At the turn of the 21st century, pain management emerged as a pressing public health concern, becoming the 5th vital sign in the VA healthcare system.(1) Simultaneously, widespread adoption of opioid prescribing for chronic pain led to a fivefold surge in morphine milligram equivalents by 2010.(2)
In 2013, against this backdrop, the DSM-5 Substance Use Disorder (SUD) workgroup undertook a pivotal reorganization of criteria for substance use disorders, omitting tolerance and withdrawal when medically prescribed.(3)
The ensuing opioid epidemic in the United States challenged the efficacy of long-term opioid therapy for chronic pain. Current guidelines discourage opioid initiation, advocating non-medication and non-opioid approaches.(4,5) Despite this, some patients continue long-term opioid therapy, facing difficulties tapering without significant functional improvement. The medical field is now struggling to characterize this clinical scenario, which has real-world implications on what opioid medications can be used to manage them and even which practice settings they can receive care, and has prompted discourse and research on whether this population warrants classification under mild Opioid Use Disorder (OUD) per DSM-5, or necessitates a novel diagnostic framework.(6,7) This workshop will explore this debate through clinical cases (Edens), historical context on opioid prescribing (7), rationale behind current DSM-5 SUD criteria (Compton)3, and the resulting impetus to form a new diagnosis when harms outweigh benefits for people prescribed opioids (Becker).(6)
Ellen Edens , MD, Chairperson, Presenter
Ellen Edens (pronouns she/her) is an addiction psychiatrist and associate professor in the Department of Psychiatry at the Yale School of Medicine. She is Lead for the Substance-Related and other Addictive Disorders Program of the VA National Expert Consultative and Specialized Services - Mental Health (NEXCSS-MH) and serves as an associate director of the Yale Addiction Psychiatry fellowship, and co-director of two VA Interprofessional Fellowships: one in Addiction Treatment and one in Health Profession Education. Her clinical expertise is in chronic pain and opioid use, where she is co-director of the primary-care based Opioid Reassessment Clinic at VA Connecticut Healthcare System.
Karen Drexler, MD, Co-Chair, Presenter
Associate Professor of Psychiatry at Emory University and an Attending Psychiatrist in the Emory Healthcare Veterans Program.
Wilson Compton , MD, Presenter
Wilson M. Compton, M.D., M.P.E. is Deputy Director of the National Institute on Drug Abuse. Dr. Compton received undergraduate education at Amherst College and medical education, including psychiatry training, at Washington University in St. Louis. Dr. Compton has authored over 250 publications. He was Vice Chair of the DSM-5-TR manual development and has led, for NIDA, development of the Population Assessment of Tobacco and Health Study, jointly sponsored by NIDA and the U.S. Food and Drug Administration (FDA), with 45,971 participants. Dr. Compton has received multiple awards, including the American Psychiatric Association 2008 Senior Scholar Health Services Research Award, the American Psychopathological Association 2010 Paul Hoch Award, FDA awards for collaboration in 2012, 2013 and 2017, and the Health and Human Services Secretary’s Awards for Meritorious Service in 2013 and Distinguished Service in 2015, 2018 and 2019. In 2022 he became a Distinguished Life Fellow of the American Psychiatric Association.
William Becker, MD, Presenter
Dr. Becker is a general internist additionally trained in addiction medicine and pain management who is Professor in the Department of Internal Medicine, Yale School of Medicine and Core Investigator in the PRIME Center of Innovation, VA Connecticut Healthcare System. His research focuses on improving the quality of pain treatment in general medical settings, especially in its overlap with opioid prescribing and co-occurring substance use disorders.