Comment; Primary care providers treat more patients with psychiatric disorders than psychiatrists do. The perspective in this article is not surprising considering where it was published. The authors also miss the point that most opioids being abused currently are obtained non-medically.
Nora D. Volkow, MD1; Emily B. Jones, PhD1; Emily B. Einstein, PhD1; et alEric
M. Wargo, PhD1
Author Affiliations
JAMA Psychiatry. Published online December 5, 2018. doi:10.1001/jamapsychiatry.2018.3126
Importance More than 42 000 Americans died of opioid overdoses in 2016, and the fatalities continue to increase. This review analyzes the factors that triggered the opioid crisis and its further evolution, along with the interventions to manage and prevent opioid use disorder (OUD), which are fundamental for curtailing the opioid crisis.
Observations Opioid drugs are among the most powerful analgesics but also among the most addictive. The current opioid crisis, initially triggered by over prescription of opioid analgesics, which facilitated their diversion and misuse, has now expanded to heroin and illicit synthetic opioids (fentanyl and its analogues), the potency of which further increases their addictiveness and lethality. Although there are effective medications to treat OUD (methadone hydrochloride, buprenorphine, and naltrexone hydrochloride), these medications are underused, and the risk of relapse is still high. Strategies to expand medication use and treatment retention include greater involvement of healthcare professionals (including psychiatrists) and approaches to address comorbidities. In particular, the high prevalence of depression and suicidality among patients with OUD, if untreated, contributes to relapse and increases the risk of overdose fatalities. Prevention interventions include screening and early detection of psychiatric disorders, which increase the risk of substance use disorders, including OUD.
Conclusions and Relevance Although over prescription of opioid medications triggered the opioid crisis, improving opioid prescription practices for pain management, although important for addressing the opioid crisis, is no longer sufficient. In parallel, strategies to expand access to medication for OUD and improve treatment retention,including a more active involvement of psychiatrists who are optimally trained to address psychiatric comorbidities, are fundamental to preventing fatalities and achieving recovery. Research into new treatments for OUD, models of care for OUD management that include health care, and interventions to prevent OUD may further help resolve the opioid crisis and prevent it from happening again.
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