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. 2017 May 12;2(3):e599.
doi: 10.1097/PR9.0000000000000599. eCollection 2017 May.

The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents

Winfried Häuser  1 , Stephan Schug  2   3 , Andrea D Furlan  4
Affiliations

The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents

Winfried Häuser et al. Pain Rep. .

Abstract

Introduction: A marked rise in opioid prescriptions for patients with chronic noncancer pain (CNCP) with a parallel increase in opioid abuse/misuse, and resulting deaths was noted in the Unites states in the past decade (opioid epidemic). In response, the US Center of Diseases Control (CDC) developed a guideline for prescribing of opioids for patients with CNCP.

Objectives: To assess (1) if there is an opioid epidemic in Australia, Canada, and Germany (2) to compare Australian, Canadian, German, and Center of Diseases Control guidelines recommendations for long-term opioid therapy for CNCP.

Methods: National evidence-based guidelines and PubMed were searched for recommendations for opioid prescriptions for CNCP.

Results: There are signs of an opioid epidemic in Australia and Canada, but not in Germany. Guidelines in all 4 countries provide similar recommendations: opioids are not the first-line therapy for patients with CNCP; regular clinical assessments of benefits and harms are necessary; excessive doses should be avoided (recommended morphine equivalent daily doses range from 50 to 200 mg/d); stopping rules should be followed. All guidelines do not recommend the use of opioids in chronic pain conditions without an established nociceptive or neuropathic cause such as fibromyalgia and primary headache.

Conclusion: Implementation of opioid prescribing guidelines should ensure that physicians prescribe opioids only for appropriate indications in limited doses for selected patients and advice patients on their safe use. These measures could contribute to reduce prescription opioid misuse/abuse and deaths.

Keywords: Abuse; Addiction; Chronic noncancer pain; Guidelines; Misuse; Mortality; Opioids.

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Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1.
Figure 1.
Opioid consumption in Morphine Equivalence minus methadone, mg per person in Australia from 1980 to 2014.
Figure 2.
Figure 2.
Opioid consumption in Morphine Equivalence minus methadone, mg per person in Canada from 1980 to 2015.
Figure 3.
Figure 3.
Opioid consumption in Morphine Equivalence minus methadone, mg per person in Germany from 1980 to 2015.
Figure 4.
Figure 4.
Opioid consumption in Morphine Equivalence minus methadone, mg per person in United States from 1980 to 2015.
See this image and copyright information in PMC

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