In the balance: No new diagnosis needed in addition to opioid use disorder to study harms associated with long-term opioid therapy

We propose that a separate diagnosis may cause public health harm, further stigmatizing people with OUD and widening healthcare disparities among vulnerable populations. If there is a silver lining to the opioid crisis, it is that the nation can no longer ignore OUD and its negative impact on individuals, families and communities, including reductions in life expectancy in the United States [1]. Adding a new diagnosis in an attempt to protect long-term opioid therapy for pain (LTOT) patients from stigma may have the unintended consequence of leaving those with more severe OUD behind while those with milder disease enjoy preferential access to life-saving medication. This moment in history offers an important opportunity to remove barriers to care for all patients who have opioid-related harms and yet cannot stop their opioid use without medication treatment. Creating a separate diagnosis for those with prescription OUD may undermine this singular benefit and increase disparities in care for those with illicit OUD who are disproportionately persons in minoritized communities.