Summary: Despite a decline in opioid prescriptions, the opioid crisis continues. Opioid use disorder (OUD) and deaths due to opioid overdose continue to increase. Thus, researchers say that there is a need to develop a better understanding of opioid dependence and avoid oversimplification of the problem. So though an increase in opioid prescriptions initially fueled the crisis, later, other factors came into play, like pill mills and an increased supply of illegally produced opioids.
The opioid crisis is not new, but it is not showing any signs of fading despite the best efforts of regulatory agencies and medical practitioners. What is worrisome is the upward trend of opioid overdose-related deaths, despite a significant decline in opioid prescriptions in the last few years. In addition, it appears that many are now procuring and using prescription opioids produced illicitly.
Researchers think that if we want to counter this crisis, we need to understand the complex nature of the opioid crisis. Things are not as simple as they might appear. This crisis is not fueled much by opioid prescriptions by doctors to manage chronic pain. Instead, there are other factors like pill mills and “unscrupulous” physicians fueling opioid use disorder (OUD). This pathway that is fueling OUD exists outside the domain of chronic pain management.
Figure 1 Opioid crisis (Image Source: https://www.cdc.gov/opioids/basics/epidemic.html)
Though there are indeed many faces of the opioid crisis, and it is among the most complex health crisis causing physical and psychiatric health issues. Still, it is also worth understanding that the drug landscape is continually changing. Therefore, what researchers warn is against the oversimplification of the problem.
For example, saying that the epidemic is solely fueled by opioids prescribed to manage chronic pain is just an oversimplification. On the contrary, studies show that when opioids are prescribed for managing chronic pain, very few patients abuse these drugs. Hence, opioids prescribed by doctors to manage chronic pain do not contribute much to OUD.
Similarly, initially, this factor played a role in OUD development since prescription drugs were cheaper options. However, this factor is not relevant anymore. Though pill mills continue to contribute to the crisis, they are not the only source.
It is true that initially, opioid prescription played a significant role in the opioid epidemic. The epidemic had a humble beginning, as the doctors wanted to help their patients living with chronic pain. Thus, they started prescribing opioids to many patients. However, soon opioid demand rose, and many started procuring these drugs from the illicit market. Due to high demand, the market got filled with illegal drugs. This also affected the market for illicit drugs as it shifted from heroin from Asia to illicitly produced fentanyl in Latin America.
However, researchers say we cannot blame pill mills and unscrupulous physicians alone. Many hospitals continue to prescribe opioids even for conditions with little benefit from opioid prescriptions.
Since the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, opioid prescriptions have fallen. Nonetheless, opioid prescriptions remain relatively high in the US compared to other nations worldwide. In addition, studies now confirm that 90% of those living with OUD often use these drugs for non-medical reasons.
Though studies suggest that very few people prescribed opioids for chronic pain will ever develop OUD, this is still a significant number. Moreover, studies show that the number of people older than 50 seeking treatment for OUD has continuously increased. People of this age group are more likely to source opioids from physicians.
Similarly, it is still poorly understood why some individuals are more likely to develop OUD. Nonetheless, researchers think that there is no single explanation. Most of those who develop OUD are individuals who already have other psychiatric comorbidities apart from chronic pain. Thus, this group of people is more likely to develop OUD. Consequently, they not only keep using prescription opioids but are also pretty likely to buy illicit drugs.
To sum up, the researcher says that though specific techniques like using electronic health record notification and motivational interviewing along with opioid dependence treatment may help reduce the risk of OUD, much work still has to be done to understand the causes of OUD.
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Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.