Publication date: Aug 10, 2019
Knee-jerk reactions to restrictions on opioid prescriptions have resulted in an increase in the narco-trafficking of heroin and fentanyl, and as the consumption of opioids shifted from oral intake to injections, hepatitis B and C and HIV infections have increased. 2 Opioid misuse in America dates back to the Civil War and the passage of the Pure Food and Drug Act (1906). 2 Opioid use blossomed with the invention of hypodermic syringes and the inclusion of unregulated opioids in medications. 2 With the passage of the Harrison Narcotics Tax Act in 1914 and later rulings, the perception of opioid misuse changed. 2 Opioid addiction was no longer viewed as a treatable disease, and individuals with opioid use disorders (OUD) were perceived as responsible for their condition and as lacking moral fiber. 2 The Supreme Court supported this view until 1962, when it ruled that addiction was a disease. 2 The second opioid use crisis hit the United States from 1960 to 1975. 2 Heroin spread from major cities to the countryside and was linked with disenchantment associated with the Vietnam War. 2 In the late 1960s, medication-based treatment for OUD using methadone gained acceptance, but the rapid and poorly monitored expansion of this effort created a highly regulated system of methadone clinics. 2 The passing of Federal Regulation 37 F. R. 26 806 led to tight controlled access to medication for clinics and patients, mandated drug screening, and supplemental counseling and required stringent reporting practices. 2 This regulation resulted in a system of clinics that were disconnected from the rest of the healthcare system and further stigmatized medication-based treatment for OUD. 2 More importantly, the regulation paved the way for a return to abstinence-based approaches as the more socially acceptable form of treatment for OUD. 2 . Over the past 25 years, clinicians have prescribed opioids for fear pain may be undertreated. 2 Additional factors are thought to play a role in the current OUD crisis, including a shift in the American health system toward -patient-centered” medical care.
. False claims by pharmaceutical companies regarding the potential for abuse and duration of effect of extended-release formulations of opioids and the use of incentives by these companies to promote sales and secure endorsements from prominent physicians using retainers and speaker’s fees.
“1 Researchers note that despite a documented doubling of opioid analgesic use from 2000 to 2010, they cannot find evidence that prescribing opioids for chronic pain is the principal driver of rising addiction rates in adults. 2 OUD develops in only a small percentage of adults who are prescribed opioids for acute pain. 2 In a large study of 640,000 opioid-naive patients in which chronic opioid use was examined one year after surgery for 11 surgical conditions, the prevalence was found to range from 0. 12% for cesarean section deliveries to 1. 4% for total knee replacement surgeries. 2 In another study in which chronic opioid use was examined in approximately 18 million people with acute pain who had not undergone surgery and had never taken opioids, only 0. 14% of those who were prescribed opioids were found to still use the medications a year later. 2
|disease||MESH||substance use disorder|
- Medications for management of opioid use disorder.
- A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health.
- The Cost of the Opioid Epidemic, In Context