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Commentary |

Curtailing Diversion and Abuse of Opioid Analgesics Without Jeopardizing Pain Treatment

Nora D. Volkow, MD; Thomas A. McLellan, PhD
JAMA. 2011;305(13):1346-1347. doi:10.1001/jama.2011.369.
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Opioid analgesics are among the most effective medications for pain management (including noncancer pain), but they are also associated with serious and increasing public health problems, such as abuse (ie, use for nonmedical purposes), addiction, and deaths from opioid overdose (excluding heroin). Both immediate and extended opioid release formulations, including methadone, are abused and contribute to overdose. For example, since 2002, the US prevalence of high school seniors reporting past-year nonmedical use of opioids has been 8% to 10% for hydrocodone and 4% to 5% for oxycodone.1 After excluding alcohol and tobacco, the prevalence of hydrocodone abuse is second only to marijuana abuse. Concurrently, there has been a 5-fold increase in drug treatment admissions for pharmaceutical opioids between 1998 and 2008, from 19 941 to 121 091.2 In addition, emergency department visits related to pharmaceutical opioids have increased from 144 644 to 305 885, between 2004 and 2008, and unintentional opioid-related overdose deaths have increased from about 3000 to 12 000 between 1999 and 2007.3 Opioid overdose is now the second leading cause of unintentional death in the United States, second only to motor vehicle crashes,4 which prompted the Centers for Disease Control and Prevention to label pharmaceutical opioid overdose as a national epidemic.

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