An excellent article from Vox providing some insight into how the opioid crisis evolved over the last 2-3 decades. There is no doubt that this epidemic was fueled – in no small measure – by rampant prescription of opiates by doctors. This trend particularly took off in the 1990s, and got worse from there. Much of that was driven by an underlying culture shift, which dictated that patients should be pain free. While that is a laudable goal, it is not only impractical but also dangerous.

It did not help that insurances, including Medicare, tied hospital and physician reimbursement and compensation to ‘patient satisfaction’ scores. Of course, a patient in pain will be less-than-satisfied, without giving much thought to the fact that trying to achieve a pain-free state might actually be dangerous for him or her. Over time, it became an expectation – in clinics and hospitals across the nation – that patients’ pain should be treated aggressively. No one gave much thought to the long-term consequences. Patients thought that it must be safe as a doctor was prescribing the opiates. Doctors thought that this is what the patients want, so why should they not prescribe this, particularly as there was tremendous pressure from everywhere to make them pain-free.

And now we have this crisis on our hands, which eventually ties into illicit drugs like heroin. Sooner or later, many patients are cut off from prescription opiates. Then they turn to the streets because by then they are thoroughly opioid-dependent. Many initially purchase pills, but then transition to heroin as it is much cheaper and more readily available. The heroin is often cut with a much more powerful opiate called Fentanyl. This has caused a crisis within a crisis, by causing many more overdoses and deaths.

The article makes a very salient point – illicit drugs are much more readily available in the United States than treatment for addiction. While that gap remains, we will continue to be in crisis mode. Suboxone (buprenorphine and naltrexone) offered through a medication-assisted treatment (MAT) program currently is the gold standard for opioid addiction treatment. But, suboxone clinics are few and have restrictions as to how many patients they can actively serve at any given time.