Medical and Bio-behavioral Communications Global, Inc; Private Practice, Consulting Psychology.
Pain Med. 2018 Apr 1;19(4):793-807. doi: 10.1093/pm/pnx048.
Sharp increases in opioid prescriptions, and associated increases in overdose deaths in the 2000s, evoked widespread calls to change perceptions of opioid analgesics. Medical literature discussions of opioid analgesics began emphasizing patient and public health hazards. Repetitive exposure to this information may influence physician assumptions. While highly consequential to patients with pain whose function and quality of life may benefit from opioid analgesics, current assumptions about prescription opioid analgesics, including their role in the ongoing opioid overdose epidemic, have not been scrutinized.
Information was obtained by searching PubMed, governmental agency websites, and conference proceedings.
Opioid analgesic prescribing and associated overdose deaths both peaked around 2011 and are in long-term decline; the sharp overdose increase recorded in 2014 was driven by illicit fentanyl and heroin. Nonmethadone prescription opioid analgesic deaths, in the absence of co-ingested benzodiazepines, alcohol, or other central nervous system/respiratory depressants, are infrequent. Within five years of initial prescription opioid misuse, 3.6% initiate heroin use. The United States consumes 80% of the world opioid supply, but opioid access is nonexistent for 80% and severely restricted for 4.1% of the global population.
Many current assumptions about opioid analgesics are ill-founded. Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic. National discussion has often neglected the potentially devastating effects of uncontrolled chronic pain. Opioid analgesic prescribing and related overdoses are in decline, at great cost to patients with pain who have benefited or may benefit from, but cannot access, opioid analgesic therapy.
21 世纪初，阿片类药物处方数量急剧增加，由此导致的过量用药死亡人数也相应增加，这引发了人们广泛呼吁改变对阿片类镇痛药的看法。医学文献中对阿片类镇痛药的讨论开始强调患者和公共健康危害。反复接触这些信息可能会影响医生的假设。虽然这对那些功能和生活质量可能受益于阿片类镇痛药的疼痛患者影响重大，但目前对处方阿片类镇痛药的假设，包括它们在持续阿片类药物过量流行中的作用，尚未受到审查。
通过搜索 PubMed、政府机构网站和会议记录来获取信息。
阿片类镇痛药的处方和相关的过量用药死亡人数都在 2011 年左右达到峰值，并且呈长期下降趋势；2014 年记录的急剧过量用药增加是由非法芬太尼和海洛因驱动的。没有同时摄入苯二氮䓬类药物、酒精或其他中枢神经系统/呼吸抑制剂的情况下，非美沙酮类处方阿片类镇痛药死亡的情况并不常见。在初始使用阿片类药物滥用后的五年内，有 3.6%的人开始使用海洛因。美国消耗了全球 80%的阿片类药物供应，但全球 80%的人口无法获得阿片类药物，4.1%的人口获得阿片类药物的途径严重受限。
许多当前对阿片类镇痛药的假设是没有根据的。非法芬太尼和海洛因，而不是阿片类药物的处方，现在是当前阿片类药物过量流行的主要原因。国家讨论经常忽视了未经控制的慢性疼痛可能带来的毁灭性影响。阿片类镇痛药的处方和相关的过量用药正在减少，这给那些受益于或可能受益于阿片类镇痛药治疗但无法获得治疗的疼痛患者带来了巨大的代价。
