Prescription opioid abuse: Problems and responses

• Overprescribing is a significant upstream driver of prescription opioid abuse.
• Recent research questions the appropriateness of opioid treatment for chronic pain.
• State efforts, such as Prescription Drug Monitoring Programs, show some success.
• Primary universal drug abuse prevention can reduce opioid misuse.
• Addiction treatment and overdose intervention are promising approaches.

Prescription opioid abuse and addiction, along with consequences such as overdose death and increasing transition to heroin use, constitute a devastating public health problem in the United States. Increasingly it is clear that overprescription of these medications over the past two decades has been a major upstream driver of the opioid abuse epidemic. This commentary considers the factors that have led to overprescription of opioids by clinicians, discusses recent evidence casting doubt on the efficacy of opioids for treating chronic pain, and describes the ongoing efforts by federal and community stakeholders to address this epidemic—for example, supporting prescription drug monitoring programs and improved clinician training in pain management to help reduce the supply of opioids, increasing dissemination of evidence-based primary prevention programs to reduce demand for opioids, and expanding access to effective opioid agonist therapies and antagonist medications for both treatment and overdose prevention.