In the three decades I have practiced as a psychiatrist the most difficult and challenging individuals I encountered suffered with intractable chronic pain, opioid substance use disorders and people who lost a child, sibling, parent or friend to opioid overdose. According to the CDC, deaths from drug overdose have risen steadily over the past two decades and have become a leading cause of injury and death in the United States. The most recent statistics published this week by the CDC** indicate that during the period 1999 to 2014 data indicates that 193, 947 people died as a result of opioid overdoses in the United states, which include 4320 in Pennsylvania, 157 in Montgomery county died of overdoses in 2014. Countless others are in the grips of addiction; victims of the drug wars, suffering with inadequately treated pain.
It is therefore not surprising that there is public outcry to address the Epidemic of Opioid Overdoses and Abuse which has emerged as a significant public health and national policy issue. The responding national efforts including the rare bipartisan CARA legislation passed by congress and signed into law by president Obama, CDC, FDA, DEA, as well as all major medical associations has been slow, with limited effectiveness. The state and local responses have been more profound reflecting urgency of local communities coping with the devastation of the Epidemic. Citizen groups seeking to address the need for adequate pain treatment, as well as those focused on decreasing the supply of opioids as well as treatment of addiction have grown substantially. During this period trends, public policy regulations have fluctuated between addressing pain (fifth vital sign) the growth of the addiction industry have failed to stem what has come (again) to be recognized as an epidemic.. ). The law enforcement/ criminal justice approach of the declared “war on drugs” other than costing wasted tax dollars, questionable techniques that impact civil liberties and collateral strategies. Yet, the devastation of opioid overdoses continue, individual suffering with pain have a more difficult time accessing quality care.
The treatment plan outlines a multifactorial, action process targeting specific challenges that we have identified. The action plan is divided into time segments that reflect different levels of urgency as well as psychological understanding to maximize the probability of achieving the identified goals. We believe that offering a time frame with clearly defined and measurable outcomes is an antidote to the crisis environment that leads to poor choices and worsening of the problems. Although this division is helpful, many of the actions take place at different stages of the process. For example, the efforts to create a vision for the healthcare system will be an ongoing process. Specific challenges in addressing the Pain-Opioid ecosystem will be described along with the policy options to remedy them.
To be successful the treatment plan approach has to recognize the goal for the treatment. A flexible approach with multifactorial tools that is specific to the problems with most specific treatment rather than ideological ax wielding (chainsaw solutions) solutions. Map out the plan with long term objectives and method of monitoring and readjust and reevaluate adapting to the changes. These will reflect current recommendations as well as best practice and multiple other recommendations for “curing” the Pain Opioid Epidemic.
Vision: Establish a vision for the individual, community, nation and the international community
Humanizing the epidemic: Confronting stigma associated with pain and opioid dependence
Primary prevention: Preventing the initiation of non-medical opioid use
Pain disorders: Appropriate pain management and medical use of opioids
Opioid use disorder: Best practice, scientifically informed addiction, abuse and dependence treatment
Harm reduction: Preventing and reducing harm associated with opioid use, including eliminating overdose mortality and morbidity associated with opioid use
"The War on Drugs": A criminal justice system that reflects scientific understanding on opioid use.