Kirby reviewed epidemiologic trends, emphasizing the transition from prescription opioids to heroin and, more recently, to illicitly manufactured fentanyl. He underscored fentanyl’s high potency and dose-dependent risk of respiratory depression, explaining the neurobiological mechanism by which opioids suppress ventilatory drive and increase fatal overdose risk.
A major concern involved the proliferation of nonopioid adulterants, including alpha-2 agonists such as medetomidine and emerging synthetic agents such as nitazenes.2 Kirby noted that these substances potentiated opioid effects yet did not respond to naloxone, complicating overdose reversal efforts. He described ongoing collaboration with the Drug Enforcement Administration and regional law enforcement partners to monitor shifting drug supplies, particularly on the east coast.
Kirby also addressed stigma and language in clinical care. He observed that stigma had lessened in recent years and urged clinicians to conceptualize addiction as a chronic medical condition. He stated that substance use disorders should be treated as “chronic brain illnesses, that can be treated, that can be managed, no different than hypertension, diabetes, and, bipolar disorder.” He emphasized sustained patient engagement, long-term treatment, and remission as appropriate clinical goals, aligning OUD management with other chronic diseases.
Dr Kirby is a psychiatrist and chief medical officer of Recovery Centers of America.”
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