Newspaper article St Louis Post-Dispatch (MO)

A Systemic Approach to the Opioid Crisis

Newspaper article St Louis Post-Dispatch (MO)

A Systemic Approach to the Opioid Crisis

Article excerpt

Last month, U.S. Surgeon General Dr. Vivek Murthy took an unprecedented step in addressing the opioid epidemic. In a letter addressed to every physician in America, he urged doctors to educate themselves, screen patients and destigmatize addiction. Meanwhile, in West Virginia, 29 people touched by the epidemic sued physicians, pharmacists and drug distributors for profiting from the opioid crisis at the expense of vulnerable patients.

These efforts highlight physicians' roles in the opioid epidemic but inadequately address the systemic issues that created this growing social problem. A broader perspective highlights three interrelated challenges: incomplete understandings of the opioid epidemic, limited medical approaches to pain management, and constrained treatment approaches due to health care financing.

The contemporary opioid epidemic emerged from the confluence of three interrelated problems: pain, addiction and diversion. The Institute of Medicine estimates that 100 million Americans suffer from chronic pain. The growth of the pain management movement in the 1980s and 1990s paired with the Food and Drug Administration's approval of slow-release OxyContin in 1995 created new opportunities for pain relief while simulataneously attracting illicit drug users who were drawn to the drug's purity and high doses. This fueled rates of iatrogenic (or physician-caused) addiction because of the over-prescription of narcotics and recreational addiction due to drug users seeking new highs.

Addressing pain, addiction and diversion requires a coordinated effort between health care providers, mental health specialists and law enforcement, but these groups are currently heavily siloed and unevenly funded, leaving gaps in both treatment and enforcement.

Lack of training and lack of time compromise physicians' capacity to treat pain. Most physicians receive little to no formal training on pain management, and pain diagnosis is subjective and dependent on patient self-report, leaving physicians ill-equipped to differentiate between pain patients, addicted patients and drug diverters. …

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