Disentangling the effects of racism-related stress on opioid use disorder and chronic pain outcomes.

In recent years, Black people in the U.S. have had one of the highest increases in opioid overdose mortality rates, despite being less likely to be prescribed opioids for pain. This population is also less likely to receive medications for opioid use disorder (MOUD). Chronic pain is a central factor in understanding this crisis, as minoritized people are more likely to live with undertreated pain, a major risk factor for developing opioid use disorder (OUD). Current practices fail to effectively treat pain among persons with OUD, a missed opportunity that is worse in minoritized populations and further producing disparities. In this perspective, we discuss how racism-related stress and disparities in addiction treatments may impact the pain experience, diagnosis, treatment, contribute to developing OUD, and perpetuate stigma. This high-level perspective invites clinicians and researchers to reflect on the biopsychosocial burden imposed upon historically minoritized people with pain and OUD. To address such complex issues, multidisciplinary efforts and methodological improvements are required, imbued by antiracist values. Collaboration across disciplines is necessary toward the common goal of improving pain management and mitigating opioid mortality among minoritized populations. As antiracist perspectives inform research practices and cultural humility principles guide care, we will be better equipped to close current gaps in knowledge and address widening healthcare disparities.

Chronic use of benzodiazepines: The problem that persists.

Though clinical guidelines and policies discourage the chronic prescribing of benzodiazepines, rates of prescribing have continued to rise in the United States with an estimated 65.9 million office visits per year made for this purpose. Quietly, we have become a nation on benzodiazepines. There are numerous reasons for this discrepancy between official recommendations on the one hand, and actual clinical practice on the other. Drawing from the literature, we argue that while patients and providers both shoulder some of the responsibility, they cannot be solely blamed. Rather, policies and guidelines regarding benzodiazepine prescribing have become out of touch with the clinical reality that benzodiazepines are now deeply entrenched in modern medicine. We propose that guidelines regarding benzodiazepines need to reconsider how to apply concepts such as harm reduction and other lessons learned in the opioid epidemic in order to help physicians manage this increasingly pressing problem affecting millions of Americans.