Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain
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COMMENTARY
Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain Aziza Alenezi1 · Asma Yahyouche1 · Vibhu Paudyal1 Received: 1 April 2020 / Accepted: 17 November 2020 © The Author(s) 2020
Abstract The increase in opioid prescriptions in the United States has been accompanied by an increase in misuse as well as overdose and toxicity related morbidity and mortality. However, the extent of the increased opioid use, including misuse in the United Kingdom, currently remains less debated. Recent studies in the United Kingdom have shown a rise in opioid use and attributed deaths, particularly in areas with higher deprivation. There are also large variations amongst the devolved nations; Scotland has the highest drug-related deaths and year-on-year increase within Europe. Better clinical guidelines that can enable person-centred management of chronic pain, medicines optimisation, and early diagnosis and treatment of opioid use disorder are crucial to addressing opioid-related morbidity and mortality in the United Kingdom. Keywords Chronic non-malignant pain · Chronic opioid therapy · Opioid use disorder · United Kingdom
Impacts on practice • Triangulation of currently available data from multiple
sources confirms that opioid crisis is deepening in the United Kingdom which needs urgent policy and practice focus on patient pathways to opioid misuse. • Clinical guidelines and innovative service models that can enable person-centred management of chronic pain, medicines optimisation, and early diagnosis and treatment of opioid use disorder are needed. • There is a need for better linkage of data across sectors to enable epidemiological surveillance and monitoring of prescribed and illicit opioids use.
Introduction The term ‘opioid epidemic’ specifically refers to increased deaths and hospitalisations due to prescribed and illicit opioids and their analogues. The opioid epidemic in the United States (US), [1] has led to calls internationally regarding * Vibhu Paudyal [email protected] 1
School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK
rational prescribing and use of prescribed opioids as well as the need to address the misuse of illicit opioids (for instance, heroin and opium) and diverted pharmaceutical opioids (such as buprenorphine, methadone, and morphine). The aim of this paper is to critically discuss current practice and research regarding the extent of prescribed opioid use, particularly in the context of chronic non-malignant pain (CNMP) management, and identify how rising opioid (both prescribed and illicit use) related morbidity and mortality can be addressed.
Chronic opioid therapy (COT) in the management of CNMP COT defined as the use of opioids on most days for more than three months, remains the mainstay of CNMP [2]. CNMP is a condition where patients persistently or recurrently experience pain for at least three months [3]. CNMP affects 20% of adults worldwide. In the United Kingdom (UK), studies suggest that up to ha
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