The treatment of
chronic pain, therapeutic
opioid use and abuse, and the nonmedical use of
prescription drugs have been topics of intense focus and debate. After the liberalization of laws governing
opioid prescribing for the treatment of chronic non-
cancer pain by state medical boards in the late 1990s, and with the introduction of new
pain management standards implemented by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2000,
opioids, in general, and the most potent forms of
opioids including Schedule II drugs, in particular, have dramatically increased. Despite the escalating use and abuse of therapeutic
opioids, nearly 15 to 20 years later the scientific evidence for the effectiveness of
opioids for chronic non-
cancer pain remains unclear. Concerns continue regarding efficacy; problematic physiologic effects such as
hyperalgesia,
hypogonadism and sexual dysfunction; and adverse side effects - especially the potential for misuse and abuse - and the increase in
opioid-related deaths. Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global
opioid supply, and 99% of the global
hydrocodone supply, as well as two-thirds of the world's
illegal drugs. Retail sales of commonly used
opioid medications (including
methadone,
oxycodone,
fentanyl base,
hydromorphone,
hydrocodone,
morphine,
meperidine, and
codeine) have increased from a total of 50.7 million grams in 1997 to 126.5 million grams in 2007. This is an overall increase of 149% with increases ranging from 222% for
morphine, 280% for
hydrocodone, 319% for
hydromorphone, 525% for
fentanyl base, 866% for
oxycodone, to 1,293% for
methadone. Average sales of
opioids per person have increased from 74 milligrams in 1997 to 369 milligrams in 2007, a 402% increase. Surveys of
nonprescription drug abuse, emergency department visits for prescription controlled drugs, unintentional deaths due to prescription
controlled substances,
therapeutic use of
opioids, and
opioid abuse have been steadily rising. This manuscript provides an updated 10-year perspective on
therapeutic use, abuse, and non-medical use of
opioids and their consequences.