Alternatives to Opioids

Opioid-related lawsuits are expected to generate more than $50 billion in settlement funds for states and localities to remediate the catastrophic consequences of the opioid crisis. Guidance on the distribution of settlement funds has primarily focused on reducing opioid-related deaths and other opioid-related harms and on improving treatment for substance use disorders. However, an effective approach to this crisis will also require primary prevention strategies to reduce unnecessary opioid initiation, particularly through effective pain management. Although numerous strategies have been implemented to slow the issuance of opioid prescriptions, little attention has been given to providing effective nonopioid alternatives for people in pain at the point when they initially seek care. This lack of a preventive focus represents a dangerous gap given that pain remains a leading reason people seek health care.

Upstream prevention strategies are a vital aspect of any successful multidimensional plan to stem the tide of the opioid crisis and to make communities whole. This paper outlines recommendations for opioid settlement funds to also be directed toward strategies that decrease clinically unnecessary opioid use, specifically by better leveraging evidence-based, nonpharmacological pain management.