Chasing the Dragon: Driving the Paradigm Shift to Move Beyond Opioids.

"Chasing the dragon" is a term that originated 150 years ago in China after the Opium Wars to refer to the act of heating opium and inhaling its vapor. The phrase has a second meaning, describing the dangerous pursuit of the mythical, ultimate high. However, health systems are using opioids in the pursuit of something likely mythical but similarly elusive - a passive treatment for pain that is rapid, effective, and safe. Regrettably, this worldwide pursuit is treacherous on an immense scale. The opioid crisis is more severe in the US than in any other country. This may be due, in part, to a cultural problem related to pain: Americans have come to expect quick, easy, physician-provided pain relief. We must admit that pharmaceuticals can neither cure injuries nor correct the underlying cause of any chronic musculoskeletal condition. Fortunately, people who regularly exercise have less pain, and guidelines for the management of painful chronic conditions already recommend exercise therapies over passive care. This suggests that self-care approaches emphasizing exercise are the logical, lowest-cost, first-line approach. For patients requiring guidance with exercise, the stepped care approach to pain management commonly taught in medical school curricula should include guided physical rehabilitation early, if not first. This has been shown to be associated with fewer high-cost services and less opioid medication. Keeping people opioid-naïve, when appropriate, might save tens of thousands of American lives annually and many more globally. Attitudes, behaviors, and policies must evolve to shed the culture of first-line pharmaceutical pain management. J Orthop Sports Phys Ther, Epub 19 Oct 2020. doi:10.2519/jospt.2020.10210.