_________________________________________________________________________ Opioid Use Disorder
tion, which results in a crisis of mistrust between the patient and the healthcare team. Pseudoaddiction is preventable when the patient’s report of pain is accepted as valid [1; 3; 4; 5].
• 40% of all hydromorphone • 19% of all fentanyl
The nonmedical use of opioids is a virtually universal phe- nomenon, but Asia and the Americas account for the majority of users [11]. Subregions with a relatively high prevalence of past-year opioid use include North America (3.3%), and Near, Middle East, and South-West Asia (3.19%) [11]. In the major- ity of Europe, Africa, and Asia, heroin is the most prevalent illegally consumed opioid. In the Americas and Oceania (Australia and New Zealand), illegally diverted or misused prescription opioids (e.g., codeine, hydrocodone, morphine, hydromorphone, oxycodone, meperidine) are the primary opi- oids of abuse. However, some African and European nations have reported a surge in prescription opioid abuse in the last decade, and there is growing evidence of the nonmedical use of opioids in India [11]. Traditional opium-cultivating countries and their neighbors contain the majority of raw opium users. The Drug Abuse Warning Network (DAWN) was established in 1972 by the DEA to track and publish data collected from participating states on emergency department (ED) visits resulting from substance misuse or abuse, adverse reactions, drug-related suicide attempts, and substance abuse treatment [15]. By its final year in 2011, DAWN had collected data from metropolitan areas in 37 states, with complete coverage in 13 states. Although their total figures did not capture all 50 states, the population rates were representative and able to be extrapolated to the United States as a whole [15]. Data from the DAWN network indicates that opioid abuse is a growing problem in the United States. In 2011, the overall admission rate for misuse or abuse of opioid analgesics (exclud- ing adverse reactions) was 134.8 per 100,000, an increase of 153% compared with 2004. In the 13 states involved in the DAWN network, the top four opioid analgesics involved in drug-related ED visits for 2011 were various formulations of oxycodone (175,229), hydrocodone (97,183), methadone (75,693), and morphine (38,416). Between 2004 and 2011, ED admissions increased 74% for methadone, 220% for oxycodone, 96% for hydrocodone, and 144% for morphine. Heroin-related ED episodes increased from 213,118 in 2009 to 258,482 in 2011 [16]. There was no meaningful change in ED admission rates involving opioid analgesics between 2009 and 2011 [15]. However, more than 81,000 drug over- dose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period, and the rise was mainly attributed to synthetic opioids [17]. From 2013 to 2019, the age-adjusted rate of deaths involving synthetic opioids other than methadone increased 1,040% [18]. Although prescription opioid abuse decreased by approxi- mately 12% between 2010 and 2011, heroin use increased. There were 119,000 total users in 2003, but 281,000 by 2011 and 948,000 by 2016 [19]. In addition, first-time past-year use increased significantly between 2006 (90,000) and 2016 (170,000), with the greatest increases among young adults 18
BACKGROUND The first reference to opium is found in the 3rd century B.C.E. The use of opium was well-understood by Arab physicians, and Arab traders introduced the drug to Asia, where it was utilized primarily for the control of dysentery [9]. The isolation of morphine from opium was achieved in 1806 and was named for Morpheus, the Greek god of dreams [9]. The discovery of other alkaloids in opium followed: codeine in 1832 and papaverine in 1848. By the mid-nineteenth century, pure alkaloids were used in medical practice in place of crude opium preparations [9]. In addition to the highly beneficial therapeutic effects, the toxic side effects and addictive potential of opioids have been known for centuries. These undesired effects have prompted a search for a potent synthetic opioid analgesic free of addictive poten- tial and other complications. However, all synthetic opioids introduced into medical use share the same liabilities of the classical opioids. The search for new opioid therapeutics has resulted in the synthesis of opioid antagonists and compounds with mixed agonist-antagonist properties, such as buprenor- phine, which has expanded therapeutic options and provided the basis of expanded knowledge of opioid mechanisms [9]. Nonmedical use of prescription opioids was reported in lit- erature as early as 1880. A report in 1928 documented that injection of opioids contributed to the development of non- medical use and misuses of prescription opioids. Before 1930, the prevalence of nonmedical opioid injecting in the United States was low. But by the mid-1940s, more than one-half the admissions to the National Institute of Mental Health’s Lexing- ton Hospital were for the misuse of prescription opioids [10].
EPIDEMIOLOGY OF OPIOID USE DISORDER
As of 2021, the estimated worldwide prevalence of past-year opioid use was 60 million people [11]. In 2021, an estimated 9.2 million people in the United States had misused prescrip- tion opioids in the past year, and of those people, 8.7 million reported the nonmedical use of prescription opioids while nearly 1.1 million reported past-year use of heroin [12]. With only 4.23% of the world’s population, the United States annually consumes more than 80% of all opioid supplies, including [13; 14]:
• 99% of all hydrocodone • 68% of all oxycodone • 52% of all methadone
17
MDRI2026
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