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Responding to the Opioid Epidemic: How did we get here and how do we get out?

Glenn Treisman, Ph.D.
June 8, 2018, 9:30 am - 12:45 pm
Loyola University, Columbia Campus or Online via Zoom
3 CEs
$85/MPA/MSPA members, $135/Non-members

Workshop Instructional Level:All Levels

There is no potential conflict of interest and/or commercial support for this program or its presenter.

The over-prescription of opiates is the subject of numerous publications over the last several years. We present a broad overview of many of the factors that contributed to the dramatic increase in the use of opiates for chronic pain and opiate addiction, as well as a critique of the inadequate response to the problem and an outline of suggested responses. Between 1999 and 2010, the number of opioid pain reliever (OPR) prescriptions has nearly quadrupled, despite no change in reported pain. This has coincided with a tripling of opioid-related deaths across the U.S. In 2010, the United States consumed 99% of the world's supply of hydrocodone, 80% of the world's oxycodone and 65% of the world's hydromorphone. Physicians directly prescribe the majority of these opioids for the treatment of chronic pain, however a black market for these drugs has also emerged.

The street cost for oxycodone and OxyContin (oxycodone CR or controlled release) has dramatically increased as opiate prescribing has been curtailed. The street price of heroin, on the other hand, has steadily fallen in price since the mid 1980's in response to the wide availability of prescription opiates that were increasingly available until the last few years. One 80-milligram OxyContin pill currently has a street value of roughly $80; a comparable dose of heroin costs only $10. This relatively low cost has drawn many OPR users toward heroin, leading to a 6-fold increase in heroin-related deaths in the past 15 years. The widespread transition from OPRs to IV heroin has led to concurrent epidemics in needle-transmitted infections, such as hepatitis C and HIV, particularly among young Americans. In 2015, opioid-related deaths overtook motor vehicle crashes as the number one cause of accidental death in the U.S. That same year, opioid-related deaths also surpassed HIV-related deaths during the peak of the HIV epidemic. In addition to these dramatic social consequences, increased opiate use has also taken a toll on the economy. In 2001 alone, the economic burden was estimated to be roughly 11.7 billion dollars.

The Center for Disease Control and Prevention (CDC) guidelines for opioid prescription released in 2016 demonstrate the need for a deeper understanding. The guidelines detail how to use opioids for chronic pain, including duration, dosage, discontinuation and opioid selection, but fail to mention that no evidence supports opioids for the treatment of chronic non-cancer pain. The guidelines do not explain the various types of chronic pain, how to assess pain, chronic pain syndromes, opiate-induced hyperalgesia, or rehabilitative strategies. Most importantly, they do not address alternative treatments for chronic pain, leaving physicians with the sentiment that opioids are wrong to prescribe but that they have no other option. As a nation we understand that we have an opioid crisis, but to reverse the trend we must more clearly understand chronic pain, addiction and the indications for opioids.

This workshop is designed to help you:

  1. Identify the factors that have led to increased opiate prescription and the current opioid epidemic;
  2. Discuss the 2016 CDC guidelines for opioid prescription and what they do and don't cover; and
  3. List some alternative treatments for clients with chronic pain.


Glenn Jordan Treisman is the Eugene Meyer III Professor of Psychiatry and Medicine, Director of the AIDS Psychiatry Service, Co-Director of the Chronic Pain Treatment Program at the Johns Hopkins University School of Medicine. Dr. Treisman is internationally known for his engaging presentations, his scholarly defense of psychiatry, and his vigorous commitment to the betterment of patient care for underserved populations. He is best known for his groundbreaking work in the field of HIV, where he has been described as "the father of AIDS psychiatry." He is involved in the care of psychiatrically ill HIV infected patients and has been since early in the epidemic, and has described and raised awareness of the role of mental illness as a driving force in the HIV epidemic as well as a barrier to effective care. He is the author of The Psychiatry of AIDS, the first comprehensive textbook on the subject, as well as numerous articles on the issues of mental health in the HIV clinic. He was recognized for this work by the American College of Physicians with the presentation of the William C. Menninger Memorial Award for Distinguished Contribution to the Science of Mental Health in 2006.

Starting with his Ph.D. in Pharmacology and his background in geriatric psychiatry, Dr.Treisman has worked at the interface between medicine and psychiatry, and has become a noted clinical expert on depression, addiction, personality disorders, chronic pain, and the interaction between psychiatric disorders and medical illness. From 2011 through 2013, with selection based upon a peer survey, Dr. Treisman appeared among Baltimore Magazine's Top Doctors. His lectures on psychiatry and medical ethics have earned him international invitations and eponymous lectures including the prestigious Mapother Lecture in London and Findling Lecture at the Mayo Clinic. Dr. John G. Bartlett has referred to his lecture on DNR orders and medical ethics as "the Gettysburg Address of medicine". He is invited to give grand rounds presentations throughout the United States, and is a favorite at HIV meetings and courses throughout the world.