Simrat Kaur Sarai, M.D., Steven Lippmann, M.D.

Over nine million Americans consume narcotics regularly; about two million of them  evidence substance use disorders related to prescription opioid pain relievers (1,2). There were about 259 million prescriptions for opioid medications written during 2012, a four-fold increase since 1999 (3). Although the number of prescription opioids sold has nearly quadrupled, there is no change reported in the amount of patient’s pain complaints (4-7). About 25 million people initiated non-medical narcotics between 2002-2011 (8). Since 2002, non-medical utilization has reportedly declined; however, addiction treatment admissions and overdose deaths or other adverse outcomes have escalated (8). During 1997-2011, there was a 900% increase in number of individuals seeking addiction treatment (9).The economic costs were over $55 billion (10). A decline in illegal drug use by adolescents is documented despite a rise in their abuse of prescription opioids (11).

Health-care efforts are focusing on preserving access to narcotics for appropriate patients with chronic pain, while diminishing non-medical usage. Despite this, such efforts have been insufficient to curb overdoses. There is much opioid-related dysfunction among people with pain, even when receiving these pharmaceuticals for legitimate purposes (9). Addiction is associated with rises in heroin-related morbidity and mortality (9,12,13). Reportedly, 80% of heroin users indicate that they began opioids following prescription pain medicine applications, but resorted to heroin since it is less expensive (13). Investigations demonstrating the safety and efficacy of these pain relievers for chronic, non-cancer pain have not been finalized. There is little evidence to support comparative effectiveness of opioids over non-steroidal anti-inflammatory agents, nor evidence of benefits by long-term narcotic applications (2). Surveys of subjects receiving opioids regularly indicate that most of them continued to experience distress.
  
During 2000-2014, deaths from opioid overdose reportedly doubled to nearly 15 per 100,000 inhabitants (14). Almost half a million people died from overdoses during this period, with the year of 2014, having the most fatalities ever reported. Opioid overdoses kill about 78 Americans daily (4,14). Although opioid overdoses occur in medical and non-medical users who are not addicted, deaths are most common among those who are drug dependent. The prevalence of suicide attempts among opioid addicts is between 8-17% (15). Veterans are more likely to die from accidental opioid overdoses than others; approximately 13% of them, or 68,000, utilize these analgesics (12,16,17).

Doctors should be cautious to avoid unnecessary prescribing of these analgesics, even in chronic conditions (9). It is difficult for physicians to predict which patients might be vulnerable to addiction and which individuals would benefit. Because of this uncertainty, we should screen for vulnerabilities to substance abuse and provide careful follow-up. Current methods for reducing abuse of prescription analgesics are directed at prescription regulations for physicians; yet, these measures have not been effective. To diminish narcotic abuse, the American Pain Society and the American Academy of Pain Medicine have convened a panel to create better opioid protocols appropriate for the treatment of chronic, non-cancer pain (11,18).

References

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