Opioid prescribing is rising in many countries

Opioids are effective in managing acute and cancer pain.1 However, their effectiveness in chronic pain is uncertain, with limited evidence of consistent pain relief beyond 12 weeks. Tolerance and opioid induced hyperalgesia can develop, leading to prescription of higher doses with minimal benefit.2 In addition, adverse effects occur with prolonged use and higher doses, including dependency, overdose (intentional and unintentional), cardiovascular events, and impaired respiratory, endocrine, and immune functioning.34

The United States is currently in the middle of a so called opioid epidemic. Its causes are complex but include an ageing population with increased risk of chronic pain, changes in prescribing practice with new opioid formulations, changes in recommendations about opioid use for chronic pain, and aggressive marketing by drug companies (including direct marketing to patients) that overstated the benefits and misrepresented the potential dangers.5

Although marketing may have a less prominent effect outside the US, there are indications that opioid prescribing is increasing worldwide, with considerable variation among and within …