This article covers general actions undertaken by Middlesex to combat the opioid crisis, including restricting and monitoring opioid prescribing practices and suggesting the use of MAT. Several comments stand out including one psychiatrist’s observation that during a career in which he has treated over 1,000 heroin addicts, not one of them started with heroin — they all began with a prescription opioid.

Another doctor relays her experience in training during the time period when pain had been elevated to the “5th vital sign.” She was instructed to ask patients daily about their pain levels and based on the response prescribe whatever was needed to treat their pain. The result? She is quoted as noting “… we started prescribing huge amounts of opiates.”

These highlight in a practical way the role both prescription drugs and prescribing practices contributed to our current problem. Although practices are changing, little evidence exists to suggest that the errors and root causes that resulted in the current crisis have been completely eliminated from the system — a reality that makes moves to open up access to new opioids disconcerting.