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    Why is there an opioid crisis?


    Take-home message

    The current opioid crisis has multiple reinforcing etiologies. It represents a failure of evidence-based medicine and a remarkable example of how public opinion can be shaped by a few vocal advocates whose emotional appeal transcends their empirical evidence. Of course, all this was synergistically complemented by a massive and misguided industry marketing campaign. But the opioid crisis also reflects the hollowing out of America’s once-vital manufacturing mid-region and the social peculiarities of my Ulster-Scot relatives. Much of the political bitterness on display in the last presidential election stems from the same unmet economic and social needs, and anti-authoritarian tradition.  

    But the opioid crisis has also given birth to some very creative public policy innovations including implementation of statewide monitoring of opioid prescriptions, regulation of pill mills, heroin courts that enforce treatment regimens rather than jail terms, improved public funding for treatment centers, as well as increased emergency access to naloxone and anti-abuse medications. The Joint Commission, CMS and other agencies have begun to de-emphasize simplistic approaches to pain control. A number of governors and states stand out but significant credit has to go to Ohio’s Governor John Kasich. He was among the first to sound the alarm, and among the first to implement various narcotic control, rehabilitation and mental health measures. And the justice system ultimately acted as well. Law enforcement has also innovated to better deal with Xalisco-type heroin rings. Moreover, in 2007, Purdue Frederick Company Inc. and 3 company executives pled guilty to criminal charges of misbranding OxyContin by claiming that it was less addictive than other opioids. The company ultimately paid over $600 million in fines.7

    While these trends are salutary, physicians can play a pivotal role in curbing the epidemic by returning to traditionally stringent criteria for opioid prescriptions, utilizing a multimodality non-opioid approach to chronic pain and by better understanding opioid pharmacology.

    Ob/gyns are uniquely positioned to reduce opioid abuse because pregnancy represents a period of intensive contact with providers and because pregnant women are uniquely motivated to curb their OUD.11 In a future editorial, I will discuss steps ob/gyns can take to confront the opioid crisis. 



    1. National Academies of Sciences, Engineering and Medicine. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press; 2017. https://www.nationalacademies.org/opioidstudy.

    2. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016 Dec 30; 65(5051):1445-1452.

    3. Quinones, Sam. Dream Land: The True Tale of America’s Opiate Epidemic. Bloomsbury Press, New York, 2016.

    4. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980 Jan 10;302(2):123.

    5. Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986 May;25(2):171-86.

    6. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015 Feb 17;162(4):276-86.  

    7. Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009 Feb;99(2):221-7.  

    8. Kenan K, Mack K, Paulozzi L. Trends in prescriptions for oxycodone and other commonly used opioids in the United States, 2000-2010. Open Med. 2012 Apr 10;6(2):e41-7.

    9. Muhuri P, Gfroerer J, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Review. August 2013. https:/www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm. Accessed 9/14/2017

    10. Perreault ML, O’Dowd BF, George SR. Dopamine D₁-Dâ‚‚ receptor heteromer regulates signaling cascades involved in addiction: potential relevance to adolescent drug susceptibility. Dev Neurosci. 2014;36(3-4):287-96.

    11. Muhuri PK, Gfroerer JC. Substance use among women: associations with pregnancy, parenting, and race/ethnicity. Matern Child Health J. 2009 May;13,(3):376-85

    Charles J. Lockwood, MD, MHCM
    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...


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