Faculty Perspectives in Chronic Pain, Part 4 of 5
Are We Winning the War on Drugs?
Since the early 1970s, the United States has declared a war on drugs, focusing on ways in which to reduce the use and abuse of illicit and addicting drugs. In addition to law enforcement strategies, the pharmaceutical industry has played a role in trying to curb misuse and abuse of prescription drugs, particularly opioids. In the main article in this publication, the author describes several strategies currently being used to prevent the misuse and abuse of prescription opioids.
These approaches include the use of abuse-deterrent formulations (ADFs), along with postmarketing surveillance to confirm the benefits of these agents. Methods also involve prescription monitoring, overdose prevention, drug take-back programs, educational programs, and Risk Evaluation and Mitigation Strategies for controlled-release prescription opioids. These techniques have actually demonstrated reductions in the misuse and abuse of prescription opioids, with much of the excitement regarding this impact being focused on ADFs, as demonstrated in several postmarketing surveillance studies. One of the earliest studies, conducted by Cicero and colleagues, focused on use of a reformulated version of an extended-release (ER) prescription opioid in 2566 patients with opioid addiction who were evaluated as they were entered into treatment programs in the United States.1 A significant reduction—from 35.6% to 12.8%—was reported 21 months later in the use of this opioid as the primary drug of abuse after it was reformulated (P <.001). There was a concomitant increase in the abuse of other opioids from 20.1% to 32.3% (P = .005), whereas heroin use increased from 10% to 20%, suggesting that patients preferred heroin or other prescription opioids over the reformulated ER opioid.
Here is the conundrum we face today: Although we have focused on prescription opioids and the various methods to reduce the misuse and abuse of these therapies, we have not been effective in curbing the overall misuse and abuse of illicit and addicting drugs. Are we winning the war on drugs? The sad answer is no. In the War on Drugs: Report of the Global Commission on Drug Policy, published in June 2011, the commission reported that the consumption of opiates, cocaine, and cannabis rose by 34.5%, 27.0%, and 8.5%, respectively, between 1998 and 2008.2 The commission proposed 11 recommendations to better address the war on drugs, including having a greater focus on effective treatment options for addiction, and treating persons who are dependent on drugs as patients, not as criminals.2
We must have a comprehensive strategy to address misuse and abuse of prescription and nonprescription opioids, rather than a “whack-a-mole” strategy. We have won many battles so far, but to win the war on drugs, we need to use all the options that are available to us.
- Cicero TJ, Ellis MS, Surratt HL. Effect of abuse-deterrent formulation of OxyContin. N Engl J Med. 2012;367:187-189.
- Global Commission on Drug Policy Report. War on Drugs: Report of the Global Commission on Drug Policy; June 2011. www.globalcommissionondrugs.org/wpcontent/themes/gcdp_v1/pdf/Global_Commission_Report_English.pdf. Accessed May 31, 2015.
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