Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Abstract

The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid‐related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US‐driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non‐existent access to opioids for pain relief. Over 25 million people are at the end‐of‐life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US‐based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage. Significance The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

Neurogenic inflammation as a novel treatment target for chronic pain syndromes

“…Opioids, such as morphine, that target the Mu opioid receptor are among the most common treatments for acute pain management, but chronic usage leads to tolerance and physical dependence. Thus, alternative Mu opioid receptor agonists that do not induce tolerance and dependence need to be identified (Berger and Whistler, 2010;Kreek et al, 2019;Miyachi et al, 2021). The opioid crisis in the United States has undoubtedly shown the limits of such therapies, and the need for nonaddictive drugs is pressing.…”

Prevalence of and Risk Factors for Prescription Opioid Misuse, Abuse, Diversion and Doctor Shopping in Japan: A Survey Study

“…In the main survey, misuse was identified in 45.5%, abuse in 24.5%, diversion in 15.0%, and doctor shopping in 10.6% of survey respondents. These findings are specific to Japan and of considerable interest given the general perception by Japanese physicians that aberrant prescription opioid-taking behavior is rare [ 15 ].…”

“…Moreover, because Japanese physicians have lower opioid prescribing practices for both acute and chronic noncancer pain than US physicians [12,13], Japan has not experienced the dramatic increase in opioid consumption documented in other countries [14]. Many Japanese physicians thus consider misuse or abuse of opioid analgesics in Japan to be rare [15]. However, in view of increasingly prolonged cancer survival which may lead to long-term opioid therapy, surveillance is required.…”

Analysis of anticholinergic adverse effects using two large databases: The US Food and Drug Administration Adverse Event Reporting System database and the Japanese Adverse Drug Event Report database

“…For instance, opioids are major suspected drugs of CNS in JADER. In Japan, the prescription and inventory management of opioids has always been under very strict control by law, and their indications are limited mostly to cancer pain and some types of chronic pain [ 47 ]. Consequently, regarding the AE reports of opioids in JADER, it is considered that the AEs induced by appropriate usage (constipation, delirium, etc.)…”