The Opioid Crisis: a Comprehensive Overview

Abstract

Alarmingly, the overwhelming majority of opioid abusers begin their addiction with prescription medications, primarily for chronic pain. Chronic postoperative pain, which occurs in 10-50% of surgical patients, is a major concern in many types of surgery. Nationwide, the medical community has made it a priority to ensure that postsurgical analgesia is sufficient to control pain without increasing non-medically appropriate opioid use. The opioid epidemic remains a significant pressing issue and will not resolve easily. Numerous factors, including the inappropriate prescription of opioids, lack of understanding of the potential adverse effects of long-term therapy, opioid misuse, abuse, and dependence, have contributed to the current crisis.

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

“…The opioid epidemic extends to the pediatric population, with evidence indicating that deaths from drug overdose in adolescents more than doubled from 1999 to 2007 and have continued to rise, with the majority of deaths due to opioid‐related drug overdoses . Most adolescents who abuse opioids began with a prescription opioid and many transitions that occur during adolescence, including neurobiological, behavioral, and psychological changes can leave adolescents vulnerable to both chronic pain and drug use . Thus, adolescents are a particularly at‐risk population in the context of the opioid epidemic.…”

“…There have been many policy changes and trends over the past decade in an effort to combat the opioid crisis. These include guidelines for providers who prescribe opioids, prescription‐drug monitoring programs, and investment into prevention and treatment programs . In addition, the National Institutes of Health (NIH) launched a new scientific initiative to fund research to help combat the opioid crisis, focusing on prevention and intervention efforts to reduce mortality, identification of novel interventions to treat opioid addiction, and identification of safe nonaddictive alternatives to the management of chronic pain .…”

TRPV1 in experimental autoimmune prostatitis

“…9 Since chronic pain is predominantly treated with opioids that generate undesired side effects (eg, addiction), the research community is desperately seeking nonopioid drugs to treat chronic pain. 11,12 There is a large body of literature indicating that the nonselective cation channel known as transient receptor potential vanilloid 1 (TRPV1) mediates the effects of some stimuli that elicit pain, hyperalgesia, and inflammation. [13][14][15] The TRPV1 channel is found in neurons, epithelial cells, mast cells, and several other immune cells.…”

Semimechanistic Population Pharmacokinetic Model to Predict the Drug–Drug Interaction Between S‐ketamine and Ticlopidine in Healthy Human Volunteers

“…The so‐called “opioid crisis”2 emphasizes the need to reduce opioid use and to search for ways to improve multimodal analgesia in pain therapy. Activation of N‐methyl‐D‐aspartate (NMDA) receptors may play a crucial role in the pathogenesis of chronic pain,3 and, therefore, orally administered ketamine, a potent NMDA receptor antagonist, has been used to treat complex chronic pain 4.…”

“…A semimechanistic population pharmacokinetic model provides an intuitive way to apply a dynamic approach to account for a time-varying inhibition process and sources of unexplained interindividual variability (IIV) based on in vivo data, as highlighted previously. [15][16][17] We have reanalyzed our S-ketamine data with the aim of developing a population pharmacokinetic model that could: (1) account for the complex metabolic processes, which constitute the metabolism of S-ketamine to norketamine; (2) adequately predict the concentration-time course of S-ketamine and its primary metabolite norketamine, and of ticlopidine; and (3) mechanistically account for the DDI between Sketamine and ticlopidine and accurately predict the rise in Sketamine plasma concentrations after ticlopidine predosing.…”