Spread the Word: There Are Two Opioid Crises!
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CURRENT OPINION
Spread the Word: There Are Two Opioid Crises! Marco Antônio Marchetti Calônego1 · Shafaq Sikandar2 · Frank D. Ferris3 · Guilherme Antonio Moreira de Barros4
© Springer Nature Switzerland AG 2020
Abstract Pain is associated with emotional and physical suffering that severely impacts quality of life. Many guidelines for the treatment of moderate to severe cancer pain indicate the use of opioids. For a small proportion of the global population, opioids are readily accessible, but are consequently also subject to risk of overuse and misuse. On the other hand, many regions provide limited access to licensed opioid therapeutics and patients struggle for better pain management. The use of prescription opioids for treatment of severe cancer and acute pain is well established, but opioid use in chronic non-cancer pain is controversial and not supported by the literature. The opioid crisis and the increasing overdose fatalities in some countries have resulted in a resurgence of opiophobia in these countries, but even worse, amplified opiophobia in countries with lower opioid consumption. In this narrative review, we highlight how the opioid crisis of overuse in some countries can negatively impact appropriate access to opioids elsewhere. The availability of opioids for clinical and recreational use differs between countries worldwide—this is an important factor in determining the occurrence of a ‘crisis of recreational use of opioids’ or a ‘crisis of under-prescription of opioids’ for pain management.
1 Introduction: Facets of an Opioid Crisis Global opioid consumption is primarily concentrated in countries comprising North America, Western Europe, and Oceania. These regions correspond to 17% of the global population, but contribute to 92% of morphine * Guilherme Antonio Moreira de Barros [email protected] Marco Antônio Marchetti Calônego [email protected] Shafaq Sikandar [email protected] Frank D. Ferris [email protected] 1
Medical School, Sao Paulo State University (UNESP), Botucatu, São Paulo, Brazil
2
William Harvey Research Institute, Barts, The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
3
Palliative Medicine, Research and Education, OhioHealth, Columbus, OH, USA
4
Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n, Botucatu, São Paulo 18618687, Brazil
consumption worldwide. This is partly due to disproportionate prescription of opioids [1]. Furthermore, local availability of opioids in quantities greater than recommended for medical use may result in diversion, misuse, and abuse, as well as other negative consequences such as overdose and addiction [2, 3]. Opiophobia (Table 1) is the exaggerated fear of the risks associated with opioid analgesic use and is rooted in the addiction epidemic of the early twentieth century that shaped modern drug policies. The stigma against medical use of opioids began to shift in medical professions f
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