The extent of the opioid epidemic in the United States is staggering. The threat is not only to public health but also to economic output and national security. The cost of the U.S. opioid epidemic since 2001 has been estimated at more than US$1 trillion and is projected to increase by an additional US$500 billion by 2020. More than 62,000 Americans died from opioid overdoses in 2017 alone. Moreover, there have been dramatic increases in opioid use by pregnant women in the United States, with a five-fold increase from 2000 to 2012 in the proportion of babies born with neonatal abstinence syndrome. A major contributor to the U.S. opioid crisis has been the over-prescription of opioid medications for pain.
At the same time, an equally alarming crisis exists in other parts of the world: lack of basic access to opioids for severe acute pain and pain at the end of life. According to a recent report in The Lancet, an estimated 25.5 million people died with serious health-related suffering in 2015, and an estimated 2.5 million children die with serious health-related suffering each year. The vast majority of these individuals are in developing countries and without access to palliative care and pain-relieving medications. According to the authors, the lack of access to morphine, which particularly affects poor people, “is a medical, public health, and moral failing and a travesty of justice.”
As the leading international pain organization, IASP has the responsibility and opportunity to address both of these crises. In 2016, I established a Presidential Task Force chaired by Jane Ballantyne, MD, FRCA, consisting of 11 IASP members from different countries representing a broad range of expertise. Its charge was to develop a position statement on opioid medications for pain based on the available scientific evidence. I hope that the consensus document produced by the task force and approved by the IASP Council, the IASP Position Statement on Opioids, will guide clinicians, policymakers, researchers, and the public worldwide in the appropriate use of opioid medications for pain.
The statement recognizes that open-ended and indiscriminate long-term prescribing of opioids for chronic pain in the United States and Canada has led to high rates of opioid abuse and overdose deaths, as well as enormous societal burdens. The statement also indicates that evidence is lacking regarding long-term effectiveness of opioids for chronic pain, whereas multiple harms, especially for high doses, are well documented. Thus, caution is recommended in prescribing opioids for chronic pain, for which treatments that integrate behavioral and physical strategies are preferred.
Importantly, the statement emphasizes that opioids are indispensable for treating severe acute pain and pain at the end of life in children and adults. The statement reiterates IASP’s position that access to pain management is a fundamental human right. No one suffering from severe pain near the end of life or after major trauma or surgery should go without treatment to relieve that pain. Opioid medication, responsibly prescribed and used, is an essential treatment for such pain problems.
Last, but also of critical importance, the statement strongly advocates for continued research to find effective treatments for all kinds of pain problems. I hope all readers of this message are planning to attend the 17th World Congress on Pain in Boston in September, where the latest groundbreaking research related to pain and its treatment will be presented.
Judith A. Turner, PhD