Overview of this issue: “Pain management in an opioid crisis”

Abstract

Opioids have been used therapeutically to treat pain for thousands of years; the primary opiate, morphine, was isolated in the early 1800s in Germany and its addictive potential noted in the 1880s [1]. Since then a range of opioids have been developed and marketed, all of which have addictive potential. Opioids are widely prescribed for a range of cancer and non-cancer pain. The first decade of the 2000s saw a substantial increase in medical (prescribed) [2, 3] and non-medical (diverted onto the illicit market) opioid use [4]. This resulted in a rise in the number of individuals diagnosed with opioid use disorder and opioid overdose-related mortality [2]. Much focus has been on North America where the extent of over-prescribing, the increase in diversion and overdose deaths has had an impact internationally on the way opioids are prescribed, and may have restricted access where it is needed [5, 6]. The size of the North American crisis has also resulted in considerable international attention and the introduction of new interventions, including the development of prescription monitoring databases, a proliferation of prescribing guidelines and restricted formularies, all of which may have led to a significant reduction of the prescription of opioids and the resultant decrease of prescription opioids on the illicit market [7, 8]. This has also left many people without access to these medications, many of whom have turned to using traditional illicit opioids such as heroin, plus more potent opioids such as fentanyl and its analogues, contributing to increasing overdose deaths [9]. Many patients require and rely on strong opioid analgesics to manage their pain and improve their quality of life, in both cancer and non-cancer related conditions. How, then, as health professionals, can we best manage pain in an era of an opioid crisis whilst attempting to reduce harmful outcomes? Research clearly points to pharmacists having important roles in pain management [10, 11]. As pharmacists we are charged with ensuring patients receive appropriate, timely, safe and effective medications and we also have a responsibility to be alert to issues of dependence and misuse, and to reduce the harms that may result from misuse and diversion. In this special edition, our authors have contributed a range of opinion pieces and research-based papers which shine a light on some of the problems, outcomes and potential solutions to issues of opioid prescribing and dispensing. Specifically, this special issue explores issues such as prevalence, risk, adherence, non-opioid alternatives, education and training, interventions, patient perspectives and policy impact. Importantly, though, while this special issue focusses on pain management in an era of opioid crisis, papers related to this are also routinely published within the scope of the journal. For example, a recent paper by Patel et al. [12] exploring the handling of unused opioids in hospices post patient death, revealed varying practices which could lead to entry of such opioids into the illicit market. Two papers in our special issue provide us with macro perspectives. Adams et al. [13] have provided an overview of unintended consequences of chronic pain guidelines. The authors suggest ways pharmacists can contribute to ensuring patients get the best care. An overview of opioid prescribing and prescription opioid-related deaths in the United Kingdom, including differences between the devolved nations, is provided by Alenezi et al. [14]. Their analysis and subsequent discussion provide a range of recommendations for policy makers and health professionals. Exploring trends in opioid prescribing, through interrogation of routinely collected data, is an important activity which can inform policy and clinical interventions. Caldeira et al. [15] have explored opioid prescribing patterns in a region of Portugal between 2013 and 2017 and have noted a 1.5 fold increase in opioid prescribing in that period. Adewumi and colleagues have undertaken two separate * Jane L. Sheridan [email protected]