The increased morbidity and death from these products is a result of the degree to which they have been prescribed. For example, there are striking parallels between admissions to addiction treatment facilities, overdose deaths, and the volume of opioids prescribed in the United States over the past 15 years . This increase in opioid volume is similarly evident in Canada, Australia and New Zealand, where, as in the United States, increases in opioid prescribing dwarf any plausible changes in the prevalence of pain .
Many factors contribute to high rates of prescribing, including a lack of consensus regarding the appropriate use and dosing of these medicines, demand for the products among patients who have opioid dependency or are otherwise abusing or diverting these products and, in the United States, the rise of for-profit clinics whose physicians may prescribe opioid products cavalierly and beyond the evidence base .
Of course, the prominent role of pharmaceutical companies in advertising opioid pain relievers should not be overlooked, nor the historic under-treatment of pain that has motivated at times well intentioned efforts to improve the use of prescription analgesics, including opioids. Although many of these factors have also contributed to opioid-related morbidity and death beyond the United States, there are other drivers that are unique to particular countries and their systems of healthcare delivery. In many countries, the problem stems in part from a lack of supervised medicines consumption in drug treatment programmes .
For instance, throughout the s, England and Scotland experienced rising numbers of deaths linked to methadone, prescribed almost entirely through opioid substitution programmes. The death toll only began to decline when the UK established regulations requiring methadone consumption to be supervised in treatment centres and community pharmacies . New South Wales, Australia, experienced a similar problem because of regulations allowing patients to leave drug treatment programmes with prescribed methadone.
In other countries, the consumption of opioid pain relievers is closely tied to the availability of heroin .
For example, in , the shortage of heroin on the illegal drug market in Europe resulted in the abuse of illegally produced fentanyl in Estonia . Similarly, this heroin shortage was linked to the rise of illicit buprenorphine use in Finland, where addicts obtained the medicine from maintenance treatment programmes . Even in the United States, the relationship between the availability and abuse of prescription opioids and heroin has become apparent in recent years, as local reductions in opioid prescribing following legislative action have been associated with increased heroin distribution and abuse .
In all countries, drug diversion, defined as the illegal transfer of a pharmaceutical from a legitimate source to an illicit one, is also a significant contributor to the epidemic. From this origin, opioids may enter the black market to be sold by drug dealers, may be taken from the drug cabinets of relatives, or may be shared and traded with friends . The epidemic has been a long time in the making, and there are no magic bullets that will quickly restore a more balanced use of opioids in clinical practice.
Fortunately, it is hard to find a stakeholder that does not acknowledge the scope of the epidemic. And these stakeholders, which in the United States include regulators such as the US Food and Drug Administration FDA , payers such as health plans and large employers, pharmaceutical manufacturers, state policymakers, as well as provider and patient groups, are all active in their own ways in an attempt to address opioid-related injuries and deaths. Although the policy impact of most of these interventions is unclear, those that have been tested have shown mixed results.
Therefore, while this reformulation of a widely abused opioid may have succeeded in reducing its abuse, research suggests that there may have been important unintended consequences from such new technologies . Currently, parts of the United States, Canada, Europe and Australia have implemented these programmes in an effort to curb prescription opioid diversion . Although most of these programmes have yet to be tested for their efficacy, studies of their use in some US states have shown promising results .
Unfortunately, we are still a long way from experiencing the full potential of these programmes. Canada faces a similar problem of having prescription monitoring programmes in many of its provinces but falling short of informing its medical providers of the existence and appropriate use of these programmes . These programmes are intended to help case managers intervene on potentially dangerous situations before they develop, with a goal of reducing healthcare expenditures and improving outcomes, a non-trivial task given that the annual healthcare costs of opioid abusers are on average 6.
Providers and patient groups have responded by spreading awareness of the growing epidemic, calling for changes in how these drugs are labelled, and demanding recall of high potency opioids with a high abuse potential. In the midst of the opioid abuse epidemic, we must acknowledge that both acute and chronic pain remain untreated in most of the world .
Even in the United States, where morphine, oxycodone, and hydromorphone consumption is greater than their combined consumption in all other nations, pain continues to be poorly managed, with disadvantaged populations facing the bulk of this under-treatment . A major part of the solution, then, must begin with addressing knowledge gaps in pain management.
The bulk of this epidemic is driven by the inappropriate treatment of pain, defined through both the under-treatment of pain and the overprescription of opioids in cases where the risks outweigh the benefits. This is especially true for the management of chronic pain, which affects one in five adults worldwide  , and for which there has been much misunderstanding regarding effective treatments . Only once we begin to address the problem of under-education and misinformation in pain management can we begin to curb this epidemic. On account of the addictive nature of opioids, many patients receiving these prescriptions for clinically approved indications develop opioid dependency.
Such information, if verified by additional investigations, would be welcome news, and may lead to a similar turnaround in the rates of injuries and deaths from these products. Such arguments are specious.
High quality care for patients in pain is not threatened by efforts to reduce inappropriate use of opioids. Instead, it is vital that they are only prescribed when necessary. United Nations Office on Drugs and Crime. The prescription drug epidemic in the United States: A perfect storm.
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The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health ;— Can Fam Physician ;— International Narcotics Control Board. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ ;— Prescription opioid abuse in the UK. Br J Clin Pharmacol ;— Extent of illicit drug use and dependence, and their contribution to the global burden of disease. The Lancet ;— The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits.
J Addict Dis ;— Prescription opioid policy: improving management of chronic non-malignant pain and prevention of problems associated with prescription opioid use. Sydney: CDC Vital Signs. July Addiction ;— Opium, sometimes called God's Own Medicine , has been used in this way since the dawn of civilization. The root cause of the prescription drug epidemic, especially in the US, was perhaps not back ache or neck pains, but the need to avoid or mollify bad feelings.
Dispensing Truth: Divine Prescriptions to Restore and Maintain Good Health by Dr | eBay
The drive to become medicalized is not just about opioid painkillers. Cathryn Kemp ran into a wall of opioid painkillers when she was diagnosed with pancreatitis in After a series of operations she was prescribed morphine, then oxycodone for three years and, finally, fentanyl. But while they temporarily relieved my pain, I became dependent on them. The oxycodone made me feel relaxed, like sinking into a warm bath. Because your body is good at metabolizing opioids, you need more of them to get the same effect.
So my dose went up, but the pain never actually went away.
It made my life bearable. I was relaxed in a way I'd never been before. It was a feeling of being in touch with the divine. Are we sleepwalking into a fuzzy oblivion? Is the pain industry beast medicalizing citizens to such an extent that people are gravitating to a state of swapping real life for being comfortably numb? Now we realize the problem is with patients who take them and basically opt out of life," one medical expert told the New York Times reporter Barry Meier, who has written two books on America's OxyContin disaster.
Meier found that, "while opioid painkillers do work for some patients, when workers are treated with high doses of opioid drugs fairly soon after these injuries, it's the leading predictor for them not coming back to work for long periods of time, or ever.
These drugs are not just blocking pain receptors so you don't feel pain. These drugs are depleting people of energy. In Britain, these are dwarfed by the use of anti-depressants, of which 53 million prescriptions were dispensed last year. In short, none of the conditions exist in the UK—in terms of healthcare and the existing illegal drugs market—for the OxyContin epidemic to occur here among either middle-class or seasoned drug addicts.
With no OxyContin epidemic, there is no heroin epidemic. Perhaps, as a society, by expecting our emotional or physical pain to be numbed on demand, we have lost our ability to cope without the use of drugs. In , the Austrian philosopher Ivan Illich, a massive critic of Western medicine, warned of what he called society's " medical nemesis.
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