin availability combined with high potency and relatively low price,” and note, “the strongest risk factor for heroin use and dependence is misuse of or dependence on prescription opioids.”
Sociologists who study the construction of social problems are interested in more than just the nature of an issue and the harm that it may cause. A social constructionist approach goes beyond the question of “is this a problem?” and asks many more questions, such as:
- Who has defined this issue as a problem?
- Who do we most associate with this issue?
- When did people start paying attention to this issue? What put it on a public agenda? Has this issue been ignored until recently?
- How are the proposed solutions defined?
A social constructionist approach does not necessarily mean that social problems are figments of our imagination or are made up. It’s not simply a matter of thinking of a problem as “real” or “fake.” Instead, this approach encourages us to think critically about what comes to our attention as a social problem, as well as why some issues are not defined as social problems despite their causing harm—sometimes even more harm than those that we think of as social problems. (For a more complete discussion, see Joel Best’s text, Social Problems.)
Sociologists taking a social constructionist approach to understanding the opioid overdose issue would likely agree that there is real harm caused by abusing heroin and synthetic opioids. The questions posed above encourage us to take a step back and examine how we collectively make meaning of social issues.
Who has defined the issue as a problem?
In the social constructionist perspective, this is a question of central importance. Was the problem defined by a group of grassroots activists with no previous political ties or access to media outlets, or has this issue been primarily defined by a group that already had clout on similar matters?
Public health officials—like those who analyze data for the CDC and other agencies that could observe the overdose trends rising—might be the first to notice this issue and work to share information. But they need the help of politicians (on the local, state, and federal levels), the news media, and other groups to work with them to define something as a social problem. Activist groups often work very hard to get the public to view their issue as a social problem, sometimes successfully.
We can see this process at work with the opioid issue in PBS's Frontline episode, "Chasing Heroin". In the film, public health officials detail the challenges they have faced getting policy makers to address the problem and provide funding for outreach and treatment. The film also helps us answer the questions below, and I encourage you to watch the video and consider how we might answer the questions posed above.
Who do we associate most with this issue?
Those that work to get the public to pay attention to an issue also work to frame the problem for us and detail who is most likely to suffer because of this problem. Typically, activists work to frame victims of a problem as sympathetic figures so the public will want to see something done to address an issue.
Drug users, and heroin addicts in particular, have traditionally not been sympathetic figures. One reason the opioid issue is the public agenda is that activists and the media often focus on those who became heroin users “accidentally” after being prescribed painkillers after in illness or injury and becoming addicted. People from otherwise “good” backgrounds are more likely to draw sympathy than those with more troubled histories.
When did people start paying attention?
You have likely heard quite a bit about opioid usage and its associated problems in numerous news stories; getting an issue in the public agenda is part of the construction process, which sociologists seek to understand as well. What issues are able to generate media attention, and which ones are not?
Media attention does not automatically follow if a problem exists; people have to work to get a problem on the agenda. We can look at data on opioid overdose deaths and compare the timing with the number of news reports on opioid overdoses using a research tool like Lexis-Nexis (which many universities have access to). We might find one event that puts the issue in the spotlight and the number of news stories might rise following that event.
How are proposed solutions defined?
Opioid overdose deaths have largely been defined by public health officials, and often by politicians, as a public health problem to be addressed by increasing funding and opportunities for treatment. We might look critically at how other drug abuse and overdose deaths have been defined as problems to be solved by law enforcement or other types of social institutions.
During the Temperance movement, for instance, alcoholism was also defined as a moral problem to be solved by passing new laws and criminalizing the sale of alcohol. The social constructionist perspective might help us look critically at the differences between concerns about crack cocaine in the 1980s and the current construction of the opioid problem today, as well as the different solutions that have been enacted. We can see that in both of the historical examples, that when people with less social power are constructed as the main source of the problem, solutions were more punitive than the current construction of opioid users.
The social constructionist approach provides us with tools that help us think critically about how we make sense of and react to social issues. What other questions might we ask about the opioid overdose problem based on this perspective?