__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use THE PAIN MANAGEMENT MOVEMENT By the mid-2000s, professional and law enforcement efforts had emerged to curtail OxyContin abuse, including the pain management movement and creation of the pain management subspecialty. How- ever, these efforts had some unintended negative consequences. Pharmacists were tasked with evalu- ating legal prescription appropriateness through a “drug use review.” Encouraged by drug enforcement authorities, some became adversaries of physicians and patients by reporting any out-of-the-ordinary prescribing to the police [56].
in lifesaving trauma interventions; poorly managed post-surgical pain; and greater public awareness of pain as a condition warranting medical attention [7]. In addition, many armed forces veterans have been returning from military action in Afghanistan and Iraq with traumatic injuries and chronic pain, and veterans’ care clinicians have been reporting the per- ception that long-term pain management is lacking support in the veteran healthcare infrastructure [58]. The extent of opioid analgesic use in the United States today is unprecedented in the country’s his- tory and unparalleled anywhere in the world. Before 1990, prescribers in the United States were skeptical of prescribing opioids for chronic noncancer pain. But as of 2017, nearly 58 opioid prescriptions were written for every 100 Americans, and more than 17% of Americans had at least one opioid prescrip- tion filled, with an average of 3.4 opioid prescrip- tions dispensed per patient [59]. Sales of opioid analgesics was an estimated $22.66 billion in 2021. Market size is expected to expand at an annual rate of 1.2% between 2022 and 2030 [60]. Worldwide consumption of opioid analgesics has increased dramatically in the past few decades, with the United States driving a substantial proportion of this increase. For example, the 1990 global con- sumption of hydrocodone was 4 tons (3,628 kg), compared with the 2021 consumption of 26.6 tons (24,131 kg); the majority (26.3 tons) of this were consumed in the United States. Similarly, 3 tons (2,722 kg) of oxycodone were consumed globally in 1990, versus 62 tons (56,246 kg) in 2021, of which 42.3 tons (38,374 kg or 68.2%) were consumed in the United States [61]. With only 4.9% of the world’s population, the United States annually consumes more than 85% of all opioid supplies, including [61]:
Legitimate OxyContin use was also tarnished by negative media coverage suggesting that drug diver- sion was the result of irresponsible prescribing practices. A 2011 study of OxyContin coverage content in lay media and professional publications found that abuse, addiction, crime, and death were emphasized, typically from law enforcement and the criminal justice system perspectives. The majority of patients with legitimate medical need who benefited from the drug were rarely mentioned. An unfortu- nate outcome is the stigma sometimes experienced by patients who require OxyContin for long-term pain control [57].
EPIDEMIOLOGY OF CHRONIC PAIN AND OPIOID USE
Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. It also affects about 100 million American adults— more than the total affected by heart disease, cancer, and diabetes combined [7]. The lifetime prevalence of chronic pain ranges from 54% to 80%, and among adults 21 years of age and older, 14% report pain lasting 3 to 12 months and 42% report pain persisting longer than 1 year [7]. An estimated 41% of patients with chronic pain report their pain is uncontrolled, and 10% of all adults with pain suffer from severe, disabling chronic pain. The increasing prevalence of chronic pain is the result of multiple factors, including the aging popula- tion; rising rates of obesity and obesity-related pain conditions, such as joint deterioration; advances
• 99% of all hydrocodone • 68% of all oxycodone • 52% of all methadone • 40% of all hydromorphone • 19% of all fentanyl
This disproportionate rate of opioid consumption reflects sociocultural and economic factors and standards of clinical medicine.
15
MDMS1526
Powered by FlippingBook