America, We Have a Problem: Solving the Opioid Overdose Epidemic

Alex Cahana, MD


June 03, 2016

In This Article

The Current State of the Opioid Abuse Epidemic

Two Princeton economists startled Americans recently when they reported that between 1999 and 2013, white middle-aged men and women in the United States, especially those with a high school education, were dying at an increasing rate from prescription and illegal drug overdose, alcohol and liver-related disease, and suicide.[1] Such results are not news to those engaged in day-to-day patient care; to those patients who continue to endure debilitating pain and chronic disease; or to those who have buried a loved one from a drug or alcohol overdose. Fortunately, there is the impression that finally the government and media are paying attention to this national epidemic.[2]

Presidential candidates are sharing personal stories of pain and loss and thus diminishing the stigma associated with pain, depression, posttraumatic stress, and addiction. The President's first mention of healthcare in his final State of the Union Address was about the crushing problem of drug abuse. In February 2016, Obama announced his plans to invest over $1.1 billion in the next 2 years to expand access to treatment for prescription drug abuse and heroin use, improve access to the overdose-reversal drug naloxone for first responders, and support targeted enforcement activities.[3]

The Princeton study also forces us to recognize that drug abuse is not a malady afflicting only poor, minority, inner-city communities but rather is an across-the-country phenomenon, affecting rural white adults in particular.[1] Of note, this mortality trend countering the declining death rates from other chronic diseases demonstrates that the undertreatment of pain among minorities has inadvertently "protected" them from overdose, thus reducing a decades-long death rate gap between white and nonwhite patients. These realizations are driving bipartisan support in Washington that is reflected in the Comprehensive Addiction and Recovery Act (CARA), intended to revise punitive drug policies, promote best medical practices, and strengthen data sharing among states' prescription drug monitoring programs.[4]

But are these laudable and necessary efforts the right way to go? Will increased access to care for those already harmed by addiction, addressing the enduring shortfalls in prescriber education, and research into alternative abuse-deterrent medications actually reverse this deadly epidemic?

The short answer is maybe but probably not without more initiative. Why so?


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