A Call to Arms: The Role of the Psychiatry Resident in the Current Opioid Epidemic

On February 2, 2016, the White House released an update to the President’s annual budget, proposing $1.1 billion in additional funding to address the growing epidemic of prescription opiate and heroin abuse in the United States. This revision of the 2010 National Drug Control Strategy and 2011 Prescription Drug Abuse Prevention Plan pledged improved access to medication-assisted treatment, addiction research, prescriber training and expanded prevention efforts for an illness to which the Centers for Disease Control and Prevention attributes greater annual mortality than motor vehicle accidents (1). Even as top government agencies fight to stem the tide of opiate abuse, overdoses, and deaths, the stigma of addiction persists—among the general population, those who represent us in government, and even our colleagues in medicine—resulting in inadequate access to what is now the standard of care for opiate use disorders: detoxification then multimodal treatment programs that include long-term opiate replacement medication (2). Reluctance to accept opiate replacement and harm-reduction practices as the new standard perpetuates inadequate care practices, despite compelling data that detoxification-only and abstinence-only approaches result in high rates of relapse and overdose (2–4).

The numbers of opioid users, overdoses, and deaths continue to escalate, with an alarming transition rate to heroin (now often laced with fentanyl at unpredictable potencies), despite legislative measures increasing prescriber oversight and limiting opioid availability (4). As psychiatrists, we have a unique role to play in this public health crisis.