This document discusses the opioid epidemic and proposes starting a conversation around clinicians' experiences with it. It recommends exploring the epidemic's effects on different areas of medicine and society, identifying focus areas to help clinicians, and proposing prevention and care solutions. The document then provides context on factors that contributed to the epidemic, including a 1986 paper that concluded opioids could be prescribed long-term safely, the 1995 introduction of OxyContin, and Purdue Pharma funding pain education programs from 1996-2002 that encouraged long-term opioid use. Hospital opioid prescription increased sharply as well due to policies like "Pain is the Fifth Vital Sign" and patient satisfaction surveys.

1. LET’S TALK

2. START THE CONVERSATION
ABOUT THE OPIOID EPIDEMIC
ASK CURRENT CLINICIANS ABOUT
THEIR EXPERIENCE WITH THE
EPIDEMIC IN PRACTICE
EXPLORE THE EFFECTS OF THE
EPIDEMIC ON VARIOUS AREAS OF
MEDICINE/SOCIETY
IDENTIFY AREAS OF FOCUS THAT
WILL HELP MAKE US BETTER
CLINICIANS
PROPOSE SOLUTIONS TO
IMPROVE PREVENTION AND THE
DELIVERY OF CARE

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5. In 1986 a paper
describing the
treatment of 38 chronic
pain patients concluded
that OPRs could be
prescribed safely on a
long-term basis. It was
widely cited to support
expanded use of
opioids for chronic non-
cancer pain.
1995:
Introduction of
OxyContin, an
extended
release
formulation of
oxycodone
manufactured
by Purdue
Pharma.
Between 1996 and 2002,
Purdue Pharma funded
more than 20,000 pain-
related educational
programs to encourage
long-term use of OPRs for
chronic non-cancer pain.
As part of this campaign,
Purdue provided financial
support to the American
Pain Society, and other
organizations. In turn, these
groups all advocated for
more aggressive
identification and
treatment of pain.

6. • VITAL SIGNS: BODY TEMPERATURE, BLOOD PRESSURE, PULSE,
RESPIRATORY RATE
• IN 1995, THE PRESIDENT OF THE AMERICAN PAIN
SOCIETY INTRODUCED A CAMPAIGN ENTITLED “PAIN IS THE
FIFTH VITAL SIGN.” THIS CAMPAIGN URGED MORE
AGGRESSIVE USE OF OPIOIDS FOR CHRONIC NON-CANCER
PAIN.
• DESPITE THE PRECAUTIONS OF OVER PRESCRIBING, THE RISK
OF ADDICTION AND TOLERANCE WAS SAID TO BE LOW.

7. Opioid use for acute pain among hospitalized
patients has also increased sharply. A recent
study found that physicians prescribed opioids
in more than 50% of 1.14 million nonsurgical
hospital admissions from 2009 to 2010, often
in high doses.
The Joint Commission's adoption of the Pain is
the Fifth Vital Sign campaign and federally
mandated patient satisfaction surveys
patients to rate how often hospital staff did
“everything they could to help you with your
pain” are noteworthy, given the association
with increased hospital use of OPRs.

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11. • HTTPS://WWW.YOUTUBE.COM/WATCH?V=WHPAYW9KCT8
• HTTPS://WWW.ANNUALREVIEWS.ORG/DOI/FULL/10.1146/ANNUREV-PUBLHEALTH-031914-
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