To Diagnose or Not to Diagnose

Image depicts a person with a cast on one hand holding tablets in the other hand.

Image courtesy of iStock Photo.

After the opioid epidemic peaked between 1990 and 2013, the challenge facing healthcare professionals is how to treat patients on long-term opioid therapy (LTOT) who are at risk of addiction. To better comprehend this challenge, Dr. William Becker and his team at the VA Connecticut Healthcare System and Yale School of Medicine invited medical specialists from the U.S. and Europe to discuss potentially creating new diagnostic criteria for patients on LTOT for whom the benefit of the therapy is no longer outweighing the harm, but who may not meet criteria for opiate use disorder (OUD). Specialists who favored the creation of new diagnostic criteria, like Becker, want to shine light on the unique circumstances these patients face. “We did have a substantial minority of experts who said… there should not be a different entity,” Becker said. “We’ve heard from these experts that if we create a new diagnosis, it may… have the unintended consequence of stigmatizing people who have opioid addiction to non-medical sources of opioids.”

In continuing this conversation, Becker strives to incorporate more specialists from diverse racial backgrounds as well as patient voices. “There’s been a strong movement in bringing persons with lived experiences into clinical research. It hasn’t happened much… in terms of thinking of creating diagnostic entities, but it probably should,” he said. Nevertheless, Becker is excited for this conversation to lead to new ways of tackling patient needs. “We have to be proactive earlier,” Becker said. “We can identify this early, give it a name, and then develop protocols for getting appropriate treatment to patients sooner, rather than waiting until more adverse consequences develop.”