A Flood of Opioids, a Rising Tide of Deaths

Georgetown University School of Medicine, Washington, DC, USA.
New England Journal of Medicine (Impact Factor: 55.87). 11/2010; 363(21):1981-5. DOI: 10.1056/NEJMp1011512
Source: PubMed


Faced with an epidemic of drug abuse and overdose deaths, the FDA has proposed a Risk Evaluation and Mitigation Strategy for prescription opioid pain relievers, involving improved education for physicians and patients about risks associated with long-acting opioids.

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    • "Fatal poisonings, most of which are caused by drug overdose , have increased by nearly 600% in the past three decades and are now the leading cause of injury death in the United States (Warner et al., 2011). This rise was initially driven primarily by deaths attributable to opioid painkillers, which nearly quadrupled between 1999 and 2011 and reached over 16,000 in 2013 (Chen et al., 2014; Modarai et al., 2013; Okie, 2010). The country has also seen a dramatic surge in heroinrelated deaths, which increased by nearly 400 percent between 2000 and 2013 to over 8,000 per year (Chen et al., 2015; Hedegaard et al., 2015; Jones, 2013; Pollini et al., 2011; Rudd et al., 2014). "
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    ABSTRACT: Background: Opioid overdose, which has reached epidemic levels in the United States, is reversible by administration of the medication naloxone. Naloxone requires a prescription but is not a controlled substance and has no abuse potential. In the last half-decade, the majority of states have modified their laws to increase layperson access to the medication. Methods: We utilized a structured legal research protocol to systematically identify and review all statutes and regulations related to layperson naloxone access in the United States that had been adopted as of September, 2015. Each law discovered via this process was reviewed and coded by two trained legal researchers. Results: As of September, 2015, 43 states and the District of Columbia have passed laws intended to increase layperson naloxone access. We categorized these laws into three domains: (1) laws intended to increase naloxone prescribing and distribution, (2) laws intended to increase pharmacy naloxone access, and (3) laws intended to encourage overdose witnesses to summon emergency responders. These laws vary greatly across states in such characteristics as the types of individuals who can receive a prescription for naloxone, whether laypeople can dispense the medication, and immunity provided to those who prescribe, dispense and administer naloxone or report an overdose emergency. Conclusions: Most states have now passed laws intended to increase layperson access to naloxone. While these laws will likely reduce overdose morbidity and mortality, the cost of naloxone and its prescription status remain barriers to more widespread access.
    Drug and alcohol dependence 10/2015; DOI:10.1016/j.drugalcdep.2015.10.013 · 3.42 Impact Factor
    • "In this respect the comment of Paulozzi (CDC) is of interest as he suggested that the higher prescription rates and sales of opioids during the 1990s brought " abusable " drugs into rural areas where the availability of illicit drugs, such as heroin or cocaine, was very low. " Everybody's within a few miles of a pharmacy " , he said, though he admits that increased availability is not the only relevant factor [4]. That misuse of POs interacts with heroin use is corroborated 0 3000 6000 9000 12000 15000 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 "
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    ABSTRACT: In the the past two decades the medical use of prescription opioids (POs), in particular oxycodone, increased up to 14-fold in the U.S. and Canada. The high consumption of these pain relievers also led to non-medical use and abuse of these substances which in turn resulted in a dramatic increase in the number of PO related fatalities and opioid dependent subjects. In the U.S. POs became the second most prevalent type of abused drug (4.5 million abusers; 1.7% of the population) after marijuana (8 million abusers) with currently 1.9 million (0.7% of the population) people dependent on opioid pain relievers. Pain relief was the leading motive for non-medical use in about 40% of the cases, but about half of non-medical PO users reported non-pain relief motives only, like to get high or to relax. Since 2011, there is a decline in the use and misuse of POs and reduction in painkiller overdose deaths in the U.S. probably due to the introduction of a variety of restrictive regulations. In Europe, the medical use of POs is increasing as well, but at a much slower rate than in the U.S. Moreover, in Europe non-medical use of POs and fatal PO incidents are (still) rare. The paper highlights and discusses the differences between Europe versus U.S. and Canada in an attempt to assess the risk of a PO abuse and overdose epidemic in Europe. It is concluded that the risk in Europe seems to be rather limited but vigilance is needed.
    Current Drug Abuse Reviews 06/2015; 8(1):3-14. DOI:10.2174/187447370801150611184218
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    • "Although the prevalence of long-term opioid use has increased since the 1990s [20] [21] [22], opioids used as monotherapy may not be the optimal choice for many patients with acute pain due to opioids' abuse potential, associated adverse effects, and inadequate efficacy compared with other therapies for certain conditions. Contemporaneous increases in abuse, abuse-related morbidity and mortality [23] [24], and illegal diversion may lead emergency care providers to be reluctant to prescribe opioids [25]. Such opiophobia could result in inadequate analgesia if patients with inadequately managed pain are mistaken for those seeking to abuse opioids due to physician bias or patient presentation with behaviors interpreted as drug-seeking [26,27]. "
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    ABSTRACT: Abstract Undertreatment of pain (oligoanalgesia) in the emergency department is common, and it negatively impacts patient care. Both failure of appropriate pain assessment and the potential for unsafe analgesic use contribute to the problem. As a result, achieving satisfactory analgesia while minimizing side effects remains particularly challenging for emergency physicians, both in the emergency department and after a patient is discharged. Improvements in rapid pain assessment and in evaluation of noncommunicative populations may result in a better estimation of which patients require analgesia and how much pain is present. New formulations of available treatments, such as rapidly absorbed, topical, or intranasal nonsteroidal anti-inflammatory drug formulations or intranasal opioids, may provide effective analgesia with an improved risk-benefit profile. Other pharmacological therapies have been shown to be effective for certain pain modalities, such as the use of antidepressants for musculoskeletal pain, γ-aminobutyric acid agonists for neuropathic and postsurgical pain, antipsychotics for headache, and topical capsaicin for neuropathic pain. Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture. Tailoring of available treatment options to specific pain modalities, as well as improvements in pain assessment, treatment options, and formulations, may improve pain control in the emergency department setting and beyond.
    Hospital practice (1995) 01/2015; 43(1):1-10. DOI:10.1080/21548331.2015.1000794
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