Structural iatrogenesis—a 43-year-old man with "opioid misuse."

Stonington S, Coffa D. N Engl J Med. 2019;380:701-704

The authors describe how increasing complexity and bureaucracy associated with opioid prescribing led a patient with chronic pain that had been previously well controlled on a stable dose of acetaminophen–hydrocodone for many years to experience job insecurity, withdrawal symptoms, and uncontrolled pain, which ultimately prompted him to seek opioids illegally. The authors refer to this type of harm as "structural iatrogenesis."

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