Confronting the opioid epidemic through publication, promotion, and dissemination of evidence-based addiction scholarship

In the last few years, US policymakers and health care stakeholders have become increasingly concerned with the rise of opioid-related morbidity and deaths. They have enacted many health policies and innovative, community-based initiatives in response. For example, recent US Centers for Disease Control and Prevention (CDC) guidelines stress caution before initiating opioid treatment for noncancer pain and warn that excessive opioid doses may be particularly deleterious to patient health.^1,2 Although some of these recommendations have merit, the quality of peer-reviewed evidence for others is underwhelming.

Similarly, health care providers and communities have adopted a range of strategies to address this public health crisis. These strategies include the use of opioid-related risk assessment tools, risk mitigation tools, opioid disorder and opioid risk screening instruments, and naloxone rescue initiatives.³ Again, although there is some support for the efficacy of these activities, more research is needed regarding the utility of wide-scale adoption of specific strategies. Although it is understandable that stakeholders want to do “something” about problematic opioid use, just doing something is likely not as effective as selecting an evidence-based intervention.

Furthermore, in cases where health care providers have some idea of what might help a patient with an addiction disorder, there are often patient-, provider-, and system-level barriers that prevent access to this care. For example, a patient may be identified as having problematic opioid use, but may lack access to medication-assisted treatment for addiction. Furthermore, the stigma associated with having an addiction disorder prevents many individuals from beginning and successfully completing treatment.^4–6 There exist enormous challenges for providing access to high-quality, evidence-based care. More published evidence regarding the efficacy, effectiveness, and implementation strategies of addiction interventions are sorely needed.

There is great variety in the ways that clinicians, researchers, administrators, and policymakers understand and treat opioid addiction. On the one hand, a plurality of treatments and perspectives makes sense and enriches our work, given the complex nature of addiction disorders. On the other hand, too often addiction treatment is driven by personal bias, pseudoscience, or the “flavor of the week.” This can both limit treatment success for individuals and hold back progress in the field as a whole. Thus, to whatever extent possible, our views and our work must be informed by good science. Although strides have been made, many questions remain unanswered. Many barriers to care remain standing; there is much work to be done.

At the Substance Abuse journal, the Editorial Office takes great pride at disseminating the latest evidence regarding the identification, assessment, and treatment of persons with addictive disorders. An editor's primary responsibility is to make sure that published work is of the highest quality. The journal's recent exponential rise in the Thomson Reuters Impact Factor (currently at 2.576, 5-year Impact Factor 2.364) indicates that the journal is increasingly meeting this mission.

But to influence the health and welfare of patients, just publishing the science is not enough. Distributing the results of the published science through social media (e.g., Twitter, https://twitter.com/SubstanceAbuseJ, Facebook, https://facebook.com/substanceabusejournal), Web sites (blog posting, https://amersa.org/journal/blog), and our affiliated organizations (Association for Medical Education and Research in Substance Abuse [AMERSA], International Society of Addiction Medicine [ISAM], and the International Coalition for Addiction Studies Education [INCASE]) enables our published work to reach audiences that can impact addiction policy, education, research, and health service delivery. Thus, although publishing work is important, the application of that publication into real-world settings is the ultimate result that the editor should strive for. We hope to increase efforts to disseminate our work in innovative ways in the next few years. The authors who publish their work in our journal and the patients who might be impacted deserve these efforts and stewardship.

Acknowledgments

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the authors affiliated institutions, the Department of Veterans Affairs, or the United States government.