The mortality rate from opioid analgesics has increased fourfold over the past decade in the United States, a national study, published in JAMA, has found.

The researchers used a variety of data sources to quantify trends in the harm caused by misuse of prescribed opioid pain relieving medication between 1999 and 2008. Sources included death rates obtained from the National Vital Statistics System cause of death files, national surveys identifying misuse of prescribed pain killers, information on annual drug sales of opioid analgesics (to pharmacists, hospitals and medical practitioners, and excluding medication used in substance misuse treatment programmes), data on rates of hospital admission related to misuse of opioid analgesics and national ethnicity and poverty information.

In 2008, opioid analgesics were involved in a total of 14,800 overdose deaths, almost three quarters of the 20,044 prescription medication overdose deaths. Death rates were highest in non-Hispanic whites and Native Americans, those aged 35-54 years, and in areas with high poverty levels.

Both opioid-related death rates and opioid analgesic drug sales increased by a factor of approximately four between 1999 and 2008, while hospital admissions for prescribed opioid substance misuse rose sixfold over the same period.

This paper clearly identifies rapid growth in the prescribing of opioid analgesics in the United States over the past decade, with a large parallel increase in related morbidity and mortality, leading the authors to claim that death from prescribed opioid pain relievers is now ‘an epidemic’.

Prescribers in the UK need to remain acutely aware of the dangers of prescribed opioid analgesics, while safeguarding legitimate access to treatment. This paper echoes current clinical guidance and recommends use of opioid analgesics only in carefully screened and monitored patients when non-opioid treatments have not been effective.

Dr Jez Thompson