乌鸦传媒

LAS VEGAS -- In the late 1990s, U.S. providers were for undertreating patients with pain, and the first things to come to mind when considering "opioid risks" were perhaps somnolence, itching, and constipation, researchers said here.

So how, within 2 decades, have these "opioid risks" morphed and escalated to an "opioid epidemic" -- in which from an opioid-related overdose each day?

The problem cannot be traced back to an isolated moment, nor can it be solved with a single solution, said Kevin Zacharoff, MD, of SUNY Stony Brook School of Medicine in New York, at the keynote presentation of .

"We hear the media refer to the opioid epidemic as if it is a single entity," he said. "I don't like hearing people use the phrase 'let's cure cancer,' because when I think about cancer I think of it as hundreds of different diseases. The opioid epidemic is not a single entity."

Overdose deaths were , with the first wave attributed to a rise in prescription opioid-related deaths, the second due to a rise in heroin-related deaths, and the most recent increase driven by synthetic opioids or polysubstance use.

Providers, the pharmaceutical industry, state and federal government agencies, payers, patients, and countless others played a role in the opioid epidemic, said another speaker at the keynote, Michael Clark, MD, MPH, of John Hopkins University in Baltimore.

"There were many forces that got us here, and there are going to be many forces that get us out," Clark said. "The solutions will require more than just limiting access to medications -- that is not going to stop this."

Clark said better therapy options need to be provided to patients with chronic pain and that treatment for substance use disorders should be improved. However, he advised clinicians to be wary of new proposed solutions that are "perhaps just a repeat of what we've been through," citing marijuana, buprenorphine, and ketamine.

Benzodiazepines, specifically, "should no longer be in the silent majority," he said. They stand out among other substances for their role in polysubstance-related opioid deaths and are involved in .

"We should not forget benzodiazepines just because it's hard to kill yourself on benzodiazepines alone -- it's not so with other substances in the mix," Clark said. "And more and more people are on benzodiazepines now."

Compounding the situation is language surrounding the opioid crisis that divides, stigmatizes, and confuses the players involved, said Jennifer Bolen, JD, a former federal prosecutor who previously served as a pain management consultant.

In many indictments or licensing board cases when providers are prescribing opioids outside of the CDC-recommended 90 morphine milligram equivalents (MMEs), for example, some medical experts focus on the number of pills prescribed while ignoring the context in which they are provided, Bolen said.

"When anti-opioid attitudes permeate the media, government, and regulatory enforcement agencies, the attitude becomes weaponized and takes on a life of its own," Bolen said.

Zacharoff outlined eight attempts to improve pain management that have occurred since the was introduced in 2000, such as the White House's in 2011, the establishment of , and the .

Most had good intentions, though none have successfully curbed the epidemic, he said.

However, Zacharoff did highlight the released by the Department of Health and Human Services in May that emphasizes individualized, patient-centered approaches to treating pain.

Still, the problem is that there is no catchall solution for curbing the opioid crisis, Zacharoff said. Instead, there must be coordinated educational efforts between physicians, policymakers, and patients to stop it.

"There is no single silver bullet at the end of the day," Zacharoff said. "There has got to be a much more considered effort to using all of these tools."

Comment