Shoshana Herzig, MD, MPH

In part 2 of this episode of Crisis Point, 4 experts on pain and opioid misuse discuss continuing efforts to turn the tide.

Crisis Point: Turning the Tide in The Opioid Crisis

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

Addressing the Opioid Crisis: Efforts to Turn the Tide

This episode examines the growing and evolving opioid crisis, a public health emergency that has claimed more than half a million lives over the past 2 decades in the United States.

What began as a prescribing-driven epidemic has evolved into a more complex crisis fueled by the proliferation of illicit synthetic opioids, persistent gaps in access to treatment, and social determinants that drive vulnerability to substance use disorder.

In 2023, the overall rate of mortality from drug overdoses slightly fell for the first time since 2018.

 The decrease could be due to a number of factors, including new pharmaceutical options for treating opioid use disorder, a shift away from opioid prescribing regimens, regulatory and advocacy action, and even the COVID-19 pandemic. While the decrease is a positive sign for those working with OUD, overdose deaths related to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine remain at historic highs and the work is only beginning.

Be sure to check out part 1 of this episode, which into the complex challenges surrounding OUD, exploring how the opioid crisis has evolved and grown in recent years and how new pharmaceuticals and prescribing regimens may be helping to turn the tide.

In part 2, the conversation shifts to ongoing advocacy and regulatory action and significant progress in turning the tide in the opioid crisis so far.

Brief descriptions of the speakers featured in this project are provided below:

Angel Goenawan, MD, hospitalist at Bayhealth in Delaware

Bobby Mukkamala, MD president-elect of the American Medical Association (AMA) and chair of the AMA’s Substance Use and Pain Care Task Force

Michele J. Buonora, MD, MS, MSHS, assistant professor of medicine, Albert Einstein College of Medicine, Montefiore Einstein

Shoshana Herzig, MD, assistant professor of medicine, Harvard Medical School and Beth Israel Deaconess Medical Center

For more video content, visit our Crisis Point page to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

U.S. Overdose Deaths Decrease in 2023, First Time Since 2018. Webpage. CDC. May 15, 2024. 

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm

AMA Substance Use and Pain Care Task Force recommendations. Webpage. AMA. 2025. 

https://www.ama-assn.org/delivering-care/nation-s-overdose-epidemic/ama-substance-use-and-pain-care-task-force

HHS Announces Transformation to Make America Healthy Again. Webpage. HHS. March 27, 2025. 

https://www.hhs.gov/press-room/hhs-restructuring-doge.html

More than a dozen states, DC sue Trump administration over ‘dismantling’ of federal health agencies. Webpage. CNN. May 5, 2025. 

https://www.cnn.com/2025/05/05/health/states-sue-trump-administration-hhs-rfk

Videos

In part 1 of this episode of Crisis Point, 4 experts on pain and opioid misuse discuss the evolving public health crisis.

Crisis Point: Prevention and Treatment in the Evolving Opioid Epidemic 

The Opioid Epidemic: Trying to Turn the Tide on an Evolving Issue

Prescribing practices have begun to change in recent years, with opioid prescriptions decreasing by 49.4% nationwide since 2012.

 This shift is supported by emerging research and is important for addressing the public health crisis, as prescription opioids are no longer the primary driver in developing OUD but can still play significant role in its development.

Other efforts to curb the crisis have included expanding access to naloxone and improving options and access for medication-assisted therapy for opioid use disorder, and approvals such as suzetrigine, a non-opioid pain option, and a labeling expansion of buprenorphine for treating opioid use disorder (OUD).

 These advances continue to shape the care landscape along with advocacy and regulatory reforms, although barriers to progress remain.

 Notably, naloxone prescription rates have remained low even for individuals at risk of OUD.

Part 1 of this episode of Crisis Point delves into the complex challenges surrounding OUD, exploring how the opioid crisis has evolved and grown in recent years and how new pharmaceuticals and prescribing regimens may be helping to turn the tide.

Office of the Commissioner. FDA approves novel non-opioid treatment for moderate to severe acute pain. U.S. Food and Drug Administration. January 30, 2025. Accessed January 30, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain.

Indivior Announces FDA Approval of Label Changes for SUBLOCADE® (buprenorphine extended-release) Injection. 

https://www.prnewswire.com/news-releases/indivior-announces-fda-approval-of-label-changes-for-sublocade-buprenorphine-extended-release-injection-302382920.html

In part 1 of this episode of Crisis Point, 4 experts on pain and opioid misuse discuss the evolving public health crisis.



Herzig discussed special considerations for treating pain in people with OUD.

Balancing Pain Management and OUD in the Hospital, with Shoshana Herzig, MD

Managing acute pain in patients with opioid use disorder (OUD) remains one of the most complex challenges in hospital medicine. These patients often face under-treatment of pain, contributing to high rates of premature discharge and incomplete medical care. Clinicians also need to consider factors like medications for OUD, such as buprenorphine, in their pain management regimens.

Shoshana Herzig, MD, MPH, Associate Professor of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, gave a talk at the 

American College of Physicians (ACP) Internal Medicine (IM) Meeting 2025

, held April 3-5, in New Orleans, Louisiana, reviewing current best practices and the most updated data supporting strategies for effective and safe acute inpatient pain management. One special population of consideration in pain management is patients with opioid use disorder (OUD), which Herzig also touched on in her talk.

 sat down with Herzig during the conference to learn more about the latest strategies for managing pain, especially in patients with OUD. She noted that management is generally similar but includes considerations like balancing medications for treating OUD with analgesics. She also mentioned new emerging strategies for pain management in this population, including dose-splitting of pain medications and microdosing of buprenorphine.

“You don't want to send them out of the hospital without managing their OUD, but you also don't want to precipitate withdrawal. And so microdosing of buprenorphine is becoming more [common]. Patients across the country are becoming more familiar with that, although that still usually requires involvement of Addiction Medicine consult.

Herzig S. Acute Pain Management in the Inpatient Setting. Presented at: ACP IM Meeting 2025; April 3-5; New Orleans, Louisiana.

Herzig outlined a talk she gave at the ACP Internal Medicine 2025 meeting reviewing the latest data in acute inpatient pain management.

Opioids or NSAIDS? Current Pain Management Best Practices, with Shoshana Herzig, MD, MPH

Effective pain management remains a cornerstone of inpatient care, yet practice patterns often vary widely—and not always in ways that reflect current evidence. Despite the availability of multiple pharmacologic options, many clinicians default to familiar regimens rather than tailoring treatment based on safety, efficacy, and patient-specific factors.

, held April 3-5, in New Orleans, Louisiana, reviewing current best practices and the most updated data supporting strategies for effective and safe acute inpatient pain management.

“One of the main messages in my talk… is to remind people that NSAIDs are over the counter for a reason and opioids are not over the counter for a reason, and I think we need to kind of recalibrate our perceptions of risks and benefits as they relate to NSAIDs versus opioids,” Herzig told 

during the meeting. “There's been some emerging data that does support the assertion that we should use NSAIDs more often.”

sat down with Herzig during the conference to learn more about the latest strategies for managing pain, as validated by the literature. She stressed the importance of ensuring consistent pain management strategies between centers and clinicians and also noted widespread, unnecessary NSAID-avoidance by many practitioners, although its use is supported by data. She outlined some recent findings of opioid compared with non-opioid pain management strategies, although she also said that more studies would be beneficial to strengthen the currently available data.

Shoshana Herzig, MD, MPH

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