America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis
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Purpose of Review
In the USA, there has been a sharp increase in heroin, prescription opiate, and illicitly manufactured fentanyl abuse with overdoses tripling since the 1990s. Several states have been deemed as “high-burden” abuse states where there is a greater proportion of synthetic opiate use. During the same period that prescription limitations were initially implemented throughout the country, the fentanyl epidemic started nationwide.
In the setting of data demonstrating an almost fourfold increase in overdose deaths from 1999 to 2008, states began restricting access to Food and Drug Agency (FDA) approved opioid medications. Another factor further exacerbating the opioid crises is that the cost of all formulations of naloxone has increased significantly over the past several years.
In order to combat the opioid epidemic, stricter prescribing practices and prescription-monitoring programs have been instituted. Also, improvements in abuse-deterrent strategies for all opioid preparations can play an important role by increasing the safety of these medications and is a major focus of the FDA.
KeywordsFentanyl Heroin Opioid abuse Opioid addiction Opioid epidemic Opioid overdose
Compliance with Ethical Standards
Conflict of Interest
Dr. Ostling, Dr. Davis, Dr. Helander, and Dr. Wyche declare no conflicts of interest.
Dr. Kaye is a speaker for Depomed, Inc. and Merck, Inc. He also reports that he has been a member of the FDA Advisory Board on Anesthetics, Analgesics, and Addiction Medicine since 2012.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 10.Medicaid expansion: behavioral health treatment use in selected states in 2014. 2017. Report No.: GAO-17-529.Google Scholar
- 11.National Federation of Independent Business V. Sebelius, 132 S.Ct. 2566 (June 2012). Benefits Q. 2013;29(1):64–6.Google Scholar
- 12.Maclean J, Saloner, B. The effect of public insurance expansions on substance use disorder treatment: evidence from the Affordable Care Act In: Research NBoE, editor. 2017.Google Scholar
- 14.Opioid addiction: laws, regulations, and other factors can affect medication-assisted treatment access. In: Office USGA, editor. 2016.Google Scholar
- 15.Rinaldo SG, Rinaldo RW. Availability without accessibility: state Medicaid coverage and authorization requirements for opioid dependence medications 2013 [Available from: https://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final.
- 16.H.R.2634 - Drug Addiction Treatment Act of 2000.Google Scholar
- 17.FDA. Subutex and suboxone approved to treat opiate dependence 2002 [Available from: https://www.fda.gov/Drugs/DrugSafety/ucm191521.htm.
- 21.Morlion BJ, Mueller-Lissner SA, Vellucci R, Leppert W, Coffin BC, Dickerson SL, et al. Oral prolonged-release oxycodone/naloxone for managing pain and opioid-induced constipation: a review of the evidence. Pain Pract. 2017.Google Scholar
- 27.•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Galan V, Beakley BD, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse: part 1. Pain Physician. 2017;20(2S):S93–S109. This is an excellent review on prescription opioid abuse. Google Scholar
- 28.•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Jones DE, Galan V, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse (part 2). Pain Physician. 2017 Feb;20(2S):S111–33. This is an excellent review on prescription opioid abuse. Google Scholar
- 29.•• Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2017;20(2S):S3–S92. This is an excellent review on opioids for noncancer pain. Google Scholar