Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update

Abstract

Objective Prescription opioid abuse and dependence have escalated rapidly in the United States over the past 20 years, leading to high rates of overdose deaths and a dramatic increase in the number of people seeking treatment for opioid dependence. The authors review the scope of the abuse and overdose epidemic, prescription practices, and the assessment, treatment, and prevention of prescription opioid misuse and dependence. Method The authors provide an overview of the literature from 2006 to the present, with the twin goals of highlighting advances in prevention and treatment and identifying remaining gaps in the science. Results A number of policy and educational initiatives at the state and federal government level have been undertaken in the past 5 years to help providers and consumers, respectively, prescribe and use opioids more responsibly. Initial reports suggest that diversion and abuse levels have begun to plateau, likely as a result of these initiatives. While there is a large body of research suggesting that opioid substitution coupled with psychosocial interventions is the best treatment option for heroin dependence, there is limited research focusing specifically on the treatment of prescription opioid dependence. In particular, the treatment of chronic pain in individuals with prescription opioid use disorders is underexplored. Conclusions While policy and educational initiatives appear to be effective in decreasing prescription opioid abuse and misuse, research focusing on the development and evaluation of treatments specific to prescription opioid dependence and its common comorbidities (e.g., chronic pain, depression) is critically needed.

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

“…Similar to this, previous studies report that patients with opioid use disorder are overrepresented in ED settings. 1,12,25,26 This could be due to the individual or combined effects of complex medical conditions, injury, or overdose, 26 which have large impact on the burden of disease and are some of the more persistent barriers to improving overall health outcomes among patients with opioid use disorder. 15 Consequently, ED settings offer important opportunities to identify patients with opioid use disorder and initiate treatment.…”

Evaluation of a Predictive Algorithm that Detects Aberrant Use of Opioids in an Addiction Treatment Centre

“…Prescriptions for opioids began increasing in the late 1990's when doctors were urged to improve their treatment of patients suffering from pain [4]. More than 30% of Americans have some type of acute or chronic pain and persistent pain is estimated to cost $560-$635 billion annually due to healthcare costs, lost productivity, and lower wages [5][6][7].…”

Inhibition of α9α10 nicotinic acetylcholine receptors prevents chemotherapy-induced neuropathic pain

“…However, the unprecedented and epidemic use of opioids to treat chronic nonmalignant pain has resulted in a broad range of problems, including an estimated 12 million Americans who currently abuse or are addicted to prescription opioids, with tens of thousands of overdose deaths (1,2). To deal with this crisis, recent US Health and Human Services efforts have targeted physician-prescribing practices, medicationassisted treatments for addiction, and distribution of opioid antagonist kits to enable attempts to reverse opioid overdose, with billions of dollars expended annually in these efforts (2,3). In the long term, however, greater impact on therapy would arise from discovery and development of medications based on nonopioid mechanisms that can effectively treat chronic pain, and that may additionally have disease-modifying actions on chronic pain.…”