With the opioid epidemic now claiming nearly 2000 lives from overdose in the United States each month, the medical profession is increasingly accepting the assessment of noted surgeon and writer Atul Gawande, MD: “We started it.” Specialty societies such as the American Academy of Family Physicians and American College of Physicians are offering tools to reduce the unnecessary use of opioids for pain and the risk of addiction. The Federation of State Medical Boards has released guidelines for the treatment of chronic pain, and many state medical boards have adopted their own policies. Physicians are responding. Since peaking in 2012, opioid prescriptions have declined by more than one-fourth.
Avoiding future cases of opioid addiction, however, does little to address the harm that already exists. More than 2 million US residents now have an opioid use disorder. Yet the Surgeon General’s Report Facing Addiction in America found major gaps in access to effective treatment. The gaps go beyond financial and geographic barriers to include major quality concerns. In 2016, among those with opioid addiction who were able to receive specialty addiction care, only about 1 in 3 expected to receive treatment with medications. Yet it is the use of medications, particularly methadone and buprenorphine, that has the greatest potential to save lives. These treatments are associated with substantial reductions in the risk of death for individual patients and many fewer overdose fatalities at the population level.
By Joshua M. Sharfstein, MD, and Yngvild Olsen, MD
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