Skip to main content
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 1/2016

01.01.2016 | Review Article/Brief Review

The prescription opioid epidemic: an overview for anesthesiologists

verfasst von: Asim Alam, MD, David N. Juurlink, MD, PhD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 1/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem.

Source

We searched PubMed, Google Scholar, and EMBASE™ for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest.

Principal findings

In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem.

Conclusion

Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.
Fußnoten
1
The number of citations were calculated using Google Scholar (accessed June 19, 2015).
 
Literatur
1.
Zurück zum Zitat Gomes T, Mamdani MM, Dhalla IA, Cornish S, Paterson JM, Juurlink DN. The burden of premature opioid-related mortality. Addiction 2014; 109: 1482-8.PubMedPubMedCentralCrossRef Gomes T, Mamdani MM, Dhalla IA, Cornish S, Paterson JM, Juurlink DN. The burden of premature opioid-related mortality. Addiction 2014; 109: 1482-8.PubMedPubMedCentralCrossRef
2.
Zurück zum Zitat Fischer B, Gooch J, Goldman B, Kurdyak P, Rehm J. Non-medical prescription opioid use, prescription opioid-related harms and public health in Canada: an update 5 years later. Can J Public Health 2014; 105: e146-9.PubMed Fischer B, Gooch J, Goldman B, Kurdyak P, Rehm J. Non-medical prescription opioid use, prescription opioid-related harms and public health in Canada: an update 5 years later. Can J Public Health 2014; 105: e146-9.PubMed
3.
Zurück zum Zitat Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies - tackling the opioid-overdose epidemic. N Engl J Med 2014; 370: 2063-6.PubMedCrossRef Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies - tackling the opioid-overdose epidemic. N Engl J Med 2014; 370: 2063-6.PubMedCrossRef
4.
Zurück zum Zitat Rintoul AC, Dobbin MD, Drummer OH, Ozanne-Smith J. Increasing deaths involving oxycodone, Victoria, Australia, 2000-09. Inj Prev 2011; 17: 254-9.PubMedCrossRef Rintoul AC, Dobbin MD, Drummer OH, Ozanne-Smith J. Increasing deaths involving oxycodone, Victoria, Australia, 2000-09. Inj Prev 2011; 17: 254-9.PubMedCrossRef
5.
Zurück zum Zitat Handley SA, Flanagan RJ. Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000-2011. Clin Toxicol 2014; 52: 1-12.CrossRef Handley SA, Flanagan RJ. Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000-2011. Clin Toxicol 2014; 52: 1-12.CrossRef
6.
Zurück zum Zitat Dhalla IA, Persaud N, Juurlink DN. Facing up to the prescription opioid crisis. BMJ 2011; 343: d5142.PubMedCrossRef Dhalla IA, Persaud N, Juurlink DN. Facing up to the prescription opioid crisis. BMJ 2011; 343: d5142.PubMedCrossRef
7.
Zurück zum Zitat Johnson EM, Lanier WA, Merrill RM, et al. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008-2009. J Gen Intern Med 2013; 28: 522-9.PubMedPubMedCentralCrossRef Johnson EM, Lanier WA, Merrill RM, et al. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008-2009. J Gen Intern Med 2013; 28: 522-9.PubMedPubMedCentralCrossRef
8.
Zurück zum Zitat Gomes T, Redelmeier DA, Juurlink DN, Dhalla IA, Camacho X, Mamdani MM. Opioid dose and risk of road trauma in Canada: a population-based study. JAMA Intern Med 2013; 173: 196-201.PubMedCrossRef Gomes T, Redelmeier DA, Juurlink DN, Dhalla IA, Camacho X, Mamdani MM. Opioid dose and risk of road trauma in Canada: a population-based study. JAMA Intern Med 2013; 173: 196-201.PubMedCrossRef
10.
Zurück zum Zitat Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372: 241-8.PubMedCrossRef Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372: 241-8.PubMedCrossRef
11.
Zurück zum Zitat Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol 2008; 16: 405-16.PubMedPubMedCentralCrossRef Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol 2008; 16: 405-16.PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Brownstein MJ. A brief history of opiates, opioid peptides, and opioid receptors. P Natl Acad Sci USA 1993; 90: 5391-3.CrossRef Brownstein MJ. A brief history of opiates, opioid peptides, and opioid receptors. P Natl Acad Sci USA 1993; 90: 5391-3.CrossRef
13.
Zurück zum Zitat Schiff PL. Opium and its alkaloids. Am J Pharm Educ 2002; 66: 186-94. Schiff PL. Opium and its alkaloids. Am J Pharm Educ 2002; 66: 186-94.
14.
Zurück zum Zitat Quinones MA. Drug abuse during the Civil War (1861-1865). Int J Addict 1975; 10: 1007-20.PubMed Quinones MA. Drug abuse during the Civil War (1861-1865). Int J Addict 1975; 10: 1007-20.PubMed
15.
Zurück zum Zitat Andersen S, Leikersfeldt G. Management of chronic non-malignant pain. Br J Clin Pract 1996; 50: 324-30.PubMed Andersen S, Leikersfeldt G. Management of chronic non-malignant pain. Br J Clin Pract 1996; 50: 324-30.PubMed
16.
Zurück zum Zitat Medina JL, Diamond S. Drug dependency in patients with chronic headaches. Headache 1977; 17: 12-4.PubMedCrossRef Medina JL, Diamond S. Drug dependency in patients with chronic headaches. Headache 1977; 17: 12-4.PubMedCrossRef
18.
Zurück zum Zitat Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980; 302: 123.PubMed Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980; 302: 123.PubMed
19.
Zurück zum Zitat Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain 1986; 25: 171-86.PubMedCrossRef Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain 1986; 25: 171-86.PubMedCrossRef
20.
Zurück zum Zitat Gomes T, Juurlink DN, Dhalla IA, Mailis-Gagnon A, Paterson JM, Mamdani MM. Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med 2011; 5: e13-22.PubMedPubMedCentral Gomes T, Juurlink DN, Dhalla IA, Mailis-Gagnon A, Paterson JM, Mamdani MM. Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med 2011; 5: e13-22.PubMedPubMedCentral
21.
Zurück zum Zitat Tennant F Jr, Robinson D, Sagherian A, Seecof R. Chronic opioid treatment of intractable, non-malignant pain. NIDA Res Monogr 1988; 81: 174-80.PubMed Tennant F Jr, Robinson D, Sagherian A, Seecof R. Chronic opioid treatment of intractable, non-malignant pain. NIDA Res Monogr 1988; 81: 174-80.PubMed
22.
Zurück zum Zitat Lorenz KA, Sherbourne CD, Shugarman LR, et al. How reliable is pain as the fifth vital sign? J Am Board Fam Med 2009; 22: 291-8.PubMedCrossRef Lorenz KA, Sherbourne CD, Shugarman LR, et al. How reliable is pain as the fifth vital sign? J Am Board Fam Med 2009; 22: 291-8.PubMedCrossRef
23.
Zurück zum Zitat Hanks S. The law of unintended consequences: when pain management leads to medication errors. P T 2008; 33: 420-5.PubMedPubMedCentral Hanks S. The law of unintended consequences: when pain management leads to medication errors. P T 2008; 33: 420-5.PubMedPubMedCentral
24.
Zurück zum Zitat Government Accounting Office. OxyContin abuse and diversion and efforts to address the problem: highlights of a government report. J Pain Palliat Care Pharmacother 2004; 18: 109-13. Government Accounting Office. OxyContin abuse and diversion and efforts to address the problem: highlights of a government report. J Pain Palliat Care Pharmacother 2004; 18: 109-13.
25.
Zurück zum Zitat Manchikanti L, Helm S 2 nd , Fellows B, et al. Opioid epidemic in the United States. Pain Physician 2012; 15: ES9-38. Manchikanti L, Helm S 2 nd , Fellows B, et al. Opioid epidemic in the United States. Pain Physician 2012; 15: ES9-38.
26.
Zurück zum Zitat Poitras G. OxyContin, prescription opioid abuse and economic medicalization. Medicolegal and Bioethics 2012; 2: 31-43.CrossRef Poitras G. OxyContin, prescription opioid abuse and economic medicalization. Medicolegal and Bioethics 2012; 2: 31-43.CrossRef
29.
Zurück zum Zitat Jovey RD. Managing Pain: The Canadian Healthcare Professional’s Reference. Sittsville: Purdue Pharma; 2008 . Jovey RD. Managing Pain: The Canadian Healthcare Professional’s Reference. Sittsville: Purdue Pharma; 2008 .
31.
Zurück zum Zitat Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 2013; 8: CD004959. Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 2013; 8: CD004959.
32.
Zurück zum Zitat Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976) 2014; 39: 556-63. Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976) 2014; 39: 556-63.
33.
Zurück zum Zitat Nuesch E, Rutjes AW, Husni E, Welch V, Juni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2009; 4: CD003115. Nuesch E, Rutjes AW, Husni E, Welch V, Juni P. Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2009; 4: CD003115.
34.
Zurück zum Zitat Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162: 276-86.PubMedCrossRef Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162: 276-86.PubMedCrossRef
35.
Zurück zum Zitat Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ 2006; 174: 1589-94.PubMedPubMedCentralCrossRef Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ 2006; 174: 1589-94.PubMedPubMedCentralCrossRef
36.
Zurück zum Zitat Manchikanti L, Ailinani H, Koyyalagunta D, et al. A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician 2011; 14: 91-121.PubMed Manchikanti L, Ailinani H, Koyyalagunta D, et al. A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician 2011; 14: 91-121.PubMed
37.
38.
Zurück zum Zitat Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 2004; 112: 372-80.PubMedCrossRef Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 2004; 112: 372-80.PubMedCrossRef
39.
Zurück zum Zitat Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 2010; 1: CD006605. Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 2010; 1: CD006605.
40.
Zurück zum Zitat Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C. Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain 2009; 10: 147-59.PubMedCrossRef Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C. Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain 2009; 10: 147-59.PubMedCrossRef
41.
Zurück zum Zitat Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 2010; 170: 1968-78.PubMedCrossRef Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med 2010; 170: 1968-78.PubMedCrossRef
42.
Zurück zum Zitat Miller M, Sturmer T, Azrael D, Levin R, Solomon DH. Opioid analgesics and the risk of fractures in older adults with arthritis. J Am Geriatr Soc 2011; 59: 430-8.PubMedPubMedCentralCrossRef Miller M, Sturmer T, Azrael D, Levin R, Solomon DH. Opioid analgesics and the risk of fractures in older adults with arthritis. J Am Geriatr Soc 2011; 59: 430-8.PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Jena AB, Goldman D, Weaver L, Karaca-Mandic P. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ 2014; 348: g1393.PubMedPubMedCentralCrossRef Jena AB, Goldman D, Weaver L, Karaca-Mandic P. Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims. BMJ 2014; 348: g1393.PubMedPubMedCentralCrossRef
44.
Zurück zum Zitat Saunders KW, Dunn KM, Merrill JO, et al. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 2010; 25: 310-5.PubMedPubMedCentralCrossRef Saunders KW, Dunn KM, Merrill JO, et al. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 2010; 25: 310-5.PubMedPubMedCentralCrossRef
45.
46.
Zurück zum Zitat Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 2006; 125: 172-9.PubMedCrossRef Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 2006; 125: 172-9.PubMedCrossRef
47.
Zurück zum Zitat Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015; 156: 569-76.PubMedCrossRef Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015; 156: 569-76.PubMedCrossRef
48.
49.
Zurück zum Zitat Bannister K. Opioid-induced hyperalgesia: where are we now? Curr Opin Support Palliat Care 2015; 9: 116-21.PubMedCrossRef Bannister K. Opioid-induced hyperalgesia: where are we now? Curr Opin Support Palliat Care 2015; 9: 116-21.PubMedCrossRef
51.
Zurück zum Zitat Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014; 348: g1251.PubMedPubMedCentralCrossRef Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014; 348: g1251.PubMedPubMedCentralCrossRef
52.
Zurück zum Zitat Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth 2014; 7: 17-22.PubMedPubMedCentral Vadivelu N, Mitra S, Schermer E, Kodumudi V, Kaye AD, Urman RD. Preventive analgesia for postoperative pain control: a broader concept. Local Reg Anesth 2014; 7: 17-22.PubMedPubMedCentral
53.
Zurück zum Zitat Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med 2012; 172: 425-30.PubMedCrossRef Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med 2012; 172: 425-30.PubMedCrossRef
54.
Zurück zum Zitat Hoppe JA, Kim H, Heard K. Association of emergency department opioid initiation with recurrent opioid use. Ann Emerg Med 2015; 65(493-99): e4.PubMed Hoppe JA, Kim H, Heard K. Association of emergency department opioid initiation with recurrent opioid use. Ann Emerg Med 2015; 65(493-99): e4.PubMed
55.
Zurück zum Zitat MacIntyre PE, Huxtable CA, Flint SL, Dobbin MD. Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain. Anaesth Intensive Care 2014; 42: 558-74.PubMed MacIntyre PE, Huxtable CA, Flint SL, Dobbin MD. Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain. Anaesth Intensive Care 2014; 42: 558-74.PubMed
56.
Zurück zum Zitat Kahan M, Gomes T, Juurlink DN, et al. Effect of a course-based intervention and effect of medical regulation on physicians’ opioid prescribing. Can Fam Physician 2013; 59: e231-9.PubMedPubMedCentral Kahan M, Gomes T, Juurlink DN, et al. Effect of a course-based intervention and effect of medical regulation on physicians’ opioid prescribing. Can Fam Physician 2013; 59: e231-9.PubMedPubMedCentral
Metadaten
Titel
The prescription opioid epidemic: an overview for anesthesiologists
verfasst von
Asim Alam, MD
David N. Juurlink, MD, PhD
Publikationsdatum
01.01.2016
Verlag
Springer US
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 1/2016
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-015-0520-y

Weitere Artikel der Ausgabe 1/2016

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 1/2016 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.