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Prev Med. 2019 Jan;118:171-175. doi: 10.1016/j.ypmed.2018.10.004. Epub 2018 Oct 11.

Clinical solutions to chronic pain and the opiate epidemic.

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Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA.
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA. Electronic address:


The current opiate epidemic has caused tens of thousands of deaths annually and hundreds of billions in economic losses. From 1979 to 2015, accidental opiate-related deaths increased by 4250%. Despite its magnitude, the driving forces remain poorly understood. A narrow understanding by physicians, administrators and policy makers has resulted in a clinical approach to chronic pain treatment misguided by expediency, shortsighted cost reduction, pharmaceutical profit, and patient satisfaction. Until the broken elements are well understood, effective policy solutions will remain elusive. In this review, we describe the first comprehensive timeline of significant contributing factors between 1979 and the present. To address the complexity of treating patients with chronic pain and its contribution to opiate overuse, we outline an alternative clinical and health systems approach to chronic pain therapy. Addressing the underlying drivers will require empowering physicians to use clinical judgment over guidelines and algorithms to provide holistic, high-quality healthcare to individual victims of the opiate epidemic.

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