Opioid Misuse: A Global Crisis

It important not to be complacent about the opioid crisis—it continues unabated and demands renewed focused attention. Almost 450 000 Americans died of an opioid-related overdose between 1999 2018.1Centers for Disease Control PreventionOpioid overdose: understanding epidemic.https://www.cdc.gov/drugoverdose/epidemic/index.htmlDate accessed: December 17, 2020Google Scholar In 2017, US Department Health Human Services declared crisis a national public health emergency.2US ServicesHHS acting secretary declares emergency address crisis.https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.htmlDate 15, Approximately 1 in 100 adults United States have active opioid-use disorder (OUD); 88% received any medication treatment. Several studies projected grim outlook epidemic States; under status quo, another 480 people could die from fatal next 10 years.3Ballreich J. Mansour O. Hu E. et al.Modeling mitigation strategies reduce morbidity mortality US.JAMA Network Open. 2020; 3e2023677Crossref PubMed Scopus (6) Google However, increased access medications OUD naloxone harm reduction prevent 179 overdoses (38% reduction).3Ballreich These statistics cannot fully express catastrophe that, put it into perspective on scale, shares similar staggering numbers as coronavirus disease 2019 (COVID-19) pandemic. 2 issues also interacting because COVID-19 pandemic appears exacerbate due severe social isolation, grief, trauma personal private tragedies inability many with already limited number in-person treatment centers.4Linas BP, Savinkina A, Barbosa C, al. A clash epidemics: impact response overdose. J Substance Abuse Treatment. https://doi.org/10.1016/j.jsat.2020.108158.Google This special themed section contributes body knowledge that focuses additional insights need manage planning required one. With respect prevention, Kurteva al show some may avoided when physicians systems use computer-assisted prescribing programs, opposed hand prescribing, patients who are being discharged hospitals.5Kurteva S. Habib B. Moraga T. Tamblyn R. Incidence variables associated inconsistencies at hospital discharge its adverse drug outcomes.Value Health. 2021; 24: 147-157Abstract Full Text PDF (1) Computer results fewer errors prescriptions opioids; research is needed understand more causal mechanisms these observed effects. series articles then various aspects effectiveness costs treatments OUD. Beaulieu Kim al’s programs treat can be, theory, both clinically effective cost-effective by conventional affordability criteria.6Beaulieu DiGennaro C. Stringfellow al.Economic evaluation modeling: systematic review.Value 158-173Abstract (5) Scholar,7Kim Suh H.S. Cost-effectiveness abuse-prevention program using narcotics information management system South Korea.Value 174-181Abstract Although encouraging, Barenie report market factors such high cost drugs regulatory statutes delay generic substitution impeded efforts get treatment.8Barenie R.E. Sinha M.S. Kesselheim A.S. Factors affecting buprenorphine utilization spending Medicaid, 2002-2018.Value 182-187Abstract (2) People suffering experience barriers receiving addiction services, stigma, confidentiality issues, too few willing licensed specialists treatment, or no insurance. Amiri further points out >85% specialty centers near their home prescribe dispense OUD.9Amiri McDonell M.G. Denney J.T. Buchwald D. Amram Disparities office-based across rural-urban area deprivation continua: nationwide small analysis.Value 188-195Abstract (7) Zhou provide evidence Medicare claims data illustrate complexity designing appropriate regimen, where total related level initial whether agonists used alone combination gabapentinoids.10Zhou L. Bhattacharjee Kwoh C.K. al.Association dual-trajectories gabapentinoid healthcare expenditures among beneficiaries.Value 196-205Abstract (3) collectively add there was substantial recognizing what might become, difficulties initiating prevention responses, proposed solutions. As we learned past HIV/AIDS and, most recently, crisis, challenge respond evolving uncertain crisis. doubt relates nature (eg, shift misuse prescription opioids illicit heroin fentanyl); lack national, cohesive, coordinated surveillance database accurately detect potentially large problem early (the so-called black swan problem); rapidly mobilize evaluations, given fragmentation services service providers local, state, federal level; (4) bias against certain vulnerable populations; major investment evidence-based treatments; ineffective punitive laws possession drugs, politization scientific/rational discussion sidelines months—even years case epidemic—voices calling critical issues. We hope recent criminal civil penalties recently imposed manufacturers, distributors, consultants will create deterrents behavior so adversely affected millions Americans. curb supply would modest effect deaths future current fueled (not prescription) opioids.11Chen Q, Larochelle MR, Weaver DT, Prevention States. JAMA 2019;2(2):e187621.Google To 500 000+ deaths—and prepare epidemics disasters—more needs done help entities (and school districts) real time happening muster responses.12Knipe D.M. Levy Fitzgerald K.A. Mühlberger Ensuring vaccine safety.Science. 370: 1274-1275Crossref (10) Additional new models delivery needed. One particular urgent interest clarifying role telemedicine bring populations currently unable centers. positive news vaccines’ approvals, exists promise end Project Warp Speed reveals achieved solve Similarly, afford become our Author Contributions: Concept design: Hornberger, Chhatwal Drafting manuscript: Critical revision paper intellectual content: Conflict Interest Disclosures: The authors reported conflicts interest. Funding/Support: financial support this research. Acknowledgment: wish acknowledge contributions, review, comment Rebecca Clearwater, Rose Do, Joe Forrester.