A Social History of Opioids' Crimedical Cycle

Historically, public and political discourse around people who nonmedically use opioids has largely been rendered via a deficits-oriented lens, presenting this population as weak, disinterested, and deviant, and thus undesirable and ill-positioned for wellness and communal integration. These narratives, and subsequent policies used to engage people who use opioids, are intermittently formed and disrupted by geopolitical changes, as public and institutional attitudes, often driven by racial and class-related considerations, shift. As part of what we term the crimedical cycle, a population's health behaviors fluctuate between periods of medicalization and criminalization. Strengths-based theory, an offshoot of "positive psychology" that helps contextualize this cycle, emphasizes the value of recognizing and affirming the inherent and learned skills that individuals possess and can leverage toward self-actualization. A strengths-based orientation and approach to clinical praxis is particularly critical in improving the health and well-being of populations, such as those who use opioids, that are highly criminalized and disenfranchised through social and public policy. However, strengths-based theory is underdeveloped in addiction medicine, despite it having deep roots in the treatment field. This ongoing omission engenders narratives around opioid use that congeal to propel the stigmatization, over-policing, economic marginalization, and poor health of those who use opioids. This article discusses the historical trajectory of views and attitudes on opioid use and presents models that advance strengths-based approaches to engaging this population.