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Spread the Word: There Are Two Opioid Crises!

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Abstract

Pain is associated with emotional and physical suffering that severely impacts quality of life. Many guidelines for the treatment of moderate to severe cancer pain indicate the use of opioids. For a small proportion of the global population, opioids are readily accessible, but are consequently also subject to risk of overuse and misuse. On the other hand, many regions provide limited access to licensed opioid therapeutics and patients struggle for better pain management. The use of prescription opioids for treatment of severe cancer and acute pain is well established, but opioid use in chronic non-cancer pain is controversial and not supported by the literature. The opioid crisis and the increasing overdose fatalities in some countries have resulted in a resurgence of opiophobia in these countries, but even worse, amplified opiophobia in countries with lower opioid consumption. In this narrative review, we highlight how the opioid crisis of overuse in some countries can negatively impact appropriate access to opioids elsewhere. The availability of opioids for clinical and recreational use differs between countries worldwide—this is an important factor in determining the occurrence of a ‘crisis of recreational use of opioids’ or a ‘crisis of under-prescription of opioids’ for pain management.

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Acknowledgements

The authors would like to thank Prof. João Batista Santos Garcia for the suggestion made in the manuscript’s introduction. This manuscript has not been presented at any conference.

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Authors and Affiliations

  1. Medical School, Sao Paulo State University (UNESP), Botucatu, São Paulo, Brazil

    Marco Antônio Marchetti Calônego

  2. William Harvey Research Institute, Barts, The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Shafaq Sikandar

  3. Palliative Medicine, Research and Education, OhioHealth, Columbus, OH, USA

    Frank D. Ferris

  4. Anesthesiology Department, Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n, Botucatu, São Paulo, 18618687, Brazil

    Guilherme Antonio Moreira de Barros

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  1. Marco Antônio Marchetti Calônego
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  2. Shafaq Sikandar
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Contributions

MAMC and GAMB: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision. FDF and SS: analysis and interpretation of data, drafting of manuscript, and critical revision.

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Correspondence to Guilherme Antonio Moreira de Barros.

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Funding

This study was financed in part by the ‘Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil’ (CAPES)—Finance Code 001 (MAMC); Versus Arthritis Career Development Fellowship—21734; and Barts Charity—MGU0515 (SS). The sponsors had no access, nor have influenced the final content of the manuscript.

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None of authors (MAMC, SS, FDF, and GAMB) have any conflicts of interest to declare.

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Marchetti Calônego, M.A., Sikandar, S., Ferris, F.D. et al. Spread the Word: There Are Two Opioid Crises!. Drugs 80, 1147–1154 (2020). https://doi.org/10.1007/s40265-020-01342-8

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