Wanted: A Public Health Approach to Prescription Opioid Abuse and Diversion (Editorial)
In this issue, Paulozzi, Budnitz, and Xi of the Centers for Disease Control and Prevention describe mortality data from the National Center for Health Statistics and retail sales of controlled substances from the U.S. Drug Enforcement Administration (DEA). The authors attribute rising opioid analgesic mortality to their medical use and "aggressive" pain management. Although these findings add to the growing body of evidence that describes adverse health consequences associated with increased abuse of prescription pain medication,1-7 they do not explain how prescribing or pain management relate to mortality. Evidence of causal relationships would be necessary to determine that a particular drug or prescriptions for pain management caused death.
The media often picks up such analyses and the result is that complex underlying problems of abuse and addiction are attributed to prescription drugs and their prescribers. Unwittingly, publicity about simple associations can exacerbate fears of appropriate medical use of prescription drugs among pain patients and the public, trigger more drug control, and increase fears of regulatory scrutiny among legitimate prescribers and dispensers. All of these can lead to further under-treatment of pain.
Abuse of prescription pain medicines leads to tragic consequences for individuals, families, and society, and has profound implications for those involved in pain management, addiction medicine, and diversion control. Here we argue that a public health approach is necessary to understand prescription opioid abuse and diversion and we discuss several elements we believe are essential.