Many physicians are concerned about the current epidemic of dependence,
abuse, and deaths that have occurred over the past two decades with the
concomitant rapid increase in opioid prescriptions. The United States now ranks
number two in the world for opioid use per capita.1, 2 A recent
study in JAMA Internal Medicine showed that in veterans with chronic
non-cancer pain, use of long-acting opioids was associated with unintentional
overdose events compared with short-acting opioids, especially in the first 14
days of use.
In a statement published on Friday, December 18, 2015, the Centers for
Disease Control and Prevention (CDC) provided the following statistics:
- U.S. deaths from drug overdoses hit a record high in 2014, propelled by
abuse of prescription painkillers and heroin.
- Drug overdoses increased 6.5 percent in 2014 from a year earlier, killing
47,055 people.
- Deaths from opioids such as prescription pain killers and heroin accounted
for 61 percent of overdose deaths and increased 14 percent in 2014.
- Deaths from prescription painkillers have been increasing for 15 years and
there has been a recent surge in heroin-related deaths, tripling in the last
four years.
- Lower heroin prices, wider availability, and higher purity are causing
more overdoses.
In addition, because of the lack of high-quality randomized trials, some
experts feel that starting opioid therapy in chronic non-cancer pain with
long-acting agents should be completely avoided. Current evidence also supports
avoiding long-acting agents altogether, not co-prescribing other sedating
drugs, keeping morphine-equivalent doses 3
The CDC recommends stricter guidelines for prescribing pain killers,
including the expanded availability of and wider access to naloxone, an
antidote for opioid-related overdoses.
Please be aware of these statistics and the CDC?s recommendations when
prescribing opioids to your patients. Read the
CDC?s press release in its entirety
here.
1Dhalla IA et al. Prescribing of opioid
analgesics and related mortality before and after the introduction of
long-acting oxycodone. CMAJ.
2009;181:891-6
2Bohnert AS et al. Association between opioid
prescribing patterns and opioid overdose-related deaths JAMA. 2011:305:1315-21
3Chou R et al. The effectiveness and risks of
long-term opioid therapy for chronic pain: A systematic review for a National
Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015:162:276-86