A Brief History of the Opioid Epidemic and Strategies for Pain Medicine.

Mark R Jones,Jacquelin Peck,Jatinder S Gill,Omar Viswanath,Alan D Kaye,Thomas T Simopoulos

doi:10.1007/s40122-018-0097-6

Mark R Jones, Jacquelin Peck + Show 4 more

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The opioid epidemic has resulted from myriad causes and will not be solved by any simple solution. Consequent to a staggering increase in opioid-related deaths in the USA, various governmental inputs and stakeholder strategies have been proposed and implemented with varying success. This article summarizes the history of opioid use and explores the causes for the present day epidemic. Recent trends in opioid-related data demonstrate an almost fourfold increase in overdose deaths from 1999 to 2008. Tragically, opioids claimed over 64,000 lives just last year. Some solutions have undergone legislation, including the limitation of numbers of opioids postsurgery, as well as growing national prevalence of enhanced recovery after surgery protocols which focus on reduced postoperative opioid consumption and shortened hospital stays. Stricter prescribing practices and prescription monitoring programs have been instituted in the recent past. Improvement in abuse deterrent strategies which is a major focus of the Food and Drug Administration (FDA) for all opioid preparations will likely play an important role by increasing the safety of these medications. Future potential strategies such as additional legislative policies, public awareness, and physician education are also detailed in this review.

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In response to the current epidemic, changes in focus to the development of new abuse deterrent opioid formulations at the US Food and Drug Administration (FDA) as well as drafting of new public standards for pain treatment were created at the Joint Commission (TJC) in 2017 [32]
In response to the opioid epidemic, FDA public policy changes were announced in February 2016. Among these new positions were a re-examination of the risk–benefit paradigm for opioids with strict emphasis on the large public health ramifications; expanded access to and encouraged development of abuse-deterrent opioid formulations; expert advisory committee assembly prior to new applications for opioids lacking abuse-deterrent properties; improved access to naloxone and other treatment options for opioid use disorder; inclusion of safety information and warnings on immediate-release (IR) opioid labeling; and support for alternative pain management modalities
In order to continue to curb opioid abuse and reduce opioid deaths while maintaining adequate access to pain relief, the American Society of Interventional Pain Physicians (ASIPP) has issued recommendations focused on two main arenas: more effective legislative efforts while maintaining appropriate access, and the promotion of non-opioid modalities including interventional techniques

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In response to the current epidemic, changes in focus to the development of new abuse deterrent opioid formulations at the US Food and Drug Administration (FDA) as well as drafting of new public standards for pain treatment were created at TJC in 2017 [32]. The Drug Addiction Treatment Act of 2000 (DATA 2000) allowed physicians with a waiver from the Center for Substance Abuse and Mental Health Services Administration to prescribe schedule III, IV, and V medications to treat opioid dependence.

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