Addressing the intersecting problems of opioid misuse and chronic pain treatment

Abstract

Misuse of prescription opioid medications has continued as a major public health problem in the United States. Review of major epidemiologic databases shows that the prevalence of opioid misuse rose markedly through the 1990s and the early part of the current decade. In this same period of time, the number of prescriptions for chronic noncancer pain increased markedly, and the intersection of these two public health problems remains a concern. Further, despite some leveling off of the overall rate of prescription opioid misuse in the past several years, surveillance data show high and increasing mortality associated with these drugs. Analysis of the 2006 National Survey of Drug Use and Health indicates the increasing prevalence of prescription opioid misuse is associated more with an increase in the general availability of these medications than misuse of the medications by those who were directly prescribed them. National Institute on Drug Abuse initiatives to address the prescription opioid problem include programs to stimulate research in the basic and clinical sciences, and to educate physicians and other health personnel.

Figure 1. Current (last month) Number of Persons Age 12 or Older Misusing Prescription Medications in the United States in 2006

Source: Substance Abuse and Mental Health Services Administration, 2007.

Figure 2. Past Year Initiates for Specific Illicit Drugs among Persons Age 12 or Older in the United States in 2006

Source: Substance Abuse and Mental Health Services Administration, 2007.

Figure 3. Source of Prescription Pain Relievers 2006 NSDUH

Note: totals may not sum to 100% because of rounding or suppressed estimates are not shown. ¹ The Other category includes the sources: “Wrote Fake Prescription Stole from Doctor’s Office/Clinic/Hospital/Pharmacy, and Some Other Way” Source: Substance Abuse and Mental Health Services Administration, 2007.

Figure 4. Annual Prevalence Rate of Narcotics Other than Heroin from 1975 to 2007

*Beginning in 2002, a revised set of questions on other narcotics use was introduced, in which Talwin, laudanum, and paregoric were replaced with Vicodin, OxyContin, and Percocet. Only data from 12^th graders is reported, because authors question validity of data from younger students for other narcotics category. Source: Monitoring the Future study, The University of Michigan, 2008.