The narrative of the opioid crisis is that ill-informed and careless prescribing by physicians has led to increases in opioid-related harms including overdose deaths. Focusing on reducing the access to prescribed opioids without treating substance use disorder has led to increases in use of heroin and illicitly produced fentanyl. Overall prescribing of opioids has declined causing collateral damage to those who use opioids appropriately to reduce pain and improve function. The complexity of this issue requires a change in focus and broad changes in society’s approach to substance abuse and mental health.
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