Opioid analgesics

Abstract

Stefano Berterame and colleagues' findings1Berterame S Erthal J Thomas J et al.Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study.Lancet. 2016; 387: 1644-1656Summary Full Text Full Text PDF PubMed Scopus (346) Google Scholar highlight a crisis of public health and public conscience. 55 years after the acknowledgment that narcotic drugs are “indispensable for the relief of pain and suffering”,2International Narcotics Control BoardReport of the International Narcotics Control Board for 1995: availability of opiates for medical needs. United Nations, New York1996Google Scholar pain management in the developing world continues to be inadequate.3UN Office on Drugs and CrimeThe international drug control conventions. United Nations, New York2009Google Scholar In 2011–13, the defined daily dose for statistical purposes of opioid analgesics was 110 per million inhabitants per day in Mexico as compared to 43879 per million inhabitants per day in the USA.3UN Office on Drugs and CrimeThe international drug control conventions. United Nations, New York2009Google Scholar As a result of the potential for diversion and misuse, Mexican regulation has classified all strong opioids (including prescription opioids) as Schedule 1 drugs, severely limiting their prescription. The introduction of abuse-deterrent formulations (ADFs), with an associated review of the drug classification convention, could remove this barrier and make prescription opioids more accessible. Most ADFs impose mechanical or chemical barriers that reduce potential misuse. Results of a study4Cicero TJ Ellis MS Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States: lessons learned from oxyContin.JAMA Psychiatry. 2015; 75: 424-430Crossref Scopus (188) Google Scholar show that ADF formulations successfully reduce misuse of the active drug, particularly in those who relied on tampering for injected or inhaled misuse. The US Food and Drug Administration has subsequently released guidelines on the evaluation and labelling of abuse-deterrent opioids and considers their use a “high public health priority”.5US Food and Drug AdministrationGuidance for industry: abuse-deterrent opioids—evaluation and labeling.http://www.fda.gov/downloads/Drugs/Guidances/UCM334743.pdfDate: January, 2013Google Scholar We hope that developing countries will follow suit. The introduction of ADFs presents an available, cost-effective, and proven strategy to increase legitimate access to pain control, without increasing the risks of diversion and misuse. We declare no competing interests. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national studyUse of opioid analgesics has increased, but remains low in Africa, Asia, Central America, the Caribbean, South America, and eastern and southeastern Europe. Identified impediments to use urgently need to be addressed by governments and international agencies. Full-Text PDF Opioid analgesics – Authors' replyHenri-Jean Aubin, Jill M Williams, and Amandine Luquiens question the non-inclusion of the risk of overdose in the list of impediments considered in our study.1 The list of impediments was based on those most commonly reported in earlier surveys in 19952 and 2010.3 We did not intend to ignore the extreme risks associated with prescription opioid abuse. Although the focus of the study was the analysis of the barriers to access and the inequality in the consumption of opioids in many countries, the Article states “Ensuring of access does not necessarily mean increased misuse and diversion, but a balance between control on the one hand and overly liberal availability on the other does need to be maintained”. Full-Text PDF