title: Prescription opioid misuse in the United States and the United Kingdom: cautionary lessons.
abstract: In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded among countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. The comparison between these two countries in opioid prescribing and opioid overdose mortality underscores important features of prescribing, culture, and health systems that may be permissive or protective in the development of a public health crisis. As access to opioid medications increases around the world, it becomes vitally important to understand the forces impacting opioid use and misuse. Trends in benzodiazepine and methadone use in the UK as well as structural elements of the National Health Service may serve to buffer opioid-related harms in the face of increasing prescriptions. In addition, the availability and price of heroin, as well as the ease of access to opioid agonist treatment in the UK may limit the growth of the illicit market for prescription opioids. The comparison between the US and the UK in opioid consumption and overdose rates should serve as a call to action for UK physicians and policymakers. Basic, proactive steps in the form of surveillance - of overdoses, marketing practices, prescribers, and patients - and education programs may help avert a public health crisis as opioid prescriptions increase.
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, United States. Electronic address: Dfweisberg@gmail.com.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Weisberg
authors.affiliation: VA Connecticut Healthcare System, West Haven, CT, United States; Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, United States.
authors.forename: William C
authors.initials: WC
authors.lastname: Becker
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Macmillan Centre Frenchay Hospital, Bristol, UK. Electronic address: cfstannard@aol.com.
authors.forename: Cathy
authors.initials: C
authors.lastname: Stannard
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D062787:Drug Overdose / Q000453:epidemiology; D004363:Drug Utilization / Q000639:trends*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D006291:Health Policy; D006801:Humans; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid
keywords: Health policy; Opioid analgesics; Prescription drug overdose; Public health