Intended for healthcare professionals


Facing up to the prescription opioid crisis

BMJ 2011; 343 doi: (Published 23 August 2011) Cite this as: BMJ 2011;343:d5142

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  1. Irfan A Dhalla, lecturer 1234,
  2. Navindra Persaud, research fellow 356,
  3. David N Juurlink, division head, clinical pharmacology147
  1. 1Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Medicine, St Michael’s Hospital, Toronto
  3. 3Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
  4. 4Institute for Clinical Evaluative Sciences, Toronto
  5. 5Department of Family and Community Medicine, St. Michael’s Hospital
  6. 6Department of Family and Community Medicine, University of Toronto
  7. 7Sunnybrook Research Institute, Toronto
  1. Correspondence to: I A Dhalla, 30 Bond Street, Toronto, ON M5B 1W8, Canada dhallai{at}
  • Accepted 1 August 2011

Deaths resulting from prescription opioids tripled in the United States between 1999 and 2007 and are also increasing in many other countries, including the United Kingdom. Irfan A Dhalla, Navindra Persaud, and David N Juurlink describe how this situation developed and propose several ways to reduce morbidity and mortality from opioids

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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