In doing so, three simple concepts can guide our thoughts, our approach and our message to policymakers, to patients and our fellow health professionals. A fierce commitment to the principles reflected in three words—honesty, context and evidence—can help us reverse the opioid epidemic and harness the resources required to solve our biggest medical challenges.
Intellectual honesty means acknowledging the opioid epidemic is a complex public health threat with no single root cause. It means recognizing that solutions developed in silos are not enough, that the stigma against those with substance use disorders must be overcome and that people struggling with SUDs deserve treatment, not incarceration. And honesty requires understanding that physicians cannot reverse the opioid epidemic singlehandedly.
We need legislators to make decisions that result in fully funded treatments for SUDs. And we should expect that health insurers and public payers like Medicaid to pay for necessary treatment and eliminate the barriers that can delay care.
Next is context, which is so important when wrestling with any large and complicated issue. We have to examine the social determinants of this epidemic and the complexity of how pain affects each individual. We have to ensure that in our appropriate zeal to solve this issue, we don’t stigmatize patients who live with chronic pain and place barriers to their getting the care they need. And we have to confront the implicit biases that lead to people of color being undertreated for pain.
I have saved the best for last. Evidence is more important now than ever—not just in our research findings regarding approaches to treatment, but also in our broader solutions. Medicine based on reliable evidence has greatly reduced the burden of preventable disease through public health approaches, and we continue to make strides in treating chronic disease and many cancers using evidence.
But as I have said before, we in the health system cannot do it alone. As a society, we should aspire to achieve legislation that is based on evidence and public policy that is based on evidence. At the intersection of public health and public policy, there are many narratives. Some are based on fact, others not. Those that are not often lead to feel-good solutions—solutions that provide only the appearance of progress, while the underlying problems—in all their messy reality requiring multifaceted solutions—grow worse every day.
Honesty. Context. Evidence. They are three vital concepts that, if applied consistently and courageously, should help us turn the tide and carry out our mission as physicians to save lives and improve the public’s health.