Risk Attenuation and Amplification in the U.S. Opioid Crisis

Abstract

The evolution of risk identification and ultimately the public and private responses that have become known collectively as the "opioid crisis" is an important case study in risk management due to the reach and magnitude of its impacts. This article examines a number of "signals" related to opioid risks using the social amplification of risk framework (SARF) to investigate a limited set of public-sector activities and policy responses. We evaluate whether the SARF presents an effective lens to examine the serious shortcomings of risk management of opioid use, which has a history of risk attenuation and, more recently, evidence of risk amplification. Our goal in this article is limited to addressing "goodness of fit" of the SARF as a descriptive tool. We consider whether the SARF effectively reveals important gaps in public risk management responses for the opioid example and other similarly situated societal risk problems. Applying SARF supports that its suggested relationship between risk signals and inappropriate attenuated public response does generate useful insights into regulatory efficacy for examples of public risk management. Similar such conclusions about inappropriate public responses stemming from the amplification factors are less supported because, in this case, the risk is, and continues to be, large. Overall, we find that the SARF's particular focus on the signaling function of risk information performs best as an organizational aid to study historical information rather than as a predictive tool for determining inappropriate risk management responses.

Keywords: Opioid crisis; risk management; social amplification of risk.

Fig 1

Rates of opioid sales, opioid‐related unintentional overdose deaths, and opioid addiction treatment admissions, 1999–2010 (adapted from Kolodny et al., , p. 560).

Fig 2

Pharmaceutical system.

Fig 3

Grams of opioids distributed in the United States, 1997–2019. Includes the following opioid molecules: codeine, dihydrocodeine, oxycodone, hydromorphone, hydrocodone, levorphanol, meperidine, morphine, opium, oxymorphone, tapentadol, and fentanyl. Grams are interpolated for the year 2000 (adapted from DEA, 1997–2019).

Fig 4

Average daily publications mentioning opioids or opioids and heroin (January 1997 through April 2020) (Factiva, 2020).