Responding to America's Iatrogenic Epidemic of Prescription Opioid Addiction and Overdose.

The United States is experiencing what is arguably the greatest iatrogenic epidemic in the history of American medicine. From 1999 to 2014, almost 200,000 prescription opioid overdose deaths have occurred in the United States. Most fatal overdoses have affected patients receiving medically prescribed opioids. An unprecedented decline in life expectancy has occurred among working-age white Americans, partially attributable to rising drug overdose deaths. Among the 9–11 million Americans using medically prescribed opioids long term,, 10%–40% of chronic opioid therapy (COT) patients may have prescription opioid use disorder. If so, several million COT patients may now be addicted to medically prescribed opioids. Meager evidence supports COT benefits and safety. Whether analgesic efficacy is sustained long term for most COT patients has been questioned. The practice of long-term opioid prescribing in the United States is inconsistent with the basic precepts of evidence-based medicine.