Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

Furlan, Andrea D.; Harvey, Alexandra; Chadha, Rashmi

doi:10.7189/jogh.10.010324

Cited by 14 publications

(7 citation statements)

References 20 publications

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“…There are numerous factors that have contributed to the opioid crisis, many of which reflect good intentions to improve pain relief in one patient population being misapplied to a different one. The global burden and societal implications of opioid use and misuse are summarized in Table 1, and many of the drivers for excessive opioid use are listed in Table 2 …”

Section: Epidemiology Of the Overuse Of Opioidsmentioning

confidence: 99%

“…In addition, the overemphasis on opioids in the US has been blamed in part on pharmaceutical companies having undue influence over professional bodies and guideline development . What is particularly worrying now is that this pattern is repeating as big pharma moves into low- and middle-income countries to promote opioid use via industry-sponsored prescribing guidelines . In our global society, can we learn from each other or are our health care systems, culture, and populations just too different?…”

Section: What’s Happening Around the World?mentioning

confidence: 99%

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Current Issues in the Use of Opioids for the Management of Postoperative Pain

et al. 2022

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ncontrolled and indiscriminate prescribing of opioids during the past 3 decades has led to an opioid crisis that started in North America and spread throughout high-income countries. [1][2][3][4][5] This crisis initially drew attention to inappropriate prescribing of opioids for the management of chronic noncancer pain. 3 This is pain that persists for more than 3 months, is not associated with tissue damage but rather a dysfunctional pain system, and for which opioids are not recommended. 5,6 In contrast, opioids remain an effective and important component of the management of acute postoperative pain, although it has recently become clear that excessive or prolonged prescribing of opioids for postoperative pain relief, both in hospital and after discharge, may also be playing a role in the crisis and increasing patient harms. 5 The genesis of this crisis is exemplified by the title of a 2018 article, "Good Intentions Gone Bad, an Industry Gone Rogue, and Watch Dogs Gone to Sleep." 2 The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, including the drivers that led to escalation of use; the resultant in-crease in patient harms, including opioid-induced ventilatory impairment (OIVI); the move away from using self-reported pain scores alone to assess adequacy of analgesia or to guide titration of opioids; concerns about the routine use of long-acting opioids including controlledrelease (also known as slow-, extended-, modified-, or sustainedrelease) formulations for the management of acute pain; and concerns about prescription of opioids on discharge from hospital. In addition, therehasbeenincreasingrecognitionthatpreadmissionlong-termopioid use can affect both short-term and long-term postoperative outcomes. Finally, this review addresses whether opioid-free anesthesia and analgesia (OFAA) might have a role to play in reducing postoperative opioid-related harms. MethodsWe searched the PubMed, Web of Science, Google Scholar, and Cochrane Library databases on June 8, 2021, using the terms opioid cri-IMPORTANCE Uncontrolled and indiscriminate prescribing of opioids has led to an opioid crisis that started in North America and spread throughout high-income countries. The aim of this narrative review was to explore some of the current issues surrounding the use of opioids in the perioperative period, focusing on drivers that led to escalation of use, patient harms, the move away from using self-reported pain scores alone to assess adequacy of analgesia, concerns about the routine use of controlled-release opioids for the management of acute pain, opioid-free anesthesia and analgesia, and prescription of opioids on discharge from hospital.OBSERVATIONS The origins of the opioid crisis are multifactorial and may include good intentions to keep patients pain free in the postoperative period. Assessment of patient function may be better than unidimensional numerical pain scores to help guide postoperative analgesia. Immediate-release opi...

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Section: Epidemiology Of the Overuse Of Opioidsmentioning

confidence: 99%

Section: What’s Happening Around the World?mentioning

confidence: 99%

Current Issues in the Use of Opioids for the Management of Postoperative Pain

et al. 2022

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“…Although the MHRA recommendations will need to be adhered to within the UK, they are equally applicable globally, especially as drug companies are now aggressively marketing their products in low and middle income countries 15. An important omission in the recommendations is opioid diversion, which is a major cause of harm.…”

Section: Wider Approachmentioning

confidence: 99%

UK recommendations on opioid stewardship

Levy

Lord

Lobo

2021

BMJ

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“…This analysis assessed whether RZV administration to these groups may reduce drug use during HZ breakthrough, a particularly relevant topic in light of the current excess opioid use observed in several countries. 15 , 23 , 36 …”

Section: Introductionmentioning

confidence: 99%

Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials

Kim

Johnson

Kovac

et al. 2022

Pain

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Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults $50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and $70 years old (ZOE-70; NCT01165229) and in immunocompromised adults $18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score $3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ ("breakthrough cases") from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinically significant HZ-associated pain during HZ episodes by 38.5% (P-value: 0.010) in the ZOE-HSCT study. Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P-value: 0.008) and duration of medication use (49.3%, P-value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.

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Warning from Canada: Latin America, South Africa and India may face an opioid epidemic in the coming years

Cited by 14 publications

References 20 publications

Current Issues in the Use of Opioids for the Management of Postoperative Pain

Current Issues in the Use of Opioids for the Management of Postoperative Pain

UK recommendations on opioid stewardship

Adjuvanted recombinant zoster vaccine decreases herpes zoster-associated pain and the use of pain medication across 3 randomized, placebo-controlled trials

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