Solutions to end pandemic and opioid crises

Words on a page should provoke not only thought but also action. ¹ They might also inspire hope. It might be hard to see hope in an opioid crisis that affects patients and health systems globally, with new data showing the impact on hospital care, ² but solutions are possible. ³ One of those is to distinguish acute from chronic pain, and use opioids to support people with poorly controlled acute pain while weaning people with chronic pain off opioids.

That still leaves the complex management challenge of treating the underlying cause of pain, and perhaps opioids manage failures of care as much as they manage a patient’s pain? Chronic pain may involve psychological and social factors which are hard to address properly in a time pressured service, but complex problems rarely come with simple solutions.

Take the pandemic transition to endemicity, for example. ⁴ Reading the word “endemicity” certainly provokes thought but it isn’t clear what actions should follow. Questions do follow, however. What do we mean by endemicity? How will we know when it has arrived? And what will we do about it?

We attempt to answer these questions in this month’s JRSM, with a clear plan of action. It’s a plan that leans heavily on traditional public health. Even what that old school public health involves may be unclear? It shouldn’t be. The principles of a public health response to an infectious disease are long established but easily overlooked. ⁵

Teachers are part of a pandemic public health response, but too many have felt alienated by government policies. The nexus of health and education is an absolute reality and an opportunity, but it’s an opportunity we miss because compartmentalising different sectors is how most political systems work. ⁶ The same applies to chronic pain where physical, psychological, and social issues are best considered together.

Clinicians are familiar with dealing with complexity but working across sectors and disciplines also requires systems level support. And it is this systems level support that would truly inspire hope.