Opioid addiction isn’t going away and it will continue to grow for several years
The etiology of the current opioid epidemic can be traced to a series of events which began around 2000. The perfect storm. First, pain pills became stronger, impacting the neurobiology of the brain significantly. Second, the pressure was placed on physicians to treat pain as one would treat an abnormal vital sign (rating of pain became a common question).
Third, pain clinics opened to better treat pain but just made patients more addicted to the opioids being prescribed. By 2013-2014 in Tennessee, where I see patients, there were 333 pain clinics and more than 8.5 million prescriptions written for pills such as oxycodone, hydrocodone, and oxymorphone.
The United States was the leading user of oxycodone, and this placed Tennessee as one of the prominent users of oxycodone in the world. Against this backdrop of pill availability, was an unawareness by many providers that opioids could be as addictive as they are.
One of the most significant problems that currently exists is a lack of access to care. Opioid addiction is a chronic condition that does not respond to short-term treatment. It requires long-term, recovery-oriented services. The occurrence of withdrawal from opioids, as well as the triggers to use opioids, are so severe that relapse is typical in an individual who tries to maintain abstinence.
It is for this reason that medication is used as a maintenance treatment to prevent withdrawal, keep engagement and allow the individual to participate in behavioral therapies to build on strengths and address needs. This life course perspective changes the treatment concept from a short stay and discharges to a more integrated long-term recovery.
It is this need for long-term recovery management that makes opioid addiction comparable to other chronic primary health disorders. Recovery over a lifetime must be maintained, and to do so requires a high standard of quality of care and engagement in behavioral counseling and medication-assisted treatment (MAT). To accomplish this requires more access to care that is committed to sustained recovery.