Global Supply and Demand of Opioids for Pain Management

Kunnumpurath, Sreekumar; Julien, Natasha; Kodumudi, Gopal; Kunnumpurath, Anamika; Kodumudi, Vijay; Vadivelu, Nalini

doi:10.1007/s11916-018-0689-1

Cited by 19 publications

(12 citation statements)

References 26 publications

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“…Despite the fact that global demand for opioids has increased significantly in the past 20 years (1), the international availability and acceptability of opioids for pain management varies considerably. A recent study reported that the majority of the world’s population has insufficient access to opioids for pain management (2, 3), with only 7.5% of people having adequate opioid access and 66% of people having little to no access (4). Some of the myriad reasons for limited opioid access include differences in provider practices and healthcare system operations, financial barriers, cultural beliefs regarding pain management, and/or variations in opioid-related regulations (5–7).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

et al. 2019

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Background: Tramadol is an opioid-analgesic that has shown epidemiological evidence of abuse. This review evaluates the evidence for tramadol abuse potential in humans. Methods: A systematic literature search for human abuse liability examinations of tramadol was conducted in September 2018 and yielded 13 total studies. Studies were all within-subject, double-blind, placebo-controlled human laboratory comparisons of tramadol to opioid comparators. Results are organized based upon the route of tramadol administration (oral, parenteral) and the participant population (persons with and without current opioid physical dependence). Outcomes were categorized into self-report ratings of positive and negative effects, observer-ratings of effects, time course of effects, likelihood tramadol was identified as an opioid, and tramadol self-administration. Results: Results indicated the relative abuse potential of tramadol was lower than the opioids to which it was compared. Tramadol produced highest positive effect ratings when administered orally to persons with no opioid physical dependence. Relative to other opioids, it produced substantial negative ratings, generally demonstrated a slower onset of effects, and was less likely to be identified by participants as an opioid, though it did produce a higher rate of self-administration relative to other opioids in the one study reporting that outcome. Results suggest that the abuse potential of tramadol is highest when it is administered orally to non-dependent individuals, and that it likely decreases as the dose increased and when it was administered parentally or to persons with opioid physical dependence. Conclusion: Taken together, individuals may be less likely than with other opioids to escalate tramadol doses, transition from oral to parenteral routes of administration, or continue using tramadol once opioid physical dependence develops. In that way, the human abuse potential of tramadol appears to be different from and lower than other opioid analgesic medications.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

et al. 2019

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“…When providers in other countries did prescribe outpatient medications for pain, it was more likely to be acetaminophen or ibuprofen first, followed by less potent opioids like tramadol. This difference in prescribing habits could be due to more availability of opioids in the US as evidenced by the fact that the US is one of the nations that consumes the highest percentage of the world's opioids [18] or because US physicians were more comfortable prescribing opioids. However, this difference in practice is very important to explore as it relates to overall outcomes in SCD, frequency of acute care utilization, and quality of life for affected individuals.…”

Section: Discussionmentioning

confidence: 99%

International Differences in Outpatient Pain Management: A Survey of Sickle Cell Disease

El-Amin

Nietert

Kanter

2019

JCM

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Vaso-occlusive pain crises are the hallmark of sickle cell disease (SCD) and the primary reason for health care utilization. Both national and international guidelines recommend aggressive intravenous opioids, intravenous fluids and anti-inflammatory therapy as the mainstay of treatment for acute SCD pain. However, many vaso-occlusive crises are managed at home with oral medication and supportive care. There are no guidelines on home medication management of SCD-related pain, likely due to the lack of well-defined endpoints for acute events and the lack of funding for already approved pain medications. Amplifying this issue is the growing concern for opioid abuse and misuse in the United States (US) and internationally. This study aimed to evaluate differences in opioid prescribing practices among providers treating SCD in the US and internationally. A survey was disseminated electronically to known providers using a combination of purposive and snowball sampling strategy. There were 127 responses and 17 countries represented. US providers were more likely to prescribe opioids (p < 0.001) and were more likely to be “very comfortable” prescribing opioids than non-US prescribers (p < 0.001). US providers also tended to prescribe more tablets per patient of stronger opioids than non-US physicians. US physicians were more likely to be concerned that patients were abusing opioids than non-US physicians (32% vs. 27%, p < 0.05). There are significant variations in how different parts of the world manage pain in the outpatient setting for SCD. Identifying optimal home pain management strategies is necessary to improve care and long-term outcomes in SCD.

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“…In Canada, prescription opioid analgesics (POAs) increased in all provinces from 2005 to 2011 [3]. More than 90% of licit morphine is used by roughly 20% of the global society, primarily in the US, Canada, Germany and Australia, and approximately 66% of the world' s population have almost no access to opioids, despite having a high disease burden from conditions and illnesses known to cause pain [4]. Increased access to POAs in the US and Canada has done more than treat pain-it has spurred a regional epidemic of opioid-related deaths.…”

Section: The Opioid Crisis In North America: Causes and Impactsmentioning

confidence: 99%

Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

Furlan¹,

Harvey²,

Chadha³

2020

Journal of Global Health

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Global Supply and Demand of Opioids for Pain Management

Cited by 19 publications

References 26 publications

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

International Differences in Outpatient Pain Management: A Survey of Sickle Cell Disease

Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

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