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What led to the opioid crisis—and how to fix it | News

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From February 9, 2022 Without urgent intervention, 1.2 million people will die in the US and Canada. opioid More than 600,000 people have died since 1999, plus overdoses by the end of the decade, according to Feb. report From the Stanford Lancet Commission on the North American Opioid Crisis. In this Big 3 Q&A, Howard CoeProfessor of Public Health Leadership Practices and a member of the Board, discusses the factors that contribute to the crisis and recommendations on how to curb it.

Q: What was the impetus for this new report on the opioid crisis, and why was it important for this commission to issue a report at this time?

A: The current opioid crisis ranks among the most devastating public health catastrophes of our time. It all started in the mid-1990s when OxyContin, a powerful drug promoted by Purdue Pharma and approved by the Food and Drug Administration (FDA), caused the first wave of deaths associated with legal prescription opioid use. Then came a second wave of deaths as the heroin market expanded and attracted already addicted people. Recently, there has been a third wave of deaths from illicit synthetic opioids like fentanyl. In addition to the devastating public health burden of preventable deaths, millions more are affected by related problems such as homelessness, unemployment, school refusal and family disruption.

The pandemic has hidden and amplified this crisis. The rising trend in deaths is related to factors such as COVID-19 anxiety and isolation, lack of continued access to quality care and prevention. The crisis seems unconfirmed. An urgent, unified and comprehensive response is required.

Q: What were the main drivers of the opioid crisis and what were the main takeaways of the report on how to minimize the damage?

A: One of the main conclusions is that the crisis represents a failure of regulation by multiple institutions. The approval of OxyContin is one example. Purdue Pharma was later shown to have presented a fraudulent description of the drug as being less addictive than other opioids. The profit motive in the pharmaceutical industry has always existed.

And that’s just the tip of the iceberg. After approval, it is typically left to industry, not regulators, to educate and advise prescribers on how to assess and mitigate risk. Donations from opioid manufacturers to politicians continue to influence policy decisions. Additionally, a revolving door of officials who have left government regulatory bodies such as the Drug Enforcement Administration regularly join the pharmaceutical industry with little or no “cooling-off” period. The report details these and other obvious examples.

The report recommends ways to curb the impact of the pharmaceutical industry while maintaining quality care that balances benefits and risks for people with chronic pain. We must continue to make progress to promote opioid stewardship, a physician-led and safer prescribing initiative.

Care, treatment and prevention are all very important. For example, addiction care today is not only often disconnected from mainstream medicine, it is also unequal. It is also often clouded by stigma, uneven quality, and inaccessibility. Addiction remains a long-term threat to human health that cannot be addressed by short-term fixes or short-term funding alone. We fully integrate addiction care into mainstream healthcare, provide permanent and sustainable funding, and ensure that both public and private insurance cover the full spectrum of addiction services. Equivalent legislation requires that most private health plans cover substance use disorder services and be less restrictive than services related to other medical conditions. Laws are not always followed and need to change.

Addiction training should be an integral part of all health professional education. The public health community can also work with the criminal justice system to keep more affected people out of incarceration and toward treatment.

And prevention, starting with children, is absolutely critical. I have to support my family.

Q: Looking at the current state of this crisis, is there any hope?

Progress is being made in several key areas. For example, more medical professionals use the term “substance use disorder” instead of “substance abuse” to perceive the condition as a medical and health problem rather than a moral failure. Also, instead of referring to people as ‘clean’ or ‘dirty’, more and more people are using the medical terms ‘recovery’ and ‘relapse’. It’s good to see this change in the language of addiction.

The Affordable Care Act is also a big help, starting by requiring private insurance plans to cover substance use disorder services as part of vital health benefits. It also facilitated the expansion of Medicaid, the largest payer of opioid use disorder services. The report notes that states that expanded Medicaid eligibility show evidence of fewer overdose deaths and increased access to treatment.

It inspires us to celebrate the estimated 25 million people on their way to recovery. People in recovery are my heroes. Many have been able to rebuild their relationships with loved ones, contribute again to society, and regain purpose and meaning in their lives. . In the midst of this terrible crisis, it gives me the greatest hope for the future.

Karen Felscher

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