The Opioid Crisis

By Thomas Bauer Moderator | 25 Oct, 2016

The gravity of this population health issue will be addressed in a much deeper conversation on GHDonline.

According to the United States Centers for Disease Control “More people died from drug overdoses in 2014 than in any year on record. According to the New England Journal of Medicine article ( attached below) "The use of prescription opioid medications has increased greatly in the United States during the past two decades; in 2010, there were 16,651 opioid-related deaths" Efforts to curb the opioid crisis have become heightened with the following practices

• Affecting prescribing practices
• Use of MAT. This is a proven, effective treatment for individuals with an opioid use disorder. MAT has been shown to increase treatment retention, and to reduce opioid use, risk behaviors that transmit HIV and hepatitis C virus, recidivism, and mortality

• Distribution of Naloxone

According the NEJM article “The diversion and abuse of prescription opioid medications increased between 2002 and 2010 and plateaued or decreased between 2011 and 2013. These findings suggest that the United States may be making progress in controlling the abuse of opioid analgesics.

What community based efforts has the community found to help address this opportunity?

Attached resources:



A/Prof. Terry HANNAN Replied at 8:40 PM, 25 Oct 2016

Tom, this is a very timely and critical topic. I have been attempting to implement this new knowledge into clinical care. I had a previous life as a director of a small Chronic Pain Centre where I learnt about this opioid problems. In fact here is the protocol from that unit on CPS management.

 Patient education in the principals and mechanisms of CPS
 Patient must take responsibility for “their pain”
 No one can guarantee the pain will ever be eliminated-it is similar to all other chronic illnesses
 NARCOTICS (Morphine, Endone, Codeine, DiGesic, etc.) are contraindicated-dependency, tolerance
 BENZODIAZEPINES are contraindicated-dependency, tolerance
 NO PRN (as required) medications
 All medications are to be taken “by the clock”
 Management includes “by the clock” or regular exercise
 Initially exercise and physiotherapy INCREASES the pain response. This has to be ‘TRAINED’ through as with sport training.
 Patient is not to be assisted with daily tasks as this ‘perpetuates’ the pain syndrome-increases dependency on others
 Disregard patients complaints of pain-‘it will always be there’.
 TIME FRAME for ‘functional’ recovery is 18-24 months.

Gonzo Manyasi Replied at 5:52 AM, 27 Oct 2016

Very critical information all through, thanks. What's in place for the treatment of addiction seeing as it is the ultimate end-station of most chronic cases?

A/Prof. Terry HANNAN Replied at 6:27 AM, 27 Oct 2016

Gonzo, a nicely framed question. There needs to be made available 'clinician' and patient knowledge-based services (preferably in e- to make it timely. In addition the understanding of the mechanisms of chronic pain "for which there is no surgical remedial lesion". The protocol I listed comes from the guru of modern pain management Dr Loser in Seattle. I hope this helps. Terry