We share the concerns raised in the United States in relation to both illicit and prescribed substance use that is an increasing problem across the world.
Australia, whilst not having reached the crisis levels seen in the US, has also observed an increasing use of prescribed opiates, now up to the 8th-highest rate per capita in the world. Mortality from prescribed and non-prescribed opioid overdose has also doubled since 2007. We have noted within our acute hospitals the alarming increase in admission rates of people with overdose and polysubstance use. These individuals often present complex medical, psychosocial and behavioral-management challenges. In many cases, attempts to encourage adherence to medical treatment, and in enforcing cigarette smoking and visitor access policies, can become fraught with extreme risk, with the unfortunate but often foreseeable outcome of aggressive and threatening behaviour in inpatient settings unequipped to deal with the same. The consequences for healthcare organizations are substantial in term of suboptimal patient outcomes, increased costs of treatment, delayed discharges and the ever-present risk of violence and aggression to staff.
Many illicit polysubstance users often start with well-intended prescriptions for treating chronic non-malignant pain, for which little evidence exists for opioid efficacy. Comprehensive and ongoing academic detailing and support of prescribers as well as public-awareness campaigns (as seen in some parts of the US) are essential for prevention of future addiction, as well as helping those already dependent. Multidisciplinary opioid-management teams, multimodality strategies, and behavioral-management policies are necessary, together with consistent patient engagement. We need to be judicious in the prescribing of opioids whilst ensuring close supervision and prescription of the lowest doses possible, prioritizing opioid substitution and chronic-pain-management programs. A coordinated and consistent approach worldwide is required to deal with this true global emergency.
Peter is a medical registrar in Melbourne, Australia, with experience and interests in Infectious Diseases and Addiction Medicine. He is currently completing a Masters of Science (Infectious Diseases) at the London School of Hygiene and Tropical (more...)
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