The Opioid Epidemic and the Long-Term Opioid Therapy for Chronic Noncancer Pain Revisited: A Transatlantic Perspective

Abstract

The rise of opioid prescriptions and associated deaths (‘opioid epidemic’) in North America has evoked worldwide discussions on the long-term efficacy and safety of long-term opioid therapy (LtOT) for chronic noncancer pain (CNCP). We discuss if the opioid epidemic is a real worldwide or a more North American phenomenon. We consider reasons of the opioid epidemic. We highlight differences in the appraisal of the evidence of recent systematic reviews on LtOT for CNCP of US and European authors. We discuss similarities and differences of recent North American and European guidelines on LtOT for chronic CNCP. We point out potential indications and contraindications of LtOT in CNCP syndromes.

KEYWORDS:

• chronic noncancer pain
• guidelines
• long-term opioid therapy
• misuse and addiction
• mortality
• opioids
• opioid abuse
• systematic review

Financial & competing interests disclosure

W Häuser owns mutual stock funds that may contain pharmaceutical company stocks. He has been paid for serving on an advisory board for Daiichi Sankyo. He has received lecture honoraria from the Abbott, Grünenthal, Janssen-Cilag, MSD, Sharp & Dohme and Pfizer companies. F Petzke has served as a paid consultant for the Grünenthal, Epionics Spine and Janssen-Cilag companies. He has received research support (third-party funding) and reimbursement of travel expenses from Janssen-Cilag. L Radbruch is a member of an advisory board of the German medical health insurance company AOK. T Tölle has been paid for serving on advisory boards for Mundipharma, Janssen-Cilag, Grünenthal and Ratiopharm. He has received support for travel expenses from Mundipharma and research support (third-party funding) from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

W Häuser owns mutual stock funds that may contain pharmaceutical company stocks. He has been paid for serving on an advisory board for Daiichi Sankyo. He has received lecture honoraria from the Abbott, Grünenthal, Janssen-Cilag, MSD, Sharp & Dohme and Pfizer companies. F Petzke has served as a paid consultant for the Grünenthal, Epionics Spine and Janssen-Cilag companies. He has received research support (third-party funding) and reimbursement of travel expenses from Janssen-Cilag. L Radbruch is a member of an advisory board of the German medical health insurance company AOK. T Tölle has been paid for serving on advisory boards for Mundipharma, Janssen-Cilag, Grünenthal and Ratiopharm. He has received support for travel expenses from Mundipharma and research support (third-party funding) from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.