Limited evidence, faulty reasoning, and potential for a global opioid crisis

This editorial is of public health relevance since the use of routine prescription opioid for chronic pain can lead to addiction. Studies have shown that a minority of individuals prescribed opioids may develop abuse or addiction (1). The chances of substance use disorders are increased with long-term use of prescription opioids (2,3). Hence, there should be cautious and limited prescription of opioids in health care settings. Private practitioners should also withheld the prescription of opioids, and there should be mechanisms to monitor the use of opioids by both government agencies and pharmacists or chemist shops. The relevant law on narcotics use such as the National Drug and Psychotropic Substances Act in India should be implemented stringently wherever any such law exists. Otherwise indiscriminate use will lead to more substance abuse problems and limited opioid supply when needed. There should be education campaigns among the medical professionals through organisations such as the Indian Medical Association and others. Sensitisation of doctors is a must whether practising in public or private health care set ups.

References

1. Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic non malignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008;9:444–59.
2. Breckenridge J, Clark JD. Patient characteristics associated with opioid versus non steroidal anti-inflammatory drug management of chronic low back pain. J Pain. 2003; 4:344–50.
3. Hermos JA, Young MM, Gagnon DR, Fiore LD. Characterizations of long-term oxycodone/acetaminophen prescriptions in veteran patients. Arch Intern Med. 2004; 164:2361–6.