Considerations in Addressing the Opioid Epidemic and Chronic Pain within the USA

Marshall, Blaine; Bland, Michelle; Hulla, Ryan; Gatchel, Robert J.

doi:10.2217/pmt-2018-0070

Cited by 42 publications

(26 citation statements)

References 41 publications

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“…These changes might be related to a transition in the public perception of cannabis and attitudes towards cannabis. 104,105 A survey enrolling approximately 1000 participants, among whom two-thirds were diagnosed with chronic pain, in the US found a level of 75% symptom relief with cannabis prescription. In the same study, over one-third of the near 2600 qualitative responses conveyed health benefits of the medical cannabis in treating their condition.…”

Section: Making Sense Of Current Guideline Recommendationsmentioning

confidence: 99%

Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use?

Johal

Vannabouathong²,

Chang³

et al. 2020

Therapeutic Advances in Musculoskeletal

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The treatment of chronic, non-cancer musculoskeletal pain has become a topic growing interest as it is believed to be one of the reasons for the current opioid epidemic. The medicinal use of cannabis has a long history as a number of active compounds in cannabis have been shown to interact with the body’s endocannabinoid system to reduce pain. This position paper provides a history on the evolution of cannabis, the science behind its therapeutic effects, and review of the evidence and current guideline recommendations on its use as a treatment for patients with chronic, non-cancer musculoskeletal pain. Results from systematic reviews have demonstrated a statistically significant reduction in chronic pain conditions with cannabinoids, compared with placebo, although the effects might be considered small and did not reach the minimally important difference. More adverse events were reported in the cannabinoid group than in the placebo group with longer than 2 weeks of treatment. There is a lack of evidence on dependence. With changes to policies, patients’ perception has changed to be more positive toward the use of medical cannabis. Current recommendations from North America, Latin America, Europe, Australia and Iran support the use of medical cannabis for chronic, non-cancer pain. Based on the current evidence, it is our position that cannabinoids may be considered as an adjunctive therapy after recommended first- and second-line therapies have failed to provide sufficient efficacy or tolerability. Patients should consider the balance between the desirable and undesirable effects of taking cannabis for chronic pain, and comprehensively consider their own values and preferences, as well as cost-effectiveness factors, based on the information provided by their physician.

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Section: Making Sense Of Current Guideline Recommendationsmentioning

confidence: 99%

Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use?

Johal

Vannabouathong²,

Chang³

et al. 2020

Therapeutic Advances in Musculoskeletal

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“…El uso indiscriminado de estos medicamentos está generando un importante problema de salud en países desarrollados, como la denominada epidemia de opiáceos en Estados Unidos (EEUU) más de 250.000 muertos (Guardia Serecigni, 2018;Marshall, Bland, Hulla y Gatchel, 2019;Skolnick, 2018). Esta epidemia y todas sus consecuencias no pueden ser explicadas sólo mediante propiedades farmacológicas de las sustancias, sino que responden a muy diferentes circunstancias psicosociales, culturales y económicas, que no siempre se han tenido en cuenta (Kolodny et al, 2015).…”

Section: Introductionunclassified

Consumo de fármacos opiáceos en la ciudad de Madrid: Factores sanitarios y sociodemográficos asociados

et al. 2020

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ResumenAbstract original adicciones vol. xx, nº x · 2020 El consumo de analgésicos opiáceos ha provocado una situación de emergencia sanitaria y social en Estados Unidos. En España, según datos oficiales, la prescripción de estos fármacos ha experimentado un espectacular ascenso en la última década. Este estudio explora la prevalencia del uso de estos fármacos y las características sanitarias y sociodemográficas de sus consumidores en la ciudad de Madrid. Se realizó una encuesta telefónica aplicando un muestreo estratificado y aleatorizado, en la que se preguntó por el uso de estos fármacos y si fueron médicamente prescritos o no. La muestra estuvo compuesta por n= 8.845 sujetos de edades entre 15 y 98 años. Un 16,0% declara haber usado estos fármacos en el último año y un 9,1 los toma en las dos últimas semanas. El consumo es más frecuente en mujeres, clase social baja y menor nivel de estudios. El grupo más joven (15-29 años) ya lo usa en el 12,5%. Quienes usan opioides refieren peor salud percibida, menor calidad de vida, más problemas de salud mental, más soledad no deseada, más uso de otros psicofármacos, más frecuente uso diario de tabaco y menos consumo problemático de alcohol. Un 10% de quienes los usan lo hacen sin prescripción médica. Combinando estos datos con los de prescripción ofrecidos por el Ministerio de Sanidad, resulta necesario prestar atención a un problema que puede hacerse patente en los próximos años, aconsejando la adopción de medidas urgentes para atajarlo antes de que aproxime la situación española a la ya bien conocida en otros países. Palabras clave: Opiáceos; Adicción; Encuesta de salud; Salud mental;Psicofármacos.The use of opiate analgesics has led to a health and social emergency in the United States. In Spain, according to official data, the prescription of these drugs has risen dramatically in the last decade. This study explores the prevalence of the use of these drugs and the health and socio-demographic characteristics of their consumers in the city of Madrid. A telephone survey was carried on a stratified, randomised sample, asking about the use of these drugs and whether or not they were medically prescribed. The sample consisted of n=8,845 subjects aged between 15 and 98 years. Sixteen percent stated that they had used these drugs in the last year and 9.1% had taken them in the last two weeks. Consumption was more frequent among women, lower social class and lower level of education. Among the youngest group (15-29 years old) 12.5% had already used it. Those who use opioids report worse perceived health, lower quality of life, more mental health problems, more loneliness, more use of other psychoactive drugs, more frequent daily use of tobacco and less problematic consumption of alcohol. Ten percent of those who use them do so without a doctor's prescription. Combining these data with the prescription data offered by the Ministry of Health, it is necessary to pay attention to a problem that may become apparent in the coming years, and the adoption of urgent measures to tac...

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“…[4][5] Over the past two decades, opioid prescriptions for the treatment of chronic pain have risen dramatically despite their reduced effectiveness against chronic pain states. 3,6 Unfortunately, the prolonged use of opioid analgesics elicits numerous adverse effects including respiratory depression, tolerance, and dependence. [1][2][3] Increased prescription and duration of use of short and long-acting/extended release opioids, combined with the side effect profile of opioid medications, has led to the current opioid epidemic characterized by >40,000 opioid overdose deaths per year since 2016.…”

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confidence: 99%

“…16 Notably, anecdotal reports indicate that, unlike traditional opioid analgesics, akuamma does not elicit euphoria, tolerance, or dependence. The analgesic effects of P. nitida seeds have been generally attributed to a class of indole alkaloids known as the akuamma alkaloids composed of akuammine (1), akuammidine (2), pseudo-akuammigine (3), akuammicine (4), akuammiline (5), and picraline (6) (Figure 1). 17 In standard nociception assays, both the ethanolic extract of P. nitida and isolated 3 demonstrated antinociceptive properties.…”

mentioning

confidence: 99%

Isolation and Pharmacological Characterization of Six Opioidergic Picralima nitida Alkaloids

Creed¹,

Gutridge²,

Argade³

et al. 2020

Preprint

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The seeds of the akuamma tree (Picralima nitida) have been used as a traditional treatment for pain and fever. Previous studies have attributed these effects to a series of indole alkaloids found within the seed extracts; however, these pharmacological studies were significantly limited in scope. Herein, an isolation protocol employing pH-zone-refining countercurrent chromatography is developed to provide six of the akuamma alkaloids in high purity and quantities sufficient for more extensive biological evaluation. Five of these alkaloids, akuammine, pseudo-akuammigine, picraline, akuammicine, and akuammiline, were evaluated against a panel of >40 central nervous system receptors to identify that their primary targets are the opioid receptors. Detailed in vitro investigations revealed one alkaloid as a potent kappa opioid receptor agonist and three alkaloids with micromolar activity at the mu opioid receptor. The mu opioid receptor agonists were further evaluated for analgesic properties but demonstrated limited efficacy in assays of thermal nociception. These findings contradict previous reports of the antinociceptive properties of the akuamma alkaloids and the traditional use of akuamma seeds as analgesics. Nevertheless, their opioid preferring activity does suggest the akuamma alkaloids provide distinct scaffolds from which to develop novel opioids with unique pharmacologically properties and therapeutic utility.

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Considerations in Addressing the Opioid Epidemic and Chronic Pain within the USA

Cited by 42 publications

References 41 publications

Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use?

Medical cannabis for orthopaedic patients with chronic musculoskeletal pain: does evidence support its use?

Consumo de fármacos opiáceos en la ciudad de Madrid: Factores sanitarios y sociodemográficos asociados

Isolation and Pharmacological Characterization of Six Opioidergic Picralima nitida Alkaloids

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