The trend of increasing medical use of opioid analgesics to treat pain does not appear to contribute to increases in the health consequences of opioid analgesic abuse.
This study updates a previous analysis of trends in medical use and abuse of opioid analgesics, and provides data from 1997 through 2002. Two research questions were evaluated: 1) What are the trends in the medical use and abuse of frequently prescribed opioid analgesics used to treat severe pain, including fentanyl, hydromorphone, meperidine, morphine, and oxycodone? 2) What is the abuse trend for opioid analgesics as a class compared to trends in the abuse of other drug classes? Results demonstrated marked increases in medical use and abuse of four of the five studied opioid analgesics. In 2002, opioid analgesics accounted for 9.85% of all drug abuse, up from 5.75% in 1997. Increase in medical use of opioids is a general indicator of progress in providing pain relief. Increases in abuse of opioids is a growing public health problem and should be addressed by identifying the causes and sources of diversion, without interfering with legitimate medical practice and patient care.
Misunderstandings regarding the nature and occurrence of addiction have historically been barriers to the appropriate treatment of pain and have stigmatized the medical use of opioids. This article reviews the evolution of nomenclature related to addiction, presents current scientific understanding of addiction that may help shape universally acceptable terminology, and discusses an integrated effort of pain and addiction professionals to reach consensus on addiction-related terms. The article suggests key principles that may clarify terminology including: clear differentiation of the concepts of addiction and physical dependence, conceptualization of addiction as a multidimensional disease, and use of a label for the phenomenon of addiction that does not include the ambiguous term "dependence." More universal agreement on terminology related to addiction is expected to improve the treatment of both pain and addictive disorders; improve communication between health care providers, regulators, and enforcement agencies; and reduce health care and other societal costs.
Physicians' concerns about regulatory scrutiny and the possibility of unwarranted investigation by regulatory agencies negatively affect their prescribing of opioid analgesics to treat pain. Indeed, some state medical boards have rejected prescribing practices that are considered acceptable by today's standards. This article describes a ten-year program of research, education, and policy development implemented by the Pain & Policy Studies Group aimed at updating and clarifying state medical board policies on the use of opioid analgesics to treat pain, including cancer and chronic noncancer pain. Following surveys of medical board members and educational workshops, state medical board policies began an initial period of change, drawing on guidelines from other states, particularly in California. The next phase of policy development was marked by the introduction of Model Guidelines by the Federation of State Medical Boards of the U.S. The Model Guidelines address professional standards for the appropriate prescribing of opioid analgesics for pain management, as well as physicians' fears of regulatory scrutiny. Although most state medical boards have adopted regulations, guidelines, or policy statements relating to controlled substances and pain management, to date ten boards have adopted the Model Guidelines, while ten more have adopted the Model Guidelines in part. Further actions are recommended so that state medical boards can address inadequate pain management and physician concerns about regulatory scrutiny.
In India, a million people with cancer and an unknown number of people with other incurable and disabling diseases, need opioids for pain relief. Only about 0.4% of the population in need have access to them. Major barriers to access to opioids are complicated regulations and problems related to attitude and knowledge regarding pain relief and opioids among professionals and the public. The Pain and Policy Studies Group at Madison Wisconsin has been collaborating with many Indian palliative care workers and government officials to improve availability of opioids to those who need them for pain relief. As a result of this collaborative effort, the Government of India asked all state governments to modify the narcotic regulations following a model given to them. To facilitate the process, the collaboration has conducted workshops in 13 states in association with local champions. Currently, 13 states in India and one union territory have simplified regulations, but opioid availability has improved only in a minority of these states. Establishment of simple standard operating procedures to implement the simplified regulations, advocacy, and improved education of professionals are essential for further improvement of the situation. The past decade has demonstrated that government policy can be changed if palliative care enthusiasts work in tandem with the government. The progress has been slow, but real and encouraging.
Increased abuse and diversion of prescription opioids has been a consequence of the increased availability of opioids to address the widespread problem of undertreated pain. Opioid risk management refers to the effort to minimize harms associated with opioid therapy while maintaining appropriate access to therapy. Management of these linked public health issues requires a coordinated and balanced effort among a disparate group of stakeholders at the federal, state, industry, practitioner, and patient levels. This paper reviews the principles of opioid risk management by examining the epidemiology of prescription opioid abuse in the United States; identifying key stakeholders involved in opioid risk management and their responsibilities for managing or monitoring opioid abuse and diversion; and summarizing the mechanisms currently used to monitor and address prescription opioid abuse. Limitations of current approaches, and emerging directions in opioid risk management, are also presented.
The International Narcotics Control Board consistently reports that, despite an extremely large number of transactions, little or no narcotic drugs are diverted from licit international trade into illicit channels. 1 Most diversion occurs within countries, where governments attempt to prevent diversion during the manufacture and distribution of controlled substances to the retail level (e.g., pharmacies and hospitals). In the United States, diversion occurs despite a closed distribution system of licensing, security, and record keeping.Public dialogue about prescription drug abuse in the United States focuses largely on inappropriate physician prescribing and patient misuse. 2,3 National media reports and high-profile charges against physicians enhance the perception that physician prescribing for pain is the main cause of increases in opioid analgesic abuse.An important but mostly overlooked diversion source involves thefts, including armed robberies, night break-ins, and employee and customer pilferage. The Controlled Substances Act makes thefts of controlled substances from Drug Enforcement Administration (DEA) registrants a federal crime, and requires pharmacists, manufacturers, and distributors to report significant thefts and losses.The authors submitted a Freedom of Information Act request to the DEA to obtain data from Form 106 ''Report of Theft or Loss of Controlled Substances.'' An electronic database was provided with annual data for 2000--2003. Each incident of theft/loss
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.