A Review of the Opioid Epidemic: What Do We Do About It?

Edward A Shipton, Elspeth E Shipton, Ashleigh J Shipton, Edward A Shipton, Elspeth E Shipton, Ashleigh J Shipton

Abstract

The opioid epidemic, with its noticeable increase in opioid prescriptions and related misuse, abuse and resultant deaths in the previous 12 years, is a particularly North American phenomenon. Europe, and particularly low- and middle-income countries, appear to be less influenced by this problem. There is undisputable value in using opioids not only in the treatment of acute pain, but in cancer pain as well. However, opioids are progressively being prescribed more and more for chronic non-cancer pain, despite inadequate data on their efficacy. In this paper, we describe the current prevalence of opioid misuse in a number of countries and the rationale for the commencement of opioid therapy. The safe initiation and monitoring of opioid therapy as well as the need for concurrent use of interdisciplinary multimodal therapy is discussed. The possible consequences of long-term use and predictors of high opioid use and overdose are presented. In particular, the management of opioid use disorders and the prevention of opioid abuse and dependence in the young, the old and the pregnant are discussed. Measures to prevent overprescribing and to alleviate risk are described, including the tapering of opioids and the use of opioid deterrents. Finally, the paper looks at the future development of pioneering medications and technologies to potentially treat abuse. In those parts of the world with an opioid epidemic, coroners and medical examiners, private and public health agencies, and agencies that enforce the law need to cooperate in an effort to slow down and reverse the indiscriminate use of prescribing opioids in the long-term for chronic non-cancer pain. Ongoing research is needed to create ways to minimise risks of opioid use, and to provide evidence for effective strategies for treating chronic pain.

Keywords: Acquisition; Long-term opioid therapy; Opioid epidemic; Safe initiation; Use and abuse.

References

    1. Julien N, Lacasse A, Labra O, Asselin H. Review of chronic non-cancer pain research among Aboriginal people in Canada. Int J Qual Health Care. 2018
    1. Wilson-Poe AR, Morón JA. The dynamic interaction between pain and opioid misuse. Br J Pharmacol. 2018
    1. Häuser W, Wolfe F, Henningsen P, Schmutzer G, Brähler E, Hinz A. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population—a cross-sectional survey. BMC Public Health. 2014;14:352. doi: 10.1186/1471-2458-14-352.
    1. Andrew R, Derry S, Taylor RS, et al. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Pract. 2014;14:79–94. doi: 10.1111/papr.12050.
    1. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6(6):e010364. doi: 10.1136/bmjopen-2015-010364.
    1. Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24(6):521–527. doi: 10.1097/AJP.0b013e318169d03b.
    1. Clark DJ, Schumacher MA. America’s opioid epidemic: supply and demand considerations. Anesth Analg. 2017;125(5):1667–1674. doi: 10.1213/ANE.0000000000002388.
    1. Lamvu G, Feranec J, Blanton E. Perioperative pain management: an update for obstetrician–gynecologists. Am J Obstet Gynecol. 2018;218(2):193–199. doi: 10.1016/j.ajog.2017.06.021.
    1. Häuser W, Petzke F, Radbruch L, Tölle TR. The opioid epidemic and the long-term opioid therapy for chronic noncancer pain revisited: a transatlantic perspective. Pain Manag. 2016;6(3):249–263. doi: 10.2217/pmt.16.5.
    1. Häuser W, Schug S, Furlan AD. The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents. Pain Rep. 2017;2(3):e599. doi: 10.1097/PR9.0000000000000599.
    1. Pergolizzi JV, Jr, LeQuang JA, Taylor R, Jr, Raffa RB, NEMA Research Group Going beyond prescription pain relievers to understand the opioid epidemic: the role of illicit fentanyl, new psychoactive substances, and street heroin. Postgrad Med. 2018;130(1):1–8. doi: 10.1080/00325481.2018.1407618.
    1. Justice USDo. 2016 National drug threat assessment summary Washington (DC): Drug Enforcement Administration; 2016. Available from: .
    1. Chang KC, Wang JD, Saxon A, Matthews AG, Woody G, Hser YI. Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan. Int J Drug Policy. 2017;43:1–6. doi: 10.1016/j.drugpo.2016.12.003.
    1. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445–1452. doi: 10.15585/mmwr.mm655051e1.
    1. Manchikanti L, Helm S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Opioid epidemic in the United States. Pain Physician. 2012;15(3):9–38.
    1. Drug overdose deaths in the United States continue to increase in 2015. Atlanta (GA): Centers for Disease Control and Prevention; 2016. Available from: . Accessed December 20, 2017.
    1. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–906. doi: 10.1097/MLR.0000000000000625.
    1. Manchikanti L, Boswell MV, Hirsch JA. Lessons learned in the abuse of pain-relief medication: a focus on healthcare costs. Expert Rev Neurother. 2013;13(5):527–543. doi: 10.1586/ern.13.33.
    1. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Available at: . Accessed February 16, 2018.
    1. Dispensing of prescription opioids in Canada has increased steadily since 2000, from 10,209 defined daily doses per million population per day in 2001–2003 to 30,540 in 2012–2014. International Narcotics Control Board (INCB) Narcotic drugs: estimated world requirements for 2004, statistics for 2002. United Nations Publication Sales. 2004;No.T:.16.XI.2.
    1. International Narcotics Control Board (INCB) Narcotic drugs: estimated world requirements for 2016—statistics for 2014. United Nations Publication Sales. 2016;No. T:16.XI.2.
    1. Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, Agoritsas T, Akl EA, Carrasco-Labra A, Cooper L, Cull C, da Costa BR, Frank JW, Grant G, Iorio A, Persaud N, Stern S, Tugwell P, Vandvik PO, Guyatt GH. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659–E666. doi: 10.1503/cmaj.170363.
    1. International Narcotics Control Board (INCB). Report 2016 Narcotic drugs: estimated world requirements for 2017; statistics for 2015. United Nations Publications, New York; 2015. . Accessed April 12, 2017.
    1. Karanges EA, Buckley NA, Brett J, Blanch B, Litchfield M, Degenhardt L, Pearson SA. Trends in opioid utilisation in Australia, 2006–2015: Insights from multiple metrics. Pharmacoepidemiol Drug Saf. 2018
    1. Faculty of Pain Medicine. Recommendations regarding the use of opioid analgesics in patients with chronic non-cancer pain—position statement. . Accessed December 20, 2017.
    1. Pergolizzi JV, Jr, LeQuang JA, Berger GK, Raffa RB. The basic pharmacology of opioids informs the opioid discourse about misuse and abuse: a review. Pain Ther. 2017;6(1):1–16. doi: 10.1007/s40122-017-0068-3.
    1. Schubert I, Ihle P, Sabatowski R. Increase in opiate prescription in Germany between 2000 and 2010: a study based on insurance data. Dtsch Arztebl Int. 2013;110:45–51.
    1. Werber A, Marschall U, L’hoest HW, Moradi B, Schiltenwolf M. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Physician. 2015;18(3):E323–E331.
    1. Reinecke H, Sorgatz H. S3 guideline LONTS. Long-term administration of opioids for non-tumor pain. Schmerz. 2009;23:440–447. doi: 10.1007/s00482-009-0839-9.
    1. Hauser W, Bock F, Engeser P, et al. Recommendations of the updated LONTS guidelines. Long-term opioid therapy for chronic noncancer pain. Schmerz. 2015;29:109–130. doi: 10.1007/s00482-014-1463-x.
    1. Zin CS, Chen LC, Knaggs RD. Changes in trends and pattern of strong opioid prescribing in primary care. Eur J Pain. 2014;18(9):1343–1351. doi: 10.1002/j.1532-2149.2014.496.x.
    1. Cooper AJM, Willis J, Fuller J, Benecke H, Leighton-Scott J, Andersohn F, Kim J, Maier C, Knaggs RD. Prevalence and incidence trends for diagnosed prescription opioid use disorders in the United Kingdom. Pain Ther. 2017;6(1):73–84. doi: 10.1007/s40122-017-0070-9.
    1. Neutel CI, Skurtveit S, Berg C, Sakshaug S. Trends in prescription of strong opioids for 41–80 years old Norwegians, 2005–2010. Eur J Pain. 2014;18(3):438–446. doi: 10.1002/j.1532-2149.2013.00374.x.
    1. Shipton EE, Shipton AJ, Williman JA, Shipton EA. Deaths from opioid overdosing: implications of Coroners’ inquest reports 2008–2012 and annual rise in opioid prescription rates. Pain Therapy. 2017;6(2):203–215. doi: 10.1007/s40122-017-0080-7.
    1. Häuser W, Schubert T, Scherbaum N, Tölle T. Guideline-recommended vs high-dose long-term opioid therapy for chronic noncancer pain is associated with better health outcomes: data from a representative sample of the German population. Pain. 2018;159(1):85–91. doi: 10.1097/j.pain.0000000000001067.
    1. Jena AB, Goldman D, Weaver L, Karaca-Mandic P. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ. 2014;19(348):g1393. doi: 10.1136/bmj.g1393.
    1. Substance Abuse and Mental Health Services Administration . Results from the 2013 National Survey on drug use and health: summary of national findings, NSDUH, MD. Rockville: Substance Abuse and Mental Health Services Administration; 2014.
    1. Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269. doi: 10.15585/mmwr.mm6610a1.
    1. Cheatle MD. Prescription opioid misuse, abuse, morbidity, and mortality: balancing effective pain management and safety. Pain Med. 2015;16(Suppl 1):S3–S8. doi: 10.1111/pme.12904.
    1. Ballantyne JC. Avoiding opioid analgesics for treatment of chronic low back pain. JAMA. 2016;315(22):2459–2460. doi: 10.1001/jama.2016.6753.
    1. Häuser W, Bock F, Engeser P, Tölle T, Willweber-Strumpfe A, Petzke F. Long-term opioid use in non-cancer pain. Dtsch Arztebl Int. 2014;111(43):732–740.
    1. Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;10:CD012509.
    1. Centers for Disease Control and Prevention Public Health Service US Department of Health and Human Services Guideline for prescribing opioids for chronic pain. J Pain Palliat Care Pharmacother. 2016;30(2):138–140. doi: 10.3109/15360288.2016.1173761.
    1. Manchikanti L, Abdi S, Atluri S, Balog CC, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2—guidance. Pain Physician. 2012;15(3 Suppl):S67–S116.
    1. Finnerup NB, Attal N, Haroutounian S, McNicol E, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173. doi: 10.1016/S1474-4422(14)70251-0.
    1. Dale R, Edwards J, Ballantyne J. Opioid risk assessment in palliative medicine. J Community Support Oncol. 2016;14(3):94–100. doi: 10.12788/jcso.0229.
    1. Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle B, Di Capua P, Chou R. Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain. Ann Intern Med. 2014;160(1):38–47. doi: 10.7326/0003-4819-160-1-201401070-00732.
    1. Ministry of Health New Zealand, available from . Accessed December 20, 2017.
    1. Manchikanti L, Abdi S, Atluri S, Balog CC, Benyamin RM, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part I-evidence assessment American Society of Interventional Pain Physicians. Pain Physician. 2012;15(3 Suppl):1–65.
    1. Warner EA. Opioids for the treatment of chronic noncancer pain. Am J Med. 2012;125(12):1155–1161. doi: 10.1016/j.amjmed.2012.04.032.
    1. Agarin T, Trescot AM, Agarin A, Lesanics D, Decastro C. Reducing opioid analgesic deaths in America: what health providers can do. Pain Physician. 2015;18(3):E307–E322.
    1. Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A, National Opioid Use Guideline Group Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations. Can Fam Physician. 2011;57(11):1269–1276.
    1. Frank JW, Levy C, Matlock DD, Calcaterra SL, Mueller SR, Koester S, et al. Patients’ perspectives on tapering of chronic opioid therapy: a qualitative study. Pain Med. 2016;17:1838–1847. doi: 10.1093/pm/pnw078.
    1. Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23(2):63–75. doi: 10.1097/HRP.0000000000000075.
    1. Cobb B, Liu R, Valentine E, Onuoha O. Breastfeeding after anesthesia: a review for anesthesia providers regarding the transfer of medications into breast milk. Transl Perioper Pain Med. 2015;1:1–7.
    1. Chou R, Gordon DB, de Leon- Casasola OA, Rosenberg JM, Bickler S, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, executive committee, and administrative council. J Pain. 2016;17:131–157. doi: 10.1016/j.jpain.2015.12.008.
    1. Kaiser U, Kopkow C, Deckert S, et al. Developing a core outcome-domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome-domains. Pain. 2018
    1. Chou R, Turner JA, Devine EB. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276–286. doi: 10.7326/M14-2559.
    1. Volkow ND, Koroshetz W. Lack of evidence for benefit from long-term use of opioid analgesics for patients with neuropathy. JAMA Neurol. 2017;74(7):761–762. doi: 10.1001/jamaneurol.2017.0466.
    1. Lee M, Silverman SM, Hansen H, et al. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–161.
    1. Low Y, Clarke CF, Huh BK. Opioid-induced hyperalgesia: a review of epidemiology, mechanisms and management. Singapore Med J. 2012;53(5):357–360.
    1. Rivata C, Ballantyne J. The dark side of opioids in pain management: basic science explains clinical observation. Pain Rep. 2016;570:1–9.
    1. Weber L, Yeomans DC, Tzabazis A. Opioid-induced hyperalgesia in clinical anesthesia practice: what has remained from theoretical concepts and experimental studies. Curr Opin Anaesthesiol. 2017;30(4):458–465. doi: 10.1097/ACO.0000000000000485.
    1. Dunn KE, Barrett FS, Yepez-Laubach C, Meyer AC, Hruska BJ, Petrush K, Berman S, Sigmon SC. Opioid overdose experience, risk behaviors, and knowledge in drug users from a rural versus an urban setting. J Subst Abuse Treat. 2016;71:1–7. doi: 10.1016/j.jsat.2016.08.006.
    1. Boscarino JA, Kirchner HL, Pitcavage JM, Nadipelli VR, Ronquest NA, Fitzpatrick MH, Han JJI. Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system. Subst Abuse Rehabil. 2016;7:131–141. doi: 10.2147/SAR.S108302.
    1. Chou R, Deyo R, Devine B et al. The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence report/technology assessment no. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under contract no. 290-2012-00014-I). AHRQ publication no. 14-E005- EF. Rockville, MD: Agency for Healthcare Research and Quality (2014). .
    1. Peck KR, Ehrentraut JH, Anghelescu DL. Risk factors for opioid misuse in adolescents and young adults with focus on oncology setting. J Opioid Manag. 2016;12(3):2015–2016.
    1. Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. Consensus Report, National Academy of Sciences, July 2017.
    1. Vissers KCP, Besse K, Hans G, Devulder J, Morlion B. Opioid rotation in the management of chronic pain: where is the evidence. Pain Pract. 2010;10(2):85–93. doi: 10.1111/j.1533-2500.2009.00335.x.
    1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States. MMWR Morb Mortal Wkly. 2016;65:1–49.
    1. Bonnie RJ, Kesselheim AS, Clark DJ. Both urgency and balance needed in addressing opioid epidemic: a report from the National Academies of Sciences, Engineering, and Medicine. JAMA. 2017;318(5):423–424. doi: 10.1001/jama.2017.10046.
    1. Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, Dischinger HR, Dobscha SK, Krebs EE. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: a systematic review. Ann Intern Med. 2017;167(3):181–191. doi: 10.7326/M17-0598.
    1. Berna C, Kulich RJ, Rathmell JP. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90:828–842. doi: 10.1016/j.mayocp.2015.04.003.
    1. Ihongbe TO, Masho SW. Prevalence, correlates and patterns of heroin use among young adults in the United States. Addict Behav. 2016;63:74–81. doi: 10.1016/j.addbeh.2016.07.003.
    1. Webster JR, Markman J, Cone EJ, Niebler G. Current and future development of extended-release, abuse-deterrent opioid formulations in the United States. Postgrad Med. 2017;129(1):102–110. doi: 10.1080/00325481.2017.1268902.
    1. New Zealand Population Statistics. . Accessed March 21, 2017.
    1. Blanch B, Buckley NA, Mellish L, Dawson AH, Haber PS, Pearson SA. Harmonizing post-market surveillance of prescription drug misuse: a systematic review of observational studies using routinely collected data (2000–2013) Drug Saf. 2015;38(6):553–604. doi: 10.1007/s40264-015-0294-8.
    1. Modesto-Lowe V, Swiezbin K, Chaplin M, Hoefer G. Use and misuse of opioid agonists in opioid addiction. Cleve Clin J Med. 2017;84(5):377–384. doi: 10.3949/ccjm.84a.16091.
    1. Volkow ND, Collins FS. The role of science in addressing the opioid crisis. N Engl J Med. 2017;377(4):391–394. doi: 10.1056/NEJMsr1706626.
    1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly. 2016;64(50–55):1378–1382. doi: 10.15585/mmwr.mm6450a3.
    1. Pergolizzi JV, Jr, LeQuang JA. Abuse-deterrent formulations of opioid analgesics. Pain Pract. 2014;14(3):204–206. doi: 10.1111/papr.12093.
    1. Mueller SR, Walley AY, Calcaterra SL, Glanz JM, Binswanger IA. A review of opioid overdose prevention and naloxone prescribing: implications for translating community programming into clinical practice. Subst Abus. 2015;36(2):240–253. doi: 10.1080/08897077.2015.1010032.
    1. Günther T, Dasgupta P, Mann A, Miess E, Kliewer A, Fritzwanker S, Steinborn R, Schulz S. Targeting multiple opioid receptors—improved analgesics with reduced side effects. Br J Pharmacol. 2018
    1. IASP statement on opioids, February 2018. Available at: . Accessed March 10, 2018.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa