Search Results

You are looking at 1 - 3 of 3 items for :

  • "Opioid Dependence" x
  • Refine by Access: All content x
Clear All
Joseph A. Hirsch
,
Steven Mandel
,
Kurt T. Hegmann
,
Alexandra G. Stratyner
,
Stuart Gitlow
,
James B. Talmage
, and
Christopher R. Brigham

Abstract

There is an epidemic of drug overdose–related fatalities. Recent data indicate that the age-adjusted death rate from overdoses nearly quintupled over a 20-year period (2001-2021) to 32.4 per 100,000. More than 70% of these fatalities were caused by opioid overdose, especially the synthetic drug, fentanyl. Despite an increase in substance abuse and dependency treatment, mortality and morbidity associated with opioid, cocaine, psychostimulant, benzodiazepine, alcohol, and tobacco use disorders continue to rise. To better understand the factors contributing to this crisis, the multifaceted phenomenon of drug addiction is explored. The controversial chronic, relapsing “disease of the brain” model, which emphasizes the role of the neurotransmitter dopamine, the ventral tegmental area, and the nucleus accumbens, is critically considered. In addition, more expansive neurobiological models that include a host of other neurotransmitters, brain regions, and cognitive processes, as well as classical and operant conditioning and social learning theory to help better understand compulsive drug taking, tolerance, risk-taking, and relapse, were examined. For this, the roles of genetics and epigenetics vs individual agency in drug addiction were considered. The economic and occupational consequences borne both individually and societally are enormous. Ultimately, whether the presence of drug addiction satisfies the criteria for a disability remains a conundrum, especially from the perspectives of financial support (eg, Social Security, private insurance companies) vs regulation (eg, licensing agencies).

in AMA Guides® Newsletter
Kathryn L. Mueller
,
Daniel Bruns
,
Robert L. Glueckauf
, and
Stephen R. Gillaspy

treatment focuses on achieving the correct diagnosis, identifying the best treatment, and assessing the patient for recovery after treatment. Although recovery is usually identified as a physiologic measure (eg, joint range of motion), pain is also commonly assessed. However, the opioid crisis taught health care providers that measuring pain alone could have devastating consequences by inadvertently encouraging opioid dependence. Currently, any patient who is prescribed repeat prescriptions for opioids is required to have a functional outcome measure recorded in their

in AMA Guides® Newsletter
James B. Talmage

are frequently added but rarely discontinued if ineffective. 1 In one health insurance company database 2 of 568,612 patients who were “opioid naive” before surgery but who received a prescription for an opioid after surgery, 5,906 (0.6%) patients had a physician subsequently code the diagnosis of opioid dependence, abuse, or overdose. Physicians who currently prescribe opioids for a patient may have a bias against labeling their own patient with one of these diagnoses, 3 and this probably represents the “tip of the iceberg.” The duration of opioid therapy after

in AMA Guides® Newsletter