14 “A cultural shift in the prescribing habits of physicians from being opioid phobic to prescribing opioids liberally, spurred by alleged evidence of under-treatment of pain, availability of newer long-acting opioid formulations with good bioavailability, aggressive marketing techniques by drug manufacturers, disregard for the lack of long- term effectiveness, biased guidelines developed by authorities, physician ignorance with respect to the use potential of opioids, and promulgation of reassuring implicit messages by well-meaning “pain experts” that misuse, addiction, and diversion were not key issues in the practice of pain medicine, led to an exponential increase in the number of patients who were treated with opioids. The problem compounds further with the lack of physician training on key issues such as recognizing drug diversion, addiction, and signs of excessive use; recent estimates suggest that only 20% of US physicians have received such training.” There is no definitive count of how many people in the U.S. suffer from an opioid use disorder, but the National Security Council has estimated that the number addicted to prescription or illicit opioids in 2016 was over 2 million.6 The CDC estimates 48.5 million Americans have used illicit drugs or misused prescription narcotics.7 A Pew Research Center study in August 2017 discovered that 46 percent of all adult Americans know or knew a family member or friend who suffers from a substance use disorder. There is a potential for a very high return on investment for developing a program that significantly reduces the instances of opioid use disorder. The impact on individuals with this problem is beyond quantification, negatively affecting everything from relationships to income to the quality and length of life. And, of course, the damage extends to the family and to society in general. “The cost of the country’s opioid crisis is estimated to have exceeded $1 trillion from 2001 to 2017, and is projected to cost an additional $500 billion by 2020,” according to a careful analysis released by Altarum, a nonprofit health research and consulting institute.8 Even those alarming numbers may be low. In November 2017, the President’s Council of Economic Advisors undertook a detailed study of the economic impact of the opioid crisis and estimated the cost in 2015 alone was a total of $504 billion.9