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.
That is why it is notable that, last month, the Food and Drug Administration announced new draft guidance designed to accelerate the development of safe, effective non-opioid treatments for chronic pain.
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America is not simply experiencing a crisis of addiction or overdose. It is a slower, quieter epidemic that undermines the health of millions of Americans. It devastates families in rural and low-income communities and hits veterans especially hard: people in rural areas are significantly more likely to be prescribed opioids; low-income patients suffer an outsize share of opioid deaths; and veterans, our nation’s prized heroes, face higher burdens of chronic pain and opioid-related risks than most Americans. These are precisely the communities that already bear the brunt of the chronic disease crisis to begin with.
Dependence also doesn’t have to end in overdose to be tragic. It can be a slow, grinding process that stretches on for years, eroding health, independence, and quality of life. This is the crisis that was addressed at a roundtable earlier this month on opioids and chronic disease that brought together lawmakers, policy analysts, veterans, and family members rocked by addiction and the slow toll of opioids on long-term health. Patients who never overdose still pay a steep price — lost jobs, disability, depression — and the cascading effects of chronic illness worsened or were initiated by years of opioid use.
Encouragingly, even with a government shutdown currently in place, these concerns are beginning to surface more prominently in national health conversations and actions. The FDA’s draft guidance, issued in September, is an important step forward. It lays out a clearer regulatory path for drug developers to bring non-opioid pain management therapies to market more quickly and effectively. By emphasizing innovative trial design, patient-centered measures, and rigorous evaluation, the agency is sending a signal: the 1 in 5 U.S. adults who rely on opioids for chronic pain deserve better options.
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Hopefully, we are beginning to see a paradigm shift in how pain management and opioid use are approached. For decades, our systems have rewarded interventions that manage symptoms — too often with addictive drugs — rather than investing in prevention and patient-centered care. The FDA’s new guidance is an exciting glimmer that the conversation could finally be turning. If these efforts deliver, patient-focused outcomes and non-addictive treatments will move from the margins to the foundation of a healthier future.
While resolving the opioid crisis will take time, it is significant that chronic illness and opioid alternatives are drawing such attention from the highest levels of government. Let’s make sure that the FDA’s guidance is not just another announcement buried in the news cycle, but that it is celebrated as a hopeful step forward for a new era where patients are not handed a risky bottle of pills, but are offered real alternatives and real hope. We owe it to the millions still struggling to carry that vision forward.
Nora Kenney is the director of communications at End Chronic Disease.
