Between 1997 and 2002, the sale of oxycodone and methadone quadrupled, spurred by the introduction of pain as the fifth vital sign and pharmaceutical marketing efforts. 1 Concepts such as "staying ahead of the pain" and implementation of quality metrics relating to pain scores led to overzealous opioid prescribing, precipitating the current opioid crisis. Hundreds die daily as a result of overdose, with upwards of 40% directly related to opioid prescription. 2 As a result, the US Department of Health and Human Services has declared a public health emergency. 3 In 2018, the US mortality from opioid overdose surpassed breast cancer mortality. 4 The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) act was passed with bipartisan support in 2018, highlighting the critical nature of research, education, and training to combat the opioid epidemic. 5 Emerging evidence suggests a correlation with the amount of narcotics used and
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