Abstract
Purpose of Review
In the USA, there has been a sharp increase in heroin, prescription opiate, and illicitly manufactured fentanyl abuse with overdoses tripling since the 1990s. Several states have been deemed as “high-burden” abuse states where there is a greater proportion of synthetic opiate use. During the same period that prescription limitations were initially implemented throughout the country, the fentanyl epidemic started nationwide.
Recent Findings
In the setting of data demonstrating an almost fourfold increase in overdose deaths from 1999 to 2008, states began restricting access to Food and Drug Agency (FDA) approved opioid medications. Another factor further exacerbating the opioid crises is that the cost of all formulations of naloxone has increased significantly over the past several years.
Summary
In order to combat the opioid epidemic, stricter prescribing practices and prescription-monitoring programs have been instituted. Also, improvements in abuse-deterrent strategies for all opioid preparations can play an important role by increasing the safety of these medications and is a major focus of the FDA.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Manchikanti L, Atluri S, Hirsch JA. The effect of abuse-deterrent extended-release oxycodone leads to inappropriate conclusions with over estimation of safety of abuse-deterrent formulations. Pain physician. 2015;18(3):E445–6.
Guy GP Jr, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704.
Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013-2014. MMWR Morb Mortal Wkly Rep. 2016;65(33):837–43.
Ray B, Quinet K, Dickinson T, Watson DP, Ballew A. Examining fatal opioid overdoses in Marion County, Indiana. J Urban Health. 2017;94(2):301–10.
Somerville NJ, O'Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, et al. Characteristics of fentanyl overdose—Massachusetts, 2014-2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6.
Frank RG, Pollack HA. Addressing the fentanyl threat to public health. N Engl J Med. 2017;376(7):605–7.
Slavova S, Costich JF, Bunn TL, Luu H, Singleton M, Hargrove SL, et al. Heroin and fentanyl overdoses in Kentucky: epidemiology and surveillance. Int J Drug Policy. 2017;46:120–9.
Peterson AB, Gladden RM, Delcher C, Spies E, Garcia-Williams A, Wang Y, et al. Increases in fentanyl-related overdose deaths—Florida and Ohio, 2013-2015. MMWR Morb Mortal Wkly Rep. 2016;65(33):844–9.
Wejnert C, Hess KL, Hall HI, Van Handel M, Hayes D, Fulton P Jr, et al. Vital signs: trends in HIV diagnoses, risk behaviors, and prevention among persons who inject drugs—United States. MMWR Morb Mortal Wkly Rep. 2016;65(47):1336–42.
Medicaid expansion: behavioral health treatment use in selected states in 2014. 2017. Report No.: GAO-17-529.
National Federation of Independent Business V. Sebelius, 132 S.Ct. 2566 (June 2012). Benefits Q. 2013;29(1):64–6.
Maclean J, Saloner, B. The effect of public insurance expansions on substance use disorder treatment: evidence from the Affordable Care Act In: Research NBoE, editor. 2017.
Burns RM, Pacula RL, Bauhoff S, Gordon AJ, Hendrikson H, Leslie DL, et al. Policies related to opioid agonist therapy for opioid use disorders: the evolution of state policies from 2004 to 2013. Subst Abus. 2016;37(1):63–9.
Opioid addiction: laws, regulations, and other factors can affect medication-assisted treatment access. In: Office USGA, editor. 2016.
Rinaldo SG, Rinaldo RW. Availability without accessibility: state Medicaid coverage and authorization requirements for opioid dependence medications 2013 [Available from: https://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final.
H.R.2634 - Drug Addiction Treatment Act of 2000.
FDA. Subutex and suboxone approved to treat opiate dependence 2002 [Available from: https://www.fda.gov/Drugs/DrugSafety/ucm191521.htm.
Gupta R, Shah ND, Ross JS. The rising price of naloxone—risks to efforts to stem overdose deaths. N Engl J Med. 2016;375(23):2213–5.
Ruan X, Ma L, Couch JP, Chen T, Bumgarner GW. Intractable pruritus during outpatient epidural hydromorphone infusion: a case report and a focused review of the literature. J Opioid Manag. 2015;11(2):184–90.
Gudin J. Oxycodone DETERx(R): a novel abuse-deterrent, extended-release analgesic option for the treatment of patients with chronic pain. Pain Ther. 2016;5(2):171–86.
Morlion BJ, Mueller-Lissner SA, Vellucci R, Leppert W, Coffin BC, Dickerson SL, et al. Oral prolonged-release oxycodone/naloxone for managing pain and opioid-induced constipation: a review of the evidence. Pain Pract. 2017.
DePriest AZ, Miller K. Oxycodone/naloxone: role in chronic pain management, opioid-induced constipation, and abuse deterrence. Pain Ther. 2014;3(1):1–15.
Gudin J, Levy-Cooperman N, Kopecky EA, Fleming AB. Comparing the effect of tampering on the oral pharmacokinetic profiles of two extended-release oxycodone formulations with abuse-deterrent properties. Pain Med. 2015;16(11):2142–51.
Jones MR, Carney MJ, Kaye RJ, Prabhakar A, Kaye AD. Drug formulation advances in extended-release medications for pain control. Curr Pain Headache Rep. 2016;20:36.
Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options. J Natl Med Assoc. 2012;104(7–8):342–50.
Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315–26.
•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Galan V, Beakley BD, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse: part 1. Pain Physician. 2017;20(2S):S93–S109. This is an excellent review on prescription opioid abuse.
•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Jones DE, Galan V, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse (part 2). Pain Physician. 2017 Feb;20(2S):S111–33. This is an excellent review on prescription opioid abuse.
•• Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017;20(2S):S3–S92. This is an excellent review on opioids for noncancer pain.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Dr. Ostling, Dr. Davis, Dr. Helander, and Dr. Wyche declare no conflicts of interest.
Dr. Kaye is a speaker for Depomed, Inc. and Merck, Inc. He also reports that he has been a member of the FDA Advisory Board on Anesthetics, Analgesics, and Addiction Medicine since 2012.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Other Pain
Rights and permissions
About this article
Cite this article
Ostling, P.S., Davidson, K.S., Anyama, B.O. et al. America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis. Curr Pain Headache Rep 22, 32 (2018). https://doi.org/10.1007/s11916-018-0685-5
Published:
DOI: https://doi.org/10.1007/s11916-018-0685-5