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Key Lessons from the History of the Opioid Abuse Epidemic

April 1st, 2021
April 1st, 2021

A review of the history of opioid use in the United States, especially the recent decades of escalating misuse and abuse, tells us that the crisis wasn’t just an accident. Decisions were made by individuals and corporations that led to our current state of calamity, with certain key lessons, according to the HealthStream webinar “The Evolution of the Opioid Crisis from Pain Management to Overdose.” Presenter Dr. Jill Warrington is the Chief Medical Officer at Aspenti Health and has been contributing to the field of laboratory research and medicine for 25 years. A graduate of Tufts Medical School of Medicine, Warrington obtained her Anatomic and Clinical Pathology Training at Duke University School of Medicine and joined the Larner School of Medicine at the University of Vermont in 2009, where she focused on substance use disorders. Warrington has served as a laboratory director at Burlington Labs Aspenti Health since 2011.

Warrington identifies several key threads that are a source of learning for everyone in healthcare:

  1. Opioids Are Addictive.
    Warrington says that though “this may come off as rather obvious at this point,” it bears repeating. She reminds us that as early as 1898, heroin was marketed as a less addictive alternative to morphine, and people fell for it. In fact, “heroin is by far the most addictive of all the substances used, by all measures.” Similarly, we were duped by oxycodone. At the time of approval, the FDA believed that the controlled release formulation of oxycodone would result in less abuse potential since the drug would be absorbed fully. Warrington tells listeners to be skeptical.
  2. Consider Compassionate Tapering.
    “Abrupt cessation can do a lot of things, including precipitating opioid withdrawal and in severe cases lead to death, uncontrolled pain, anguish, or even suicide,” according to Warrington. It is especially important to prevent any transition to heroin use. The FDA has endorsed this approach in a recent statement that “health professionals should not abruptly discontinue opioids in patients who are typically dependent.”
  3. Rely on Data, but Know Where It Comes From.
    Warrington cites an early marketing video from Purdue Pharma, the makers of oxycontin, about the virtues of opioids. In the video a physician makes reference to data, without where the data was found, and “we’ve learned from the history, it doesn’t come from much.” Not only should we be skeptical about data and the misleading ways it can be put to use, but “as a strategy to end the opioid crisis there’s a recognition that we need to try things in an evidence based manner.”
  4. Pain Is Complicated.
    At this heart of the opioid crisis is “a rather profound societal question about how we manage pain and suffering.” For Warrington, “Pain is the oldest medical problem and the universal physical reflection of mankind.” The healthcare industry and our society are still grappling with “what to do with pain, how much they’re willing to tolerate it, and what risks our society is willing to take to treat it.”

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