Opioids are not just an American problemBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5514 (Published 06 December 2017) Cite this as: BMJ 2017;359:j5514
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An enormous increase in the prescription of opioid analgesics has been apparent even before pain was conferred the status of the fifth clinical sign in 2001 by the joint commission. Oxycontin was introduced in the mid 1990s and Fentanyl for surgery about 30 years prior. Opioid misuse has now reached epidemic proportions to the point where recent data indicates that analgesics are the second most common drug of abuse, behind marijuana. It is likely that US statistics that suggest the leading cause of death in the less than 50 years age group is due to overdose (1) can be extrapolated to other countries.
The high cost of opioid use is not only in terms of its dependence and the high risk of secondary heroin addiction but also in terms of lives lost and exorbitant economic costs. Inappropriate over prescription and inadequate monitoring and deprescribing long-term opioid therapy remain significant drivers.
Whilst we appreciate that the direction of evidence is against usefulness of long-term opioid therapy in chronic non-malignant pain it is difficult to grasp our relative ineffectiveness in curbing initiation of new opioid therapy, deprescribing, and in limiting it for short-term use in acute severe pain.
There is now a greater understanding of the need for opioid safety through closer monitoring, initiating essential new prescribing at the lowest possible strength with slow titration of dosage and appropriate agreements and plans with patients. The importance of multimodality therapies and multidisciplinary teams in preventing opioid misuse cannot be underestimated. Improved care integration has the potential to strengthen and better align such processes. Technology affords us another potentially significant lever to help overcome some of barriers. Through the use of electronic health records to better identify patients most at risk, patient registry data highlighting red flags such as risks for drug duplication and real time prescription monitoring systems, greater success and safety in opioid therapy should be achievable.
The opioid crisis is not localised to a single country or to isolated organisations. We have observed that probing deeper in our own organisations can help uncover significant opportunities to improve opioid safety, reduce hospital readmissions and minimise unnecessary healthcare expenditure.
1. Katz, J, Drug Deaths in America are rising faster than ever. NY Times June 05 2017; CDC data 2017
Competing interests: No competing interests