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Am J Med. 2018 Jun;131(6):595-601. doi: 10.1016/j.amjmed.2017.12.045. Epub 2018 Feb 1.

Backstories on the US Opioid Epidemic. Good Intentions Gone Bad, an Industry Gone Rogue, and Watch Dogs Gone to Sleep.

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University of Mississippi Medical Center Department of Medicine, Jackson; University of Mississippi Medical Center Department of Pediatrics, Jackson; Mississippi Public Broadcasting, Jackson. Electronic address:
University of Mississippi Medical Center Department of Medicine, Jackson.
University of Mississippi Medical Center Department of Anesthesiology, Jackson.
Mississippi Public Broadcasting, Jackson.


Epidemics of opioid use are old news in the United States, but an epidemic that kills over 200,000 Americans is not. A multiplicity of intertwined factors have brought us to this place. From 30,000 feet, it is the story of good intentions gone bad, a drug industry gone rogue, and government watch dog agencies gone to sleep. At ground level, it is the story of physicians unfamiliar with addictive drugs and drug addiction, new long-acting opioids deceptively marketed, cheap black tar heroin, encouragement to use opioids for chronic noncancer pain by professional organizations with conflicts of interest and without science, a culture intolerant to pain and tolerant to drug use, and the greedy response of the pharmaceutical industry and drug cartels to an expanding market opportunity. These factors are among those that have joined to form a tsunami of addiction and deaths that keeps on coming. A better understanding of them could speed the end of the present cycle of opioid abuse, perhaps prevent others, and inform future decisions about pain management.


Addiction; Drug industry; Opioid-related deaths; Opioids; Pain

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