To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Increase In Opioid Analgesia Does Not Necessarily Mean Increase In Abuse URL: http://www.pslgroup.com/dg/195A0A.htm Doctor's Guide April 4, 2000
CHICAGO, IL -- April 4, 2000 -- The use of opioid analgesics (medications with actions similar to opium) to treat pain is increasing; however, new data suggest the abuse of opioid analgesics relative to all drug abuse may be declining, according to an article in the April 5 issue of The Journal of the American Medical Association (JAMA). David E. Joranson, M.S.S.W., from the Pain and Policy Studies Group at the University of Wisconsin Medical School, Madison, and colleagues obtained information on the extent of medical use of opioid analgesics from 1990 to 1996 using data maintained by the U.S. Drug Enforcement Administration. They used the Drug Abuse Warning Network (DAWN), a nationally representative sample of hospital emergency department admissions resulting from drug abuse, as the source for data on opioid abuse from 1990 to 1996. The authors found that from 1990 to 1996, there were increases in medical use of morphine (59 percent), fentanyl (1,168 percent), oxycodone (23 percent) and hydromorphone (19 percent) and a decrease in the medical use of meperidine (35 percent). During the same period, reports of abuse decreased for meperidine (39 percent), oxycodone (29 percent), fentanyl (59 percent) and hydromorphone (15 percent) and increased for morphine (3 percent). The authors write that the present trend of increasing medical use of opioid analgesics to treat pain does not appear to be contributing to increases in the health consequences of opioid analgesic abuse: "To maintain this trend, manufacturers, pharmacies, clinicians, and patients should continue their efforts to improve pain management while exercising care so that the diversion of opioid medications for non-medical use is minimized." "Concerns related to drug abuse permeate efforts to treat pain with opioids," the authors write. "Patients are concerned about becoming addicted to opioids. Health care professionals may be reluctant to prescribe, administer, dispense, or stock controlled substances for fear of causing addiction or contributing to the drug abuse problem." The researchers evaluated abuse trends for opioid analgesics as a class, as well as the medical use and abuse of five specific Schedule II opioids: fentanyl, hydromorphone, meperidine, morphine and oxycodone. The DAWN source provided specifics about people visiting hospital emergency departments for problems related to drug use (ie overdose, adverse reactions to drugs, problems due to long-term drug use, etc.). "For each episode of drug abuse, as many as four different substances, in addition to alcohol, can be recorded. Each is referred to as a drug mention," the authors explain. The total number of drug abuse mentions per year due to opioid analgesics increased from 32,430 to 34,563 (6.6 percent), although the proportion of mentions for opioid abuse relative to total drug abuse mentions decreased from 5.1 percent to 3.8 percent. "Several caveats are needed to place these results in context. First, these data also indicate that there is some abuse of opioid analgesics," the authors write. "However, compared with the abuse of other drugs, illicit drugs in particular, the abuse of opioid analgesics appears to be relatively low, accounting for 3.8 percent of total DAWN mentions in 1996. Moreover, even though there were increases in the total number of mentions of abuse for opioid analgesics during the study period, the proportion of mentions for opioid abuse relative to total reports of drug abuse decreased by 25 percent (from 5.1 percent to 3.8 percent)." "Second, the DAWN system may underestimate the extent of the drug abuse problem. The DAWN system measures only those episodes of drug abuse that result in an admission to an Emergency Department and thus underreports the true extent of all drug abuse, such as drug-related overdoses and deaths occurring out of the hospital. Furthermore, our study primarily addresses changes in abuse trends rather than abuse levels at a single point in time." (JAMA. 2000;283:1710-1714) Related Link: The Journal of the American Medical Association (JAMA). --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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