The public health threat involves not only prescription opioid analgesics, but also non-prescription substances such as illicit fentanyl and heroin (available online and on the street) which is also contributing to the current growth in morbidity and mortality associated with opioids [
11] Mortality rates due to heroin overdose in the USA have more than trebled from 2010 to 2014 [
12]. In 2014 in the USA, drug overdoses exceeded automobile accidents for the first time as the chief cause of accidental death [
2]. A rapid increase in the prescription of opioids has been connected to the growth in opioid overdose, with the opioid epidemic possibly contributing to the drop in average life expectancy that has occurred in the USA [
13]. In 2015, more than 33,000 opioid overdose deaths occurred in the USA [
14], where the use of opioids (licit and illicit) has risen 10–14 times in the last 20 years [
15]. The opioid epidemic was initally the result of the growth in prescription opioid medications, but now includes potent heroin and illicit fentanyl. However, decreasing the supply of prescription opioids should bring this rise down. In the USA, 91 people die on a daily basis from an overdose of opioids [
16], approximately 50% of which are not a result of an opioid product from a prescription [
16]. The economic liability of opioid misuse has been projected to be more than $78 billion a year in the USA [
17]. This does not include the cost to humanity of decreased quality of life, disordered family relationships, psychological distress, and social dysfunction [
18].
In response to the opioid epidemic, the United States Center of Diseases Control (CDC) created a guideline for opioid prescribing in patients with chronic non-cancer pain (CNCP) [
19]. The guideline focuses on the following: when to commence or continue with opioids for chronic pain; the selection of opioids, opioid dosage, duration, follow-up, and termination, and; evaluating risk and attending to harms of opioid use.