The Opioid Epidemic: The Many Causes

Part One of Two: A look at the many causes of this epidemic

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As you are undoubtedly aware our communities continue to struggle with an epidemic of opioid misuse and abuse. In 2016 42,000 people died of an opioid overdose. Apparently, 11.5 million people misuse prescription opioid painkillers. Almost 950,000 people used heroin and 2.1 million people suffered from opioid use disorder in the United States.

This epidemic has many causes. One contributing factor is our healthcare system’s over-reliance on narcotic pain medications to treat a large number of patients with chronic pain. Most physicians receive little training in the treatment of chronic pain. Opioids are most effective in the treatment of acute pain but in the treatment of chronic pain, pain that goes on for 3 to 6 months, opioids, in the end, may actually make the pain worse. Most individuals who develop an opioid addiction received opioids initially through a prescription from their physician.

In many communities, primary care physicians provide most of the care for chronic pain patients. They are often unaware of nonpharmaceutical interventions for chronic pain. To be fair those who provide these interventions such as psychologists, physical therapists and acupuncturists have not done enough to educate other providers or the public about the effectiveness of these interventions.

There is little evidence to support the use of long-term opioid therapy in the treatment of chronic noncancer pain. Considering the risk of harm posed by the misuse of opioid prescriptions and the lack of evidence to support opioids for chronic noncancer pain the Centers for Disease Control and Prevention recommend nonpharmaceutical treatments or non-opioid pharmaceutical treatments to be considered as the initial treatment approach for chronic pain. Non-opioid alternatives include, but are not limited to, acetaminophen, anti-inflammatory drugs, membrane stabilizers such as gabapentin, and muscle relaxants. And there are others. Recent research has indicated that these non-opioid alternatives are at least as effective as opioids for low back pain and are less associated with adverse events.

The most widely studied and effective interventions for chronic pain that are nonpharmaceutical include cognitive behavioral therapy and other interventions such as acceptance and commitment therapy, exercise, physical therapy, and interdisciplinary rehabilitation. Depending on the pain condition other therapies with evidence of efficacy include yoga,  biofeedback, acupuncture, spinal manipulation, and massage.

The American Psychological Association is encouraging its members to become better educated and trained in these nonpharmaceutical interventions and to educate other providers in the community and the public about these interventions. We will be talking more about these interventions in future posts.

This article was originally posted to Psychology Today, “In the Face of Adversity”, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on the Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.

Photo pf Ron Breazeale, Ph,D.
Ron Breazeale, Ph.D.