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Cited by 1,180Opioid Use Disorder TreatmentPain Management and Opioid UseSubstance Abuse Treatment and Outcomes

Opioid Epidemic in the United States

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Manchikanti, Laxmaiah·2012·Pain Physician
DOI 10.36076/ppj.2012/15/es9
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Abstract

Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain. Key words: Opioid abuse, opioid misuse, nonmedical use of psychotherapeutic drugs, nonmedical use of opioids, National Survey on Drug Use and Health, opioid guidelines.

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  • A primarily biomedical approach does not address the wholeness of the person experiencing chronic pain or their layered challenges, including socioeconomic and structural inequities and inadvertent consequences of opioid analgesics.

    “A primarily biomedical approach does not address the wholeness of the person experiencing chronic pain, nor their layered challenges including socioeconomic and structural inequities and inadvertent consequences of opioid analgesics which may have been prescribed for lack of better options.12-16”

    From Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization (2023) · cites this paper as [15]

    Section 5.0 (page not provided) describes adverse consequences of prescribed opioids for people with chronic pain, including poorer function and risks even when opioids are used as prescribed. It does not address a biomedical approach failing to consider the whole person, socioeconomic or structural inequities, or opioids being prescribed for lack of better options. (LLM, conf=0.84)

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Research works printed but not linked: 12

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Authors
Manchikanti, L.
Affiliations
University of Louisville (US)
Corresponding author
Manchikanti, Laxmaiah
ORCID
Manchikanti, Laxmaiah
Venue
Pain Physician
Publisher
American Society of Interventional Pain Physicians
Published
2012-07-14
Volume
3S;15
Issue
3S;7
Pages
ES9-ES38
ISSN
  • 1533-3159 (ISSN-L)
  • 2150-1149
DOI
10.36076/ppj.2012/15/es9
OpenAlex
W100098653
Cited by
1,180
References
210
Citations by year
2026: 19 · 2025: 33 · 2024: 34 · 2023: 55 · 2022: 69 · 2021: 90 · 2020: 160 · 2019: 115 · 2018: 144 · 2017: 121 · 2016: 95 · 2015: 99 · 2014: 80 · 2013: 55 · 2012: 8
FWCI
74.73
Type
journal article
Language
en
Open access
Locations
  • Pain Physician (publishedVersion)
  • PubMed (publishedVersion)
Funders
Substance Abuse and Mental Health Services Administration
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
opioid epidemic, opioid prescribing, chronic non-cancer pain, hydrocodone, prescription drug misuse, opioid diversion, doctor shopping, pharmaceutical industry influence, Joint Commission, National Survey on Drug Use and Health
MeSH terms
Analgesics, Opioid, Humans, Opioid-Related Disorders, Pain, Practice Patterns, Physicians', United States, Inappropriate Prescribing, Epidemics

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