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Health care professionals share a common and lofty goal: to minimize their patients’ pain. But what if we’re hurting more people than we’re helping? That may be the sad reality of the opioid epidemic, one driven in part by doctors’ desire to do good.

The use and abuse of prescription opioids like hydrocodone and oxycodone is currently among the most significant health crises today. While Americans account for only 5 percent of the world’s population, we consume approximately 80 percent of the world’s prescription opioids. Overdoses from prescription opioids are the major driver of the 15-year increase in opioid overdose deaths. Overall, prescription opioids are now killing more people each year — 22,000 by last count in 2015 — than die from homicide.

Why is the problem of prescription opioids unique to the United States?


Several historic events led us to this juncture. In the 1990s, multiple professional societies argued that physicians weren’t doing enough to treat people in pain and needed to improve pain management. This advocacy was based on the notion that the current levels of disability related to pain was unacceptable. Based on the educational efforts of major US health systems and leading professional societies, pain came to be thought of, and treated like, a vital sign.

In 2001, hospitals were prompted to create pain management standards, including the process of recording patients’ perceptions of their pain in a way that made it easier to assess and treat pain. The results of this social advocacy and regulatory behavior led to a skyrocketing number of prescriptions for opioids. But troubling data emerged from the Centers for Disease Control and Prevention: Despite this increase, there was little to no improvement in Americans’ pain.


This poor correlation between increasing opioid prescribing and health benefits is sadly and starkly contrasted with the tight correlation between increasing opioid prescribing and rising health care expenditures, opioid abuse, overdose, addiction, diversion, and death.

While the early advocates for the liberal prescription of opioids are no longer vocal, there continue to be insidious incentives to prescribe opioids. For instance, physician reimbursement is now closely linked to patient satisfaction surveys. There is deep concern in the medical community that overprescribing may be occurring as a function of the desire to optimize patient satisfaction.

How do we start to make things better?

First, we need to identify individuals who are at high risk for opioid use. Our new research on opioid prescribing found that Americans with mental health disorders such as depression and anxiety, a group that represent 16 percent of U.S. adults, receive more than half of all opioid medications distributed in the U.S. The high use of opioids among this population is particularly concerning because mental illness is also a prominent risk factor for overdose, abuse, and long-term use.

Second, we need to develop and put in place health policies and practice guidelines — totally free of influence by the drug industry — that aim to reduce physicians’ dependency on opioids for treating pain. This may involve building infrastructure to routinely offer alternative therapies such as cognitive behavioral therapy, acupuncture, physical therapy, and access to mental health experts.

Third, we need to carefully vet policies regarding financial reimbursement for outcomes such as patient satisfaction to anticipate any indirect effects on opioid prescribing.

Finally, we need to quickly put in place regulatory policies to identify fraudulent prescribing practices and improve access to drug addiction treatment.

Pain rarely kills, though we know of people in chronic pain who feel like it is killing them. But pain pills are actually killing astonishing numbers of vulnerable Americans. If we don’t resolve this opioid problem, thousands more will needlessly die.

Brian D. Sites, M.D., is an anesthesiologist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Matthew A. Davis, Ph.D., is an assistant professor at the University of Michigan School of Nursing and the Institute for Healthcare Policy and Innovation.

  • Dr Sites, you just advocated acupuncture. So, you’re saying that doctors should lie to patients to take advantage of placebo effects? That’s the only way that acupuncture does anything at all. There is no evidence that it’s effective when controlled and double-blinded, and there’s no plausible mechanism. Let’s keep the woo out of our medicine, please.

  • Dr. Sites:

    WTF???? Pain rarely kills? Spoken from the mouth of someone who has never lived it. Pain can and DOES kill – sometimes fast, sometimes slow. It gnaws away at every fiber of a pain patient’s being until something gives out.

    I invite you – or any other hysteria provoking cretin spouting this sort of garbage – to live for just one day in my shoes with the degree of pain I experience on a daily basis without pain relief, and see where you end up: in the ER, begging for pain pills. I’m willing to bet on it, in fact.

    Stop spreading lies like this. Right now, you are just contributing to the cesspool of ignorant miscreants lumping legitimate pain patients in with addicts. How DARE you.

    • I agree with Mirielle Faraj! We are all put on this earth for different reasons but one thing we all have in common is that we all are going to die at one point or another! Do you want to die in pain! Right now the government and DEA went and arrested 412 Pain Doctors and they are charging them will multiple charges to try and change the heroin epidemic that the government started back in Vietnam and by letting big Pharma make them money. Now they will be making money off Suboxone. First question why would 412 doctors be being charged with the same charges all in a matter of months, they would all have to be working together. I call BS! The reason people die from pain pills is bc they were mixing the pills and not following doctors orders. Secondly people commit suicide all the time bc they can’t stand the pain. I am a chronic pain patient who suffers from cancer with tumors all over my body and my doctor did get arrested. Let me ask you something Mr. Article writer with little life experience. What happens to us?

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