By Nelly Papalambros
As the world prepared to move into a new millennium, the opioid epidemic was quietly born. Without much fanfare, opioids began to be touted as the miracle pain drug that patients couldn’t get addicted to. The view that pain was the “5th vital sign” likely contributed, in part, to the rise of opioid prescription, with a particular focus on cancer patients . While taking away a patient’s pain with prescription medications such as oxycodone, codeine, and morphine seemed harmless at the time, it has undeniably led to the largest drug addiction crisis the United States has every seen [2-3]. Like a slow moving tide, opioid addiction began to creep into everyday life. As it was first termed an “urban” issue, perhaps federal policy change and public health responses were overlooked. The burden, carried by the families devastated by the effects of addiction, came without significant government assistance. Then the opioid crisis spread. It spread to middle class America, to rural towns in the middle of nowhere, to mothers, to their newborn babies born with drug dependency. Heroin, something that has always been on the black market, became cheaper and easily available. Fentanyl, an extremely potent synthetic opioid, began to appear in the illicit market around 2014 . When teenagers from white middle class America started dying, people started to pay attention. In fact, from 2013 to 2016 there was a 70% increase in opioid related deaths in the state of Illinois. In Chicago, there was a 93% increase in the same time frame . The opioid crisis is not only an urban problem but a suburban problem—affecting counties such as Peoria, St. Claire, and Winnebago just as much as Cook . Unfortunately, the hidden costs of the epidemic, from healthcare costs to lost productivity, are jarring. Given that the economic cost of the opioid epidemic was estimated at $78 billion in 2013 , it is likely even higher now.
This piece as well as the event described below are responses to last year’s Opioid Symposium, held at Northwestern. For more information read about some of the issues, learn about Senator Dick Durbin’s response, and watch videos from experts about the state of the opioid crisis in the US and Chicago.
Perhaps the hardest problem to contend with is that the epidemic is not showing any signs of abating. An important step in the right direction is opening a dialogue across different groups and stakeholders. Conversations around effective measures of preventing, treating, and managing the ongoing crisis is critical to moving forward. Discussions must include the doctors that prescribe for pain, the police force that responds to 911 calls, the federal agents responsible for drug investigations, the policy makers dictating availability of the anti-overdose medication naxalone, and individuals suffering from addiction and their families, just to name a few. On top of that, the dialogue must include a diverse set of individuals from all races, ethnicities, genders, and socio-economic backgrounds. The opioid crisis does not discriminate; it is affecting people from all walks of life and therefore the discussion should be inclusive. In an effort to work on solutions, groups are moving towards a more dynamic, open-minded dialogue that includes public awareness and reducing stigma against addiction treatment and management.
As part of that effort, Northwestern hosted a multidisciplinary opioids symposium in 2016. The symposium featured panels on the causes, costs, and consequences of the epidemic to the addiction and pain management process followed by a discussion on potential solutions. This October, Northwestern is set to host a follow-up roundtable on identifying metrics of success in interdisciplinary addiction response. The roundtable will bring together experts in the field, from lawmakers to patient advocates both local and national, in an effort to evaluate and create a long-term commitment to opioid addiction response in the Chicagoland area and beyond. Following the roundtable will be an afternoon Keynote address by Ed Siskel entitled “Step One, Admitting We Have a Problem: Leadership Responses to the Opioids Epidemic at Federal, State, and Local Levels”. Facilitating discussion is the first step in a long road to recovery. While the opioid epidemic may have begun two decades ago, let us hope it does not take another two decades to address.
About the Author – Nelly Papalambros
Nelly Papalambros is a PhD/MPH student in the Interdepartmental Neuroscience Program at Northwestern University. She currently studies sleep and memory in aging populations. Nelly is interested in using science to advocate for evidence based health policy.
 American Pain Society Quality of Care Committee. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA 1995;274:1874-1880.
 World Health Organization Online Mortality Database. 2017. http://www.who.int/healthinfo/mortality_data/en/
 The New York Times. Short Answers to hard questions about the opioid crisis. August 10th, 2017.
 Illinois Department of Health and Human Services. The Opioid Crisis in Illinois: Data and State Response. DHS 4480. 2016.
 Florence CS, Zhou C, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care 2016 Oct; 54(10):901-06.
Cover Photo by Julie Viken via Pexles