THE OPIOID EPIDEMIC The Origin of the Opioid Abuse Epidemic and the Actions We Must Take to Control It By Christian Bohringer, MBBS Origin of the opioid epidemic In 2001, a national effort was initiated by the Joint Commission, which was then known as the Joint Commission on the Accreditation of Health Care Organizations ( JCAHO), to improve the under-assessment and undertreatment of pain in hospitals. This was considered to be a significant problem in health care at the time. The Joint Commission introduced standards for organizations to improve the care for their patients with pain.1 The perception of undertreatment and the call for more aggressive treatment of pain was primarily based on expert opinion and some literature. An article by Mitchel Max in the Annals of Internal Medicine from 1990 had 72 | CSA Vital Times questioned whether education was enough to improve analgesic outcomes. Dr. Max lamented the introduction of triplicate prescription forms that had reduced the number of opioids prescribed by 50 percent. He also concluded that in order for pain scores to be improved, both patients and prescribers needed to abandon their aversion to opioids and that regulatory requirements for opioid prescriptions should be relaxed.2 A frequently cited letter published in the New England Journal of Medicine was quoted as evidence that developing addiction to opioids is rare when they are used for short-term pain.3 An article by Brennan from Australia went so far as to promote pain management as a fundamental human right and categorize failure to provide adequate pain management as professional misconduct.4 In 1999, the California legislature passed Assembly Bill 791, which stated that "Every health facility licensed shall, as a condition of licensure, include pain as an item