Beyond Supply: How We Must Tackle the Opioid EpidemicThe opioid epidemic is the most important and most serious public health crisis today. The effects are reported in overdose deaths but are also starkly evident in declines in sense of well-being and general health coupled with increasing all-cause mortality, particularly among the middle-aged white population.1 As exceptionally well described by Rummans et al2 in this issue of Mayo Clinic Proceedings, the cause of the epidemic is multifactorial, including an overinterpretation of a now infamous New England Journal of Medicine letter describing addiction as a rare occurrence in hospitalized patients treated with opioids, initiatives from the Joint Commission directed toward patient satisfaction and the labeling of pain as the “5th vital sign,” the advent of extended-release oxycodone (OxyContin), an aggressive marketing campaign from Purdue Pharma L.P., and the influx of heroin and fentanyl derivatives.
Bloodstream Infection Outbreaks Related to Opioid-Diverting Health Care Workers: A Cost-Benefit Analysis of Prevention and Detection ProgramsIn this issue of Mayo Clinic Proceedings, Schaefer and Perz,1 representing the Centers for Disease Control and Prevention’s (CDC’s) Division of Healthcare Quality Promotion, provide a unique and frightening look at the harm that can be inflicted by a drug-diverting health care worker (HCW). With access to heretofore-unpublished data gleaned from multiple CDC investigations, these authors use the data to define the risks to patients, health care institutions, and insurers created by the criminal actions of those willing to tamper with patients’ drugs to obtain controlled substances by diversion.
Opioid Overdose: When Good Drugs Break BadActor Philip Seymour Hoffman died on February 2, 2014, at age 46 years of an apparent accidental overdose (OD) of an opioid drug. He is yet another in a long series of talented entertainers to succumb to this class of drug; others include Elvis Presley, John Belushi, Heath Ledger, and many more. Although these celebrity deaths generate great interest in the media, journalists and the public often underappreciate that these celebrity deaths are but a single manifestation of an ongoing population-wide epidemic of opioid OD deaths.
A Need to Establish Programs to Detect and Prevent Drug DiversionMisuse of controlled substances is a problem of increasing frequency throughout the country. Access to controlled substances is obtained legally, through prescriptions, or illegally, through diversion. Concerns about both types of access are increasing. Recent articles in the New York Times1,2 describe increased requests for pain medication through emergency departments and the increased use of prescribed medications, resulting in loss of productivity as well as life. During the past 10 years, the prescription of opioids has increased 4-fold.
Opioid-Abusing Health Care Professionals: Options for Treatment and Returning to Work After TreatmentWe congratulate Mayo Clinic Proceedings and the authors Hamza and Bryson1 on their decision to publish an important and controversial article about the use of buprenorphine maintenance treatment in opioid-dependent health care professionals (HCPs). (Buprenorphine is a semisynthetic opioid agonist-antagonist drug with adverse effects shared with other opioids. It is sometimes used to treat opioid addiction, much as methadone is used.) The Hamza and Bryson article sheds light on some of the problems associated with this practice and with the state monitoring systems (eg, physician health programs [PHPs]) that are in place to secure recovery from addiction and protect the public.
Contemporary Clinical Opioid Use: Opportunities and ChallengesOpiate analgesics have been used by humans for thousands of years and are the longest continuously used class of medications. The recent increased interest in opiates (drugs derived from opium) and opioids (more generally, any natural or synthetic drug that binds to an opioid receptor) has evolved largely from 5 directions: (1) advances in the design of new opioid receptor agonist and antagonist drugs; (2) expansion and innovation in methods of drug delivery; (3) increased public awareness of pain management options and the appropriateness of aggressively treating pain (eg, declaration of pain as the “fifth vital sign”1 and pain relief as a fundamental human right2); (4) growing recognition of the serious consequences of opioid misuse, misadventure, and addiction; and (5) medicolegal aspects of practitioners' prescribing practices and legal prosecution for “overprescribing.” These and related issues are addressed in 4 articles and 1 additional editorial in the current issue of Mayo Clinic Proceedings.
Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?In the current issue of Mayo Clinic Proceedings, Berge et al1 review the challenges associated with identifying and treating chemically dependent physicians. The authors inform readers that the nature of this dependency can vary, in part, by medical specialties and practice locations and that the risk of death from dependency is associated with the drugs used in clinical practice. We explore these issues in some detail, as well as the health and professional outcomes of chemically dependent anesthesiologists who have completed a treatment program.
The Sickle Cell Crisis: A Dilemma in Pain ReliefSickle cell anemia is a progressive hemoglobinopathy producing chronic hemolytic anemia, microvascular thrombosis, ischemic pain, tissue infarction, decreased quality of life, and ultimately shortened life expectancy.1,2 In sickle cell anemia, valine is substituted for glutamic acid in the sixth amino acid of the β-globin chain. In a person who is homozygous, all hemoglobin is of the abnormal HbS type, and repeated episodes of sickling result in a less malleable molecule even at sites of normal atmospheric pressures of oxygen.