Lancet (2022) Flashcards
What is the Stanford-Lancet Commission ?
The Stanford–Lancet Commission on the North American Opioid Crisis was formed in response to soaring opioid-related morbidity and mortality in the USA and Canada over the past 25 years.
How did this North-American crisis emerge ?
The North American crisis emerged when insufficient regulation of the pharmaceutical and healthcare industries enabled a profit-driven quadrupling of opioid prescribing. This prescribing involved a departure from long-established practice norms that prevailed before the mid-1990s—particularly in the expanded prescribing of extremely potent opioids for a broad range of chronic, non-cancer pain conditions.
How deadly is this crisis ?
Hundreds of thousands of individuals have fatally overdosed on prescription opioids, and millions more have become addicted to opioids or have been harmed in other ways, either as a result of their own opioid use or someone else’s (eg, disability, family breakdown, crime, unemployment, bereavement).
Since 1999, more than 600 000 people have died from opioid overdoses in the USA and Canada, and the current rate of mortality in each country exceeds even that of the worst year of the HIV/AIDS epidemic.
How were markets affected by these fatalities ?
In response to the large pool of people who became addicted to prescription opioids, heroin markets expanded, which further increased morbidity and mortality. As heroin markets became saturated with illicit synthetic opioids, such as fentanyl, an already dire situation became a public health catastrophe, which has only worsened since the onset of the COVID-19 pandemic.
Describe the first wave of death by overdose.
- The first wave of the opioid crisis began in the 1990s, when the long-acting opioid OxyContin and other high- potency opioids were prescribed to an extremely wide array of patients. The first wave inflicted the most harm on white and Indigenous people in both the USA and Canada. An unusually high number of middle-class people and people living in selected rural areas (eg, Appalachia in the USA, the Yukon in Canada) were affected in this wave of the crisis compared with previous epidemics of opioid addiction and overdose.
Describe the second wave of death by overdose.
The second wave, as heroin markets became resurgent in response to demand from people addicted to prescription opioids, began around 2010 and led to rapidly rising mortality among African Americans in the USA, and more generally, in urban areas in the USA and Canada.
Describe the third wave of death by overdose.
These demographic shifts persisted into the third wave of the crisis, which began around 2014 and was characterized by rising addiction and fatal overdoses linked with synthetic opioids such as fentanyl. In 2020, fatal opioid
Who is benefiting from this crisis ?
The profit motives of actors inside and outside the health-care system will continue to generate harmful over-provision of addictive pharmaceuticals unless regulatory systems are fundamentally reformed
How should medical practice be changed to minimize the impacts of this crisis ?
Opioids have a dual nature as both a benefit and a risk to health, function, and wellbeing. This dual nature should be considered in drug regulation, prescribing, and opioid stewardship.
Integrated evidence-based systems for the care of substance use disorders should be developed and supported financially on a permanent basis.
Innovations in biomedical research into pain relievers and medications for opioid use disorder treatment, supply control strategies, and the delivery of treatment for substance use disorder are urgently needed in response to the opioid crisis.
What are some legal or political changes that could be implemented to help this crisis ?
Policies are available that maximise the benefit and minimise the adverse effects of criminal justice system involvement with people who are addicted to opioids.
Fostering healthier environments (eg, through programmes for the safe disposal of opioid pills, substance use prevention, and childhood enrichment) could yield long-term declines in the incidence of addiction.
How does Lancet conclude this text ?
High-income nations have a responsibility to prevent their opioid manufacturers from fomenting opioid overprescribing in other countries, and all nations should consider how to strengthen regulatory systems to prevent domestically driven opioid crises.
