Elsevier

Drug and Alcohol Dependence

Volume 81, Issue 2, 1 February 2006, Pages 103-107
Drug and Alcohol Dependence

Commentary
Major increases in opioid analgesic abuse in the United States: Concerns and strategies

https://doi.org/10.1016/j.drugalcdep.2005.05.009Get rights and content

Abstract

The problem of abuse of and addiction to opioid analgesics has emerged as a major issue for the United States in the past decade and has worsened over the past few years. The increases in abuse of these opioids appear to reflect, in part, changes in medication prescribing practices, changes in drug formulations as well as relatively easy access via the internet. Though the use of opioid analgesics for the treatment of acute pain appears to be generally benign, long-term administration of opioids has been associated with clinically meaningful rates of abuse or addiction. Important areas of research to help with the problem of opioid analgesic abuse include the identification of clinical practices that minimize the risks of addiction, the development of guidelines for early detection and management of addiction, the development of opioid analgesics that minimize the risks for abuse, and the development of safe and effective non-opioid analgesics. With high rates of abuse of opiate analgesics among teenagers in the United States, a particularly urgent priority is the investigation of best practices for treating pain in adolescents as well as the development of prevention strategies to reduce diversion and abuse.

Section snippets

Background/identification of the problem

Though abuse and addiction to opioid agents is not a new phenomenon (De Quincy, 1998), new is the scale, range and growth of the problem. Epidemiological surveys of youth in the United States in 2003 indicated that opioid analgesics were among the most frequently abused illicit drugs among secondary students (12th graders), second only to marijuana (Johnston et al., 2004). Further, the past few years have seen a marked increase in the use of opioid medications in the United States and an even

Patterns of opioid prescription

There are two basic ways that opioid medications are obtained: through medical prescription and through illicit sources. Both of these may be inter-related in that as medical prescriptions increase, more medications may be available for diversion.

Prescription of opioids falls into two major subtypes: treatment of acute pain with brief periods of opioid use and treatment of chronic pain with long-term exposure. Treatment of acute pain conditions with brief, short-term prescriptions of opioid

Increasing access to opioids

As we consider potential reasons for the upsurge in opioid abuse, there are several forces apparently driving the increases. First, there have been marked increases in the numbers of prescriptions written for opioids in the United States (Zacny et al., 2003). Thus, one explanation for the increases is as a byproduct of a growing availability of prescription opioids.

Second, internet access to prescription drugs, including opioid analgesics, has opened a new source for access to these drugs and

Variables contributing to the abuse of opioid analgesics

A key observation is that the problems associated with prescription opioids have increased in recent years in the United States. Joranson and colleagues reported that increases in medical use of opioid analgesics were not associated with increases in reported opioid-related problems during the early 1990's (Joranson et al., 2000), but more recent data contradict this finding (Zacny et al., 2003). The increase in opioid analgesic-related emergency department mentions, which is an indicator of

Scientific questions

Significant increases in the abuse and addiction to opioid analgesics provide urgency to research development of effective prevention and treatment approaches. An additional concern is that the extent of opioid analgesic abuse in countries other than the United States is uncertain. Is the situation in the United States a harbinger of problems likely to be seen in other locations? Are there cross-national differences in opioid analgesic abuse, which may help to illuminate the causes of the

Conclusion

Acute as well as chronic pain can be very handicapping to the individual. Opioid analgesics are very effective medications and when used properly have many beneficial effects. However, it is important to recognize that a potential side effect from chronic use can be abuse and addiction, and though not frequent, this complication can have devastating consequences. In fact, correct use and abuse of these agents are not polar opposites—they are complex, inter-related phenomena which need to be

Acknowledgements

The authors wish to acknowledge the contributions of Marc Brodsky in the Division of Epidemiology, Services and Prevention Research of the National Institute on Drug Abuse and Barbara Brandys at the Library of the National Institutes of Health who obtained and formatted data from the IMS Health Systems regarding opioid prescriptions in the United States 2000–2004.

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