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

Abstract

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.

Keywords: Abuse deterrent formulations; Enhanced recovery after surgery; Non-opioid pain treatments; Opioid epidemic; Overdose.

Fig. 1

Annual opioid prescribing rates in the USA, 2006–2015; prescribing rates by number of days’ supply; average daily morphine milligram equivalent (MME) per prescription; and average number of days’ supply per prescription [4]

Fig. 2

Number of opioid overdose deaths by category, 1999–2016. Opioid-related deaths increase dramatically in 2016 [5]