Keynote Presentation: The Opioid Crisis: Made in America...Fade in America

The opioid crisis is a uniquely American challenge. Many factors catalyzed this national nightmare and others continue to fuel it. This presentation delves into some of the major contributors, offer suggestions for reducing this deadly public health problem, and describe challenges for implementation.   The United States stumbled into a series of imprudent decisions can be instructive: it is feasible to “reverse-engineer” past mistakes; it is  important to compile a  “lessons learned” list, a cautionary tale for future drug crises. The initial stimulus, overprescribing of pain-killers, is being gradually reversed, albeit now requiring thoughtful actions to prevent unintended consequences. Responses cannot remain stagnant and locked into fixed solutions, as emerging trends continue to challenge old premises. Illicit fentanyl and heroin now are the two leading contributors to overdose deaths, alone or combined with psychostimulant drugs such as cocaine and methamphetamine.  Prevention strategies based on reducing supply of fentanyl/heroin/cocaine/methamphetamine are clearly different from those involving prescription opioids. Universal principles of treatment, alternatives for pain management, evidence-based treatment involving medications, rescue, and long-term recovery support can be applied to those with an opioid use disorder regardless of chemical class of opioids. Nonetheless, challenges to implementation abound, from resistance to change, stigma, scalability and effective transitions of care.

Learning Objectives:

1. Understand why the opioid crisis is a uniquely American challenge

2. Learn at least 4 factors (of  > 32 factors) that fueled the opioid crisis

3. Lessons learned that can be applied to emerging drug threats

4. Learn 12 principles of treatment and weaknesses in current system