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Failures of the healthcare system\u2014including lack of both training in pain management and caution in using an addictive class of medications\u2014precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host\u2013agent\u2013environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the \u201cvector\u201d to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host\u2013agent\u2013vector\u2013environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical\u2010related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.<\/jats:p>","DOI":"10.1111\/nyas.14209","type":"journal-article","created":{"date-parts":[[2019,8,5]],"date-time":"2019-08-05T00:39:44Z","timestamp":1564965584000},"page":"130-143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Epidemiology of the U.S. opioid crisis: the importance of the vector"],"prefix":"10.1111","volume":"1451","author":[{"given":"Wilson M.","family":"Compton","sequence":"first","affiliation":[{"name":"National Institute on Drug Abuse National Institutes of Health  Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Jones","sequence":"additional","affiliation":[{"name":"National Center for Injury Prevention and Control Centers for Disease Control and Prevention  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,4]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aau1184"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.9308"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1353\/eca.2017.0005"},{"key":"e_1_2_13_5_1","unstructured":"Hedegaard H. 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