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Facing up to the prescription opioid crisis
Cite this as:
BMJ
2011;343:d5142
This article has a correction
Please see: Facing up to the prescription opioid crisis
- Irfan A Dhalla, lecturer 1234,
- Navindra Persaud, research fellow 356,
- David N Juurlink, division head, clinical pharmacology147
- 1Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- 2Department of Medicine, St Michael’s Hospital, Toronto
- 3Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- 4Institute for Clinical Evaluative Sciences, Toronto
- 5Department of Family and Community Medicine, St. Michael’s Hospital
- 6Department of Family and Community Medicine, University of Toronto
- 7Sunnybrook Research Institute, Toronto
- Correspondence to: I A Dhalla, 30 Bond Street, Toronto, ON M5B 1W8, Canada dhallai{at}smh.ca
- Accepted 1 August 2011
Over the past 25 years, physicians in many countries have become increasingly willing to prescribe opioids for chronic pain with causes other than cancer. The burgeoning use of opioids has been accompanied by a steep increase in opioid related mortality. In the United States, deaths involving opioid analgesics increased from 4041 in 1999 to 14 459 in 2007 (fig 1⇓) and are now more common than deaths from multiple myeloma, HIV, and alcoholic liver disease.1 Opioid prescribing and opioid related deaths—most of them unintentional and of relatively young people—have also increased elsewhere, including in the United Kingdom. While drug specific data are not universally available, deaths involving oxycodone have increased especially rapidly in several jurisdictions, including Ontario in Canada and Victoria, Australia (fig 2⇓).2 3
Fig 1 Deaths involving opioid analgesics in the United States1 4
Fig 2 Deaths involving oxycodone in Ontario, Canada (data from Dhalla et al2 updated with coroner’s data) and Victoria, Australia5
The International Narcotics Control Board has noted that addiction to prescription opioids is a problem in almost all countries. For example, the board has estimated that between 1.4 million and 1.9 million Germans are addicted to prescription drugs.5 In the United Kingdom, the former chair of the House of Commons All Party Parliamentary Group on Drug Misuse has expressed concern that the United Kingdom may face a similar epidemic to that of North America in 5 to 10 years, and one doctor has …
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