August 11, 2016


There is lots in the news these days about the problem of opioid abuse, both heroin and prescription opioids. I recently wrote about this for JAMA News Forum and have received some interesting responses from my Facebook and email friends and colleagues. JAMA News Forum doesn’t permit comments to be posted on their blogs, so feel free to read the post and share your comments here.

Some of the responses I’ve received note the racial and ethnic disparities in the treatment of pain and opioid dependence. I had to cut a paragraph on this from my blog because of space constraints but think it’s a huge issue. As others have noted, today’s response to the opioid epidemic that has reached middle class white communities across the country is quite different from the nation’s response¬† to the heroin and crack epidemic that occurred in largely poor communities of African Americans in the1980s.

Several colleagues, including one who works in mental health, suggested that the marketing by pharmaceutical companies is a major factor and that legalizing illicit drug use could help to take the profit out of opioid addiction.

Most of my colleagues who have prescription authority, such as nurse practitioners, note how difficult it is to manage someone with an opioid addiction, but drug monitoring systems help. As I note in the blog, payment policies is a huge factor, since comprehensive pain management and comprehensive opioid addiction treatment are seldom covered by payers, but almost all cover opioid prescriptions.

As is apparent from my JAMA blog, there are no easy fixes here. Rather, we need a thoughtful plan for supporting providers in being able to provide comprehensive pain management, particularly for those with chronic pain, and we also need more counseling of patients who are prescribed opioids for acute pain management about the potential for dependence and how to taper off the drug. There are many other potential strategies that are underway or should be explored if we’re to prevent opioid abuse and addiction without increasing the suffering of patients who are in pain.

What do you think?