Drug Use and Substance Abuse Disorder versus Chronic Pain

Abstract

A quarter of the US adult population suffers from chronic pain – up to 25 million of them at levels of severity termed “high impact” by US public health agencies. Likewise, 48.5 million Americans (about 18% of the population over 12) have an unrelated but diagnosed substance use disorder, which includes addiction to drugs or alcohol. There is substantial overlap between these groups -- but not because patients frequently become addicts. Both groups are now substantially under-served by clinicians and/or community-based programs of clinical treatment or management.  We also know that street drug users rarely appear in clinics, and if they do then it is most commonly for treatment of medical complications like abscesses and infectious endocarditis.  The author reviews evidence from multiple sources, to demonstrate that misdirected public health policy and indeed outright misinformation long known to US public health agencies have been major contributors to the ongoing criminalization of doctors who treat pain and to deaths by suicide of tens of thousands. This presentation builds upon a previous session at the SYNC-2026 harms reduction conference of March 2026: “An Indictment of US Public Health Policy for Treatment of Pain”. [6] The work is expanded to characterize the so-called “War on Drugs” as an abject and entirely predictable failure that has deeply damaged the credibility of public health agencies at both US Federal and State levels. The work is supported by 30 references.