In America, we usually talk about opioids in the context of addiction, overdose, and the criminal consequences of illicit use. And for good reason: from 1999 to 2018, more Americans died from opioid overdose than U.S. soldiers who died in both World Wars combined.

But there is a quieter, slower epidemic lurking behind the scenes that deserves equal attention: the link between opioid use and chronic disease. Far too often, opioids prescribed to manage pain from chronic conditions such as arthritis or diabetes end up making these conditions worse — by masking symptoms and disease progression rather than treating the root cause — while instigating new chronic conditions, from cardiovascular disease to metabolic dysfunction.