"Opioid medications also have a potential for abuse (a discussion of this important issue is in the Executive Summary and Section III of the Evaluation Guide 2013). Consequently, opioid analgesics and the healthcare professionals who prescribe, administer, or dispense them are regulated pursuant to federal and state controlled substances laws, as well as under state laws and regulations that govern professional practice.70;71 Such policies are intended to prevent illicit trafficking, drug abuse, and substandard practice related to prescribing and patient care.
Prescription Analgesics, typically opioid pain relievers
" Heroin was reported as the primary substance of abuse for 26 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].
" Sixty-seven percent of primary heroin admissions were non-Hispanic White (41 percent were males and 26 percent were females). Non-Hispanic Blacks made up 14 percent (9 percent were males and 5 percent were females). Admissions of Puerto Rican origin made up 7 percent of primary heroin admissions (6 percent were males and 1 percent were females) [Table 2.3b]. See Chapter 3 for additional data on heroin admissions.
"Undertreatment of pain among African Americans has been well documented. For example, children with sickle-cell anemia (a painful disease that occurs most often among African Americans) who presented to hospital emergency departments (EDs) with pain were far less likely to have their pain assessed than were children with long-bone fractures (Zempsky et al., 2011).
Polydrug Involvement in Pharmaceutical Overdose Deaths in the US: "Opioids were frequently implicated in overdose deaths involving other pharmaceuticals. They were involved in the majority of deaths involving benzodiazepines (77.2%), antiepileptic and antiparkinsonism drugs (65.5%), antipsychotic and neuroleptic drugs (58.0%), antidepressants (57.6%), other analgesics, antipyretics, and antirheumatics (56.5%), and other psychotropic drugs (54.2%).
"Of the 36,667 drug overdose deaths with at least one mention of a specific drug, 52% mentioned only one specific drug (18,931 deaths), 26% mentioned two (9,351 deaths), 12% mentioned three (4,521 deaths), 6% mentioned four (2,041 deaths), and 5% mentioned five or more (1,823 deaths). Among drug overdose deaths with at least one mention of a specific drug, the average number of specific drugs mentioned was 1.9.
(Overdose Risk Based on Prescription Type) "Dunn et al4 found that risk of drug-related adverse events among individuals treated for chronic noncancer pain with opioids was increased at opioid doses equivalent to 50 mg/d or more of morphine. Our analyses similarly found that the risk of opioid overdose increased when opioid dose was equivalent to 50 mg/d or more of morphine.
"There is some evidence that higher prescribed doses increase the risk of drug overdose among individuals treated with opioids for chronic non-cancer pain.4 Specifically, the risk of drug-related adverse events is higher among individuals prescribed opioids at doses equal to 50 mg/d or more of morphine.
Prevalence of Analgesic Use Among Youth in Australia: "Regularity of use: Of students who had used analgesics in the past year, 54% of females and 43% of males had used analgesics 10 or more times in the previous year. Sixteen per cent of males and 10% of females reported use of analgesics only once or twice in the past year.
"Of the male students who had used analgesics in the past week, 71% had used them only once or twice, while 20% had used them 3-5 times. Of the female students who had used analgesics in the past week, 68% had used them once or twice and 22% had used them 3-5 times."
"Even though opioids have been controlled in the United States with regulations and restrictions, opioid utilization has been increasing at an unprecedented pace (1-10). Manchikanti et al (1), in an evaluation of opioid usage over a period of 10 years, showed an overall increase of 149% in retail sales of opioids from 1997 to 2007 in the United States, with an increase of 1,293% for methadone, 866% for oxycodone, and 525% for fentanyl.
"Nationwide, 14.0% of students had taken prescription pain medicine (counting drugs such as codeine, Vicodin, OxyContin, Hydrocodone, and Percocet) without a doctor’s prescription or differently than how a doctor told them to use it one or more times during their life (Supplementary Table 127)). The prevalence of having ever taken prescription pain medicine without a doctor’s prescription or differently than how a doctor told them to use it was higher among Hispanic (15.1%) than black (12.3%) students and higher among Hispanic female (16.1%) than black female (12.5%) students.