The prescription opioid epidemic: an update

Abstract

Background: Since a previous contribution to this journal in 2012, the epidemic of opioid abuse has become increasingly frightening and tragic. Of an estimated 62,632 drug overdose deaths in the US in 2016 about 2/3 were from opioids, more than deaths from traffic fatalities. Preliminary data for 2017 indicates an even higher opioid overdose death count. Methods: This paper reviews available data from public health agencies and other sources detailing the significant changes in both the regulatory response and characteristics of the opioid overdose epidemic. While discussion provided is primarily for the US, where the epidemic is centered, results from other countries, such as Canada, are also examined. Results: The available data indicates a dramatic evolution in both the characteristics of the epidemic and the legal fallout for companies involved in providing prescription opioids. Regulatory efforts to control the supply of prescription opioids, such as revised guidelines for physicians employing opioids in pain management, combined with an avalanche of lawsuits against companies involved in the prescription opioid supply chain, has resulted in a frightening shift in to fentanyl-contaminated black market opioids by addicted populations. Conclusion: The shift to black market opioids has created an even more complicated regulatory problem, exposing the deep societal problems that underpin the epidemic. While attempts to address this new stage of the epidemic, including the widespread use and availability of naloxone, creating of drug injection sites, passage of 'Good Samaritan' laws and the like, have not been accompanied by a commensurate reduction in the overdose death rate.