Trends in medical use and abuse of opioid analgesics

Context Pain often is inadequately treated due in part to reluctance about using opioid analgesics and fear that they will be abused. Although interna tional and national expert groups have determined that opioid analgesics ar e essential for the relief of pain, little information has been available a bout the health consequences of the abuse of these drugs. Objective To evaluate the proportion of drug abuse related to opioid analge sics and the trends in medical use and abuse of 5 opioid analgesics used to treat severe pain: fentanyl, hydromorphone, meperidine, morphine, and oxyc odone. Design and Setting Retrospective survey of medical records from 1990 to 199 6 stored in the databases of the Drug Abuse Warning Network (source of abus e data)and the Automation of Reports and Consolidated Orders System (source of medical use data). Patients Nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main Outcome Measures Medical use in grams and grams per 100 000 population and mentions of drug abuse by number and percentage of the population. Results From 1990 to 1996, there were increases in medical use of morphine (59%; 2.2 to 3.5 million g), fentanyl (1168%; 3263 to 41 371 g), oxycodone (23%; 1.6 to 2.0 million g), and hydromorphone (19%; 118 455 to 141 325 g), and a decrease in the medical use of meperidine (35%; 5.2 to 3.4 million g ). During the same period, the total number of drug abuse mentions per year due to opioid analgesics increased from 32 430 to 34 563 (6.6%), although the proportion of mentions for opioid abuse relative to total drug abuse me ntions decreased from 5.1% to 3.8%. Reports of abuse decreased for meperidi ne (39%; 1335 to 806), oxycodone (29%; 4526 to 3190), fentanyl (59%; 59 to 24), and hydromorphone (15%; 718 to 609), and increased for morphine (3%; 8 38 to 865). Conclusions The trend of increasing medical use of opioid analgesics to tre at pain does not appear to contribute to increases in the health consequenc es of opioid analgesic abuse.