Weekly Mind Reader: The Opioid Industry’s Legacy

On the cusp of the holidays, we’ve got commentary on the legacy of opioids, new insight into neuropsychological testing, and gender differences in PTSD.

A Generation of Prescribed Suffering

The Journal of Clinical Psychiatry this week published a commentary condemning the opioid industry’s extensive campaign to ramp up prescriptions. And the epidemic of opioid use disorder (OUD) that followed.

The recently published revised methodology of the National Survey on Drug Use and Health (NSDUH) has uncovered an underreported prevalence of prescription opioid use disorder (POUD).

Under the sway of a powerful industry lobby, the original survey excluded patients who took opioids as prescribed. This perpetuated the myth that OUD is a rarity among these patients.

The new methodology now estimates that 5 million Americans suffer from POUD, with nearly two-thirds of them – 62 percent – taking opioids as prescribed.

This challenges the persistent narrative that downplayed the risks of POUD while it misrepresented physiological dependence as a benign (and distinct) phenomen from OUD. Physiological dependence develops rapidly, often within days, leading to withdrawal symptoms that reinforce continued use. These symptoms, along with neuroplastic brain changes, explain why many patients prescribed opioids experience POUD, even if they’re not necessarily abuse the drugs.

The opioid industry actively whitewashed these risks through misinformation campaigns, influencing medical guidelines, policymakers, and public perception. For years, they portrayed aggressive opioid prescribing as a good, thing. And they blamed any harmful side effects on the “abusers.” 

This misled clinicians and left the ignored patients struggling with severe addiction.

Today, many clinicians hesitate to prescribe high doses of opioids. But they still underestimate the challenges patients face when they try to get off the drugs.

The revised NSDUH findings suggest that millions of patients suffering from POUD are victims of misinformation, not efforts to curb prescriptions. This underscores the need for better treatment and a better understanding of the challenges these patients face.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• A new PCC case series presents several patients who underwent formal neuropsychological testing that failed to diagnose dementia, but whose findings appeared consistent with the diagnosis.
• JCP has new research on the factors that drive gender differences in PTSD.
• An update on how Reunion Neuroscience is advancing maternal mental health care with RE104.
• Catch up on our latest updates in Emerging Approaches in Schizophrenia.
• And, finally, get caught up on the latest trauma research.