Page 14
Business Patterns. 16 Geospatial Analysis To identify geographic clustering, also known as spatial dependency, we visually examined maps of the relevant variables. We also estimated Moran’s I, a measure of spatial dependency. Moran’s I is on a scale from -1 to 1. A value of -1 means a perfectly negative spatial relationship, meaning a county is likely to have the opposite value of its neighboring counties. A value of 0 means there is no spatial relationship, that is nearby counties have no relationship with one another on the specific variable. A value of 1 means there is a perfectly positive relationship, meaning a county is more likely to have a similar value as its neighbors. Table A3 reports the values for Moran’s I for the measures used in this study. Table A3. Spatial Dependency, Moran’s I Variable Moran's I Poverty rate 0.5843 Unemployment rate 0.6117 Employment to population ratio 0.1401 Per capita retail opioid sales 0.4303 Per capita Medicare Part D opioid prescriptions 0.2208 Opioid-related hospitalization rate 0.4594 Drug overdose death rate 0.4944 Note: All estimates are statistically significant. The current opioid crisis in the USA arose from (at first) successful opioid pain management in three waves, starting in the'90s. Today, USA patients consume opioid drugs on a massive scale. Considering their potential for tolerance, as well as their potential for lethality in relatively small overdose, the overuse of opioids form an urgent threat to public health in the USA. Since the opioid crisis is a complex phenomenon, several stakeholders are needed to tackle the problem. Both public and private stakeholders should collaborate, e.g., in Public-Private Partnerships. Those collaborations should focus on different aspects related to the opioid crisis such as medical and societal (e.g., pain management process, including addressing opioid use disorders), as well as economical and regulatory issues (e.g., incentivizing the search for alternative non-addictive pain medication and banning aggressive marketing tactics used by the pharmaceutical industry). Additionally, collaborations should cover interdisciplinary education and training of various healthcare actors involved. In conclusion, interdisciplinary collaboration on the various opioid abuse-related aspects is urgently needed to tackle the opioid crisis in the USA.Keywords: opioid crisis, pain management, public-private partnerships, USA, a perspectiveThe opioid crisis is a byproduct, and more particularly, an adverse event of medical care (1).The “opioid drug” class contains four categories according to the Centers for Disease Control and Prevention (CDC): (1) natural opioid analgesics, such as morphine and codeine as well as the semi-synthetic opioid analgesics such as oxymorphone, hydrocodone, oxycodone, and hydromorphone, (2) the synthetic opioid methadone, (3) any other synthetic opioid, such as fentanyl and tramadol, and (4) the illegally-made opioid heroin, synthesized from morphine (2). Legally produced opioids are safe, highly effective analgesics and indispensable in modern pain management, when used for a rightful purpose, during supervised therapy and handled by a competent physician (3).In 1986, the World Health Organization (WHO)In 1986, the World Health Organization (WHO) proposed a three-step pain ladder for the treatment of pain (4). The first step comprises non-opioid analgesics, such as paracetamol, aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) for managing mild pain. In the second step come weak-opioids like codeine or tramadol for moderate pain. The third step includes strong opioids such as morphine, fentanyl, and oxycodone (5). Opioids should only be prescribed when non-opioid analgesics and adjuvant therapies were unsuccessful. Additionally, opioids should be dosed as low as possible, achieving pain relief with a minimal level of side effects (3).Dependence is a serious side effect associated with opioid use, which can lead to compulsive use despite negative consequences, a principal characteristic of substance abuse disorders as defined by the Fifth Edition of the Disease and Statistical Manual of Mental Disorders (DSM-5). Opioid use has led to a public health crisis which is characterized