When it comes to opioids, our greatest quandary is whether continuous use helps people with chronic pain, or whether the risks are too great. We know that some chronic pain suffers get comfort from opioids, but we also know that widespread and indiscriminate use of long-term opioids can lead to societal degradation. What has the widespread use of long-term opioid analgesics in some countries taught us? What has basic science taught us? Research in both areas points to the endogenous opioid system playing a key role in the development of persistent pain, opioid wanting, and high risk of adverse outcomes. This session explores the reasons that understanding the endogenous opioid system is vital for understanding what happens to individuals and to society when exogenous opioids intrude upon natural opioid functions.

Learning Objectives:

• Upon completion, participants will be able to appreciate why we see adverse selection, that being the phenomenon whereby individuals with the greatest demand for opioid pain treatment also present the greatest risk for adverse outcomes.
• Upon completion, participants will be able to recognize that over use of exogenous opioids can overwhelm opioid-based survival mechanisms that may be perceived largely by their absence.
• Upon completion, participants will be able to apply knowledge of endogenous opioid actions to clinical decision making when treating chronic pain.