Over the last decade there have been massive increases in prescribing of opioids in many countries, including the United States of America, Canada, and many European countries, including Sweden, Norway and the United Kingdom. It is sobering to consider that the USA, less than 5% of the world's population, uses 80% of the global supply of opioids.
The increase in prescribing in the USA has been paralleled by increasing misuse and mortality associated with these drugs and unintentional oversdose is now a leading cause of accidental death. In attempts to tackle the growing prescritpion opioid epidemic, lawmakers have responded with numerous policies and legislation that manadate ceiling doses, require utilisation of prescription monitoring programmes and implementation of risk minimisation strategies. A global alarm has been sounded among countries wishing to avoid this path.
There have been similar trends of increased opioid consumption in the United Kingdom and other European countries, albeit at lower levels. However, this has not been associated without apparent increases in reported misuse or drug-related deaths. Differences in prescribing, culture, and health systems probably account for some of the differences in opioid prescribing and opioid overdose mortality and suggest features that may be permissive or protective in the development of a public health crisis.
Most opioids are prescribed for non-cancer indications. Prescribing opioids has the potential to provide benefit for some patients when used as part of a comprehensive pain management plan. Unfortunately for the majority of patients opioids have little impact on pain and lead to bothersome side effects. The increased use of opioids has had little impact on the societal burden of pain, perhaps unsurprisingly, as the role of medicines in long-term pain management is limited.
Basic, proactive steps, such as promoting good prescribing practice, regular review, enhanced surveillance – of overdoses, marketing practices, prescribers, and patients – and education programmes are essential to ensure appropriate opioid use and improve clinical outcomes.
Disclosure of Interest R. Knaggs Grant/research support from: Grunenthal UK Ltd