The RCPsych Article of the Month for August is ‘The opioid crisis fuelled by health systems: how will future physicians fare?‘ and the blog is written by author, Mark Mohan Kaggwa, and the article is published in BJPsych International.

The opioid crisis is a complex and multifaceted problem that affects millions of people around the world. It is not only a medical issue, but also a social, economic, cultural, and educational one. As psychiatry trainees from different parts of the globe, we wanted to share our perspectives on the opioid crisis and how to improve our practice and education in this field.

We started our discussion with cases that illustrate the diversity and complexity of the opioid crisis. One case was from Uganda, where a man developed an opioid use disorder and sexual dysfunction after being prescribed tramadol for abdominal pain. The other case was from Canada, where a resident encountered a patient who were receiving opioids for emotional and psychological pain associated with difficult life circumstances. These cases raised several questions for us: How do we understand the causes and consequences of opioid use and misuse? How do we assess and treat patients with opioid use disorders? How do we prevent and manage the harms of opioids in our communities? How do we learn from each other’s experiences and contexts?

We realized that the opioid crisis is not a uniform phenomenon, but rather a dynamic and evolving one that varies across regions, cultures, and populations. We also learned that medical education plays a crucial role in shaping our understanding and response to the opioid crisis. We reflected on our medical school learning and found that emphasis was made on pain management using opioids but rarely was focus given to management of opioid use disorder following this. We realised that this education system generates more victims than it can support due to the disproportionate numbers of physicians who end up treating opioid use problems compared to those who remain as the main prescribers. As future psychiatrists, we envisioned a burden that may be too big to handle by the already small number of psychiatrists globally. With further interactions and dive into the literature, we noticed that this is almost fueled by a health system that mainly considers stopping of pain at all consequences no matter the nature. To worsen the situation, pharmaceutical companies are using this to their benefit by promoting the numbing of pain through their various marketed molecules. This experience provided us with a new lens as regards to the opioid crisis. We acknowledged that we need to engage in reflective practice and lifelong learning that can foster our professional growth and development. And we need to collaborate with our colleagues and mentors from different disciplines and regions who can offer us valuable insights and feedback.

The opioid crisis is a global problem that requires a global solution. As psychiatry trainees, we have a unique opportunity and responsibility to learn from the opioid crisis and to contribute to its resolution. By sharing our perspectives and experiences, we hope to inspire other learners and educators to join us in this endeavor. Together, we can make a difference in the lives of those affected by the opioid crisis.

The widespread and inappropriate prescription of opioids to manage chronic pain has fostered a scandal in the United States, where more than 100,000 people died from a drug-involved overdose in 2021, representing a five-times increase in drug-related deaths over the past 20 years. Yet the USA is not alone; the second most affected country is Scotland, followed by Canada. Of course, it is not only Western societies that are affected by this crisis, but we lack data for most other regions. The management of this situation troubles young psychiatrists, who are faced with having to manage an epidemic of addiction. Kaggwa and colleagues write about their concerns, emphasising the dilemma with which they anticipate being confronted later in their professional careers. Whilst fellow physicians provide pain-relief with opioids more freely than is appropriate to satisfy patient demands, those prescribers are not the ones confronted by a responsibility to manage the potential consequences of their actions.

David Skuse

Editor-in-Chief, BJPsych International