he opioid epidemic has rapidly emerged from the shadows and is now recognized as a plague that affects hundreds of thousands of Americans regardless of age, race, or socioeconomic status. In its destructive potential, it can be compared to the AIDS and polio epidemics. But unlike AIDS and polio, the opioid epidemic continues to rage in large part because we, as a nation, have not yet resolved to attack it head on.

As highlighted in the surgeon general’s report released this week, “Facing Addiction in America,” we are now beginning to translate rhetoric into national initiatives that target community-based education, treatment centers, and interventions to stop the distribution of opioids and to implement effective treatment and prevention programs. As the report emphasizes, those afflicted need insurance coverage as well as resources for education and treatment, which will certainly lead to new federal initiatives and financial outlays.

The surgeon general’s recommendations represent a major step forward in our fight against this deadly scourge. Like most epidemics, the immediate call to arms by our federal agencies is focused on helping those who are currently affected by opioid addiction and implementing steps to minimize the risk for addiction and death in vulnerable populations.


Yet the call to eliminate the use of opioids for chronic pain represents a major dilemma for health care providers and their patients because we are also facing an epidemic of chronic pain. As documented in the 2011 Institute of Medicine report, “Relieving Pain in America,” more than 100 million Americans suffer from chronic pain. It costs our society a staggering $600 billion a year. That is more than we spend each year on treating cancer, heart disease, and diabetes combined.

Many, but certainly not all, patients who suffer from chronic pain rely on legally prescribed opioids to live, work, and function in their daily routines. For them, opioids are among the few therapies that work.

How do we decrease addiction to opioids and still humanely and ethically treat the millions of Americans suffering from chronic pain? As a pain expert, I had hoped the surgeon general’s report would have placed a greater emphasis on the need to develop alternatives to opioids that can be used for pain management, which would eliminate a key pathway to abuse.

Although the president, Congress, and federal agencies are making substantial headway in funding educational and treatment programs, they have fallen short in funding research initiatives that will eliminate the need for opioids in medical practice. That would significantly reduce the availability of these drugs. Such an effort will require funding at the federal level for new research that will lead to new drugs, behavioral interventions, alternative medical practices, devices, and health care delivery systems to replace opioids in clinical practice.

We currently spend just 4 cents per pain patient per year on research aimed at discovering and implementing new treatment strategies and delivery systems that will reduce, and ultimately eliminate, the need for prescription opioids. At the same time, pain patients account for about 15 percent of health care costs. That’s a big imbalance.

If we are to win this fight, we must resolve two interwoven health epidemics facing our nation: opioid abuse and chronic pain. We need more federal funding to develop new drugs, procedures, and health care delivery systems that will eliminate the need for opioids in clinical practice. That would eliminate a primary contributor to opioid abuse while still providing the best possible care to patients who are suffering from chronic pain.

William Maixner, DDS, directs the Center for Translational Pain Medicine and the Innovative Pain Therapies at Brier Creek and is professor of anesthesiology at Duke University.

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