Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis

Schottenfeld, Joseph R.; Waldman, Seth A.; Gluck, Abbe R.; Tobin, Daniel G.

doi:10.1177/1073110518782923

Cited by 13 publications

(9 citation statements)

References 60 publications

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“…18 steeply. 12 At the same time, there has been a profound improvement in heroin distribution in recent decades: an increase in the availability of heroin and a decrease in its price in some parts of the country have made it easier to access than in past years.…”

Section: Figurementioning

confidence: 99%

The Opioid Crisis in Black Communities

James

Jordan

2018

J. Law. Med. Ethics

242

162

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While much of the social and political attention surrounding the nationwide opioid epidemic has focused on the dramatic increase in overdose deaths among white, middle-class, suburban and rural users, the impact of the epidemic in Black communities has largely been unrecognized. Though rates of opioid use at the national scale are higher for whites than they are for Blacks, rates of increase in opioid deaths have been rising more steeply among Blacks (43%) than whites (22%) over the last five years. Moreover, the rate of opioid overdose deaths among Blacks already exceeds that of whites in several states. The lack of discussion of Black overdose deaths in the national opioid discourse further marginalizes Black people, and is highly consistent with a history of framing the addictions of people of color as deserving of criminal punishment, rather than worthy of medical treatment. This article argues that, because racial inequalities are embedded in American popular and political cultures as well as in medicine, the federal and state governments should develop more culturally targeted programs to benefit Black communities in the opioid crisis. Such programs include the use of faith-based organizations to deliver substance use prevention and treatment services, the inclusion of racial impact assessments in the implementation of drug policy proposals, and the formal consideration of Black people's interaction with the criminal justice system in designing treatment options.

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Section: Figurementioning

confidence: 99%

The Opioid Crisis in Black Communities

James

Jordan

2018

J. Law. Med. Ethics

242

162

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“…Physicians are permitted under federal law, for example, to prescribe methadone for pain without serious limitation, but are significantly more constrained when treating addiction. 125 Similarly, much of the rhetoric around state opioid prescription limitations casts physicians as drug dealers profiting from their patients' addictions. 126 One important way to limit the influence of nonmedical, non-public health considerations in opioid policy is to maintain an open dialogue between state policymakers, medical boards, and physician groups.…”

Section: A Political Preferences As Medical Regulationsmentioning

confidence: 99%

Section: Evaluating Opioid Laws In Contextmentioning

confidence: 99%

Physician Autonomy and the Opioid Crisis

Guevremont¹,

Barnes²,

Haupt³

2018

J. Law. Med. Ethics

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The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

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“…Although no state has yet passed legislation that limits MME below levels recommended by the CDC guideline, states are writing guidelines and laws that require prescribers to consult with a “pain specialist” in order to prescribe MME well below those recommended by the CDC guideline. Given the shortage of board-certified pain specialists and that primary care physicians are generally ill-equipped and poorly supported,38 this may pose a problem, particularly in rural and other underserved areas 39. Perhaps one of the best known of such laws is that of Indiana, stipulating that after 3 months of a mere 15 MME, a “trigger” necessitating that prescribers alter their standard prescribing practices goes into effect 40.…”

Section: Efforts To Curb the “Prescription Opioid Crisis”mentioning

confidence: 99%