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The American Opioid Epidemic
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19 March 2019

The American Opioid Epidemic: From Patient Care to
Public Health provides practicing psychiatrists, trainees, and other
mental health professionals with the latest information on opioid addiction,
including misuse of heroin and other illicit opioids, the role of
prescription analgesic opioids, and recent overdose trends. Although highly
effective in relieving acute pain, opioids can cause untold damage to
people's lives, health, and social structures. Recognizing the efficacy of
these drugs when prescribed appropriately, the editors call not for
eliminating access or for incarcerating those who are addicted, but for
changing the patterns of prescribing and use. The crisis is analyzed by
expert contributors from a wide variety of perspectives; they address issues
of epidemiology and toxicology, prevention and harm reduction, and common
comorbidities. Stressing that prevention and treatment do work,
expert contributors provide down-to-earth, public-health-focused strategies
that clinicians and public health workers alike will find indispensable.
Moreover, the use of clinical vignettes and key chapter points help ground
the reader and highlight the most important concepts.
The book is
comprehensive in its exploration of all facets of the crisis:
• A thorough overview of prescription opioids is presented, including
descriptions of the agents and their physiological effects, details on the
origins of the opioid prescription use and misuse epidemic, current national
trends in the nonmedical use of these prescription medications, and the
consequences of long-term use of prescription opioids, such as the risk of
initiating use of heroin and other illegal opioids.
• Screening,
assessment, and treatment planning for opioid use disorder is explored in
detail, as is the pathophysiology, clinical signs, and management of opioid
withdrawal.
• The epidemiology, pathophysiology, and toxicology of
opioid-related overdose are covered, guiding clinicians in key principles of
overdose management—from evaluation to treatment to prevention. Readers will
learn about the pharmacology and clinical use of the main opioid overdose
reversal agent, naloxone, as well as the toxic profiles of the most common
opioids implicated in overdose deaths.
• The social determinants of the
opioid epidemic are addressed from historical, demographic, and
socioeconomic perspectives, as well as the pharmaceutical marketing-related,
regulatory, and governmental policy-oriented factors that shape health
disparities around opioid addiction and its consequences.
• Harm
reduction programs, including syringe access programs, overdose prevention
education (including naloxone training and dispensing), education for safe
injection practices, and facilitating access to opioid agonist treatment,
are thoroughly explored. Harm reduction strategies that clinicians can use
with individual patients are also discussed.
The American Opioid Epidemic: From Patient Care to Public Health provides an in-depth look at clinical and public health approaches to this epidemic from both psychiatric and medical perspectives and gives mental health professionals the big picture necessary to understand the epidemic, as well as the clinical detail required to help patients avoid or overcome opioid addition.
MEDICAL / Psychiatry / General
The American Opioid Epidemic is an outstanding effort by clinician experts to inform clinicians about the utility of and how to organize the evaluation and treatment of patients with OUDs. It is much better than most multi-authored texts in terms of its organization and overall reader friendliness, and I am glad to have it in my library.
— Mark S. Gold, M.D.
Michael T. Compton, M.D., M.P.H., is Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons in New York City.
Marc W. Manseau, M.D., M.P.H., is Clinical Assistant Professor of Psychiatry at New York University School of Medicine in New York City.
Foreword
Preface
Acknowledgments
Chapter 1.
From Fields of Poppies to a National Crisis
Chapter 2. Prescription
Opioids
Chapter 3. Heroin and Other Illicit Opioids
Chapter 4.
Opioid Overdose, Toxicity, and Poisoning
Chapter 5. The Opioid Epidemic:
Social Determinants and Health Inequities
Chapter 6. Opioid Use Disorder
and Medical Comorbidity
Chapter 7. Opioid Use Disorder and Psychiatric
Comorbidity
Chapter 8. Assessment and Care of Patients With Opioid Use
Disorder
Chapter 9. Opioid Withdrawal Management and Transition to
Treatment
Chapter 10. Medication-Assisted Treatment for Opioid Use
Disorder
Chapter 11. Psychosocial Approaches to the Treatment of Opioid
Use Disorder
Chapter 12. Harm Reduction: Caring for People Who Misuse
Opioids
Chapter 13. Prevention of Opioid Misuse and Addiction Through
Policy Approaches
Chapter 14. Performance Measures and Quality
Improvement for the Opioid Epidemic
Index