Download PDF
Suchttherapie 2020; 21(02): 85-97
DOI: 10.1055/a-1153-3988
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Die Opioidkrise in den USA: Ausmaß, Ursachen, Gegenmaßnahmen und die europäische Situation im Vergleich

The US Opioid Crisis: Extent, Causes, Counter-Measures and the European Situation in Comparison
Ulrich W. Preuss
1   Vitos Klinik Psychiatrie und Psychotherapie, Herborn und Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität, Halle-Wittenberg
,
Friedrich M. Wurst
2   Psychiatrische Universitätsklinik Basel, Universität Basel, Schweiz
,
Jessica Wei Mooi Wong
3   Klinik am Homberg, Bad Wildungen
› Author Affiliations
Further Information

Publication History

Publication Date:
13 May 2020 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der Opioid-Missbrauch und die Todesfälle durch Überdosierung haben in den USA krisenartige Ausmaße angenommen. Allein im Jahr 2017 starben mehr als 47 000 Amerikaner an einer Überdosis von Opioiden, und die Letalität ist auch in den Folgejahren auf einem hohen Niveau, da der Konsum synthetischer Opioide (z. B. Fentanyl-Derivate) in den letzten 5 Jahren erheblich zugenommen hat. Zur Bewältigung der Krise wurden mehrere Maßnahmen vorgeschlagen, darunter Programme zur Überwachung verschreibungspflichtiger Medikamente, Missbrauchs-verhindernde Opioid-Formulierungen, kognitive verhaltenstherapeutische und medikamentengestützte Ansätze und die Verteilung von Naloxon zur Behandlung von Opioid-Überdosierungen – mit bisher eher begrenztem Erfolg. Im Vergleich dazu gab es in mehreren Ländern Europas im letzten Jahrzehnt einen Anstieg der Verschreibungen von Opioiden. Die Letalität durch Opioide ist jedoch deutlich geringer als in den USA. Gründe für diese Unterschiede können auf unterschiedliche Zulassungen, Verschreibungsregeln (z. B. Deutsche Leitlinien zur LONTS, Update 2019) und bessere Implementierung von Qualitätsmaßnahmen zurückzuführen sein. In den USA erleichtert die Konzentration auf die medikamentöse Behandlung von Schmerzen anstatt der Therapie von psychosozialem Stress die Verschreibung von Opioiden. Außerdem ist MAT/OAT (medikamentös- oder opioidgestützte Substitutionstherapie) in vielen europäischen Ländern, insbesondere in ländlichen Gebieten, möglicherweise häufiger und umfassender verfügbar als in den USA.

Abstract

Opioid abuse and overdose deaths are at crisis levels in the USA. More than 47,000 Americans died of drug overdoses involving opioids in 2017 and lethality continues to stay on a high level, because synthetic opioid (e. g. fentanyl derivates) use has increased significantly during the last 5 years. Several measures have been proposed to tackle the crisis including prescription drug monitoring programs, abuse-deterrent opioid formulations, cognitive behavioral and medication-assisted therapies, and naloxone distribution to treat opioid overdose, with limited success. In comparison, several countries in Europe had an increase in opioid prescription during the last decade. However, lethality due to opioids is significantly lower than in the USA. Reasons for these differences may be due to different marketing permits, prescription rules (e. g. German Guidelines on LONTS long term opioid use in non-tumor pain, update 2019) and better results in quality measures. In the US focus on pain rather than treatment of psychosocial stress facilitate opiod prescription. Finally, MAT/OAT (medication or opioid assisted treatment) may be more frequently and comprehensively available in many European countries compared to the US, in particular in rural areas.

Schlüsselwörter

Opioid-Krise USA, - MAT (Medikamenten-Assistierte Therapie, - Substitutionstherapie), KVT (kognitive Verhaltenstherapie) Fentanylderivate - Drogenüberwachungsprogramme, Missbrauchs-abschreckende Opioid-Formulierungen - Naloxon - LONTS-Leitlinien

Key words

opioid crisis USA, MAT, CBT - fentanyl - Drug monitoring programs, abuse deterrent opioid formulations - Naloxone - LONTS guidelines
 

  • Literatur

  • 1 Volkow ND, Frieden TR, Hyde PS. et al. Medication-assisted therapies – tackling the opioid-overdose epidemic. N Engl J Med 2014; 370: 2063-2066
    CrossrefPubMedSearch in Google Scholar
  • 2 Muhuri PK, Gfroerer JC, Davies MC. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review. 2013
    PubMedSearch in Google Scholar
  • 3 European Monitoring Centre for Drugs and Drug Addiction EMCDDA Drug-related deaths and mortality in Europe Luxembourg: Publications Office of the European Union. 2019
    PubMedSearch in Google Scholar
  • 4 Hedegaard H, Minino AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief 329, National Center for Health Statistics, Hyattsville, MD. 2018
    PubMedSearch in Google Scholar
  • 5 Ahmad FB, Rossen LM, Spencer MR. et al. Provisional drug overdose death counts, CDC National Center for Health Statistics. 2019
    PubMedSearch in Google Scholar
  • 6 Florence CS, Zhou C, Luo F. et al. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016; 54: 901-906
    CrossrefPubMedSearch in Google Scholar
  • 7 Dowell D, Haegerich TM, Chou R. Cdc guideline for prescribing opioids for chronic pain – United States, 2016. JAMA 2016; 315: 1624-1645
    CrossrefPubMedSearch in Google Scholar
  • 8 Chen Q, Larochelle MR, Weaver DT. et al. Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Netw Open 2019; 2: e187621
    CrossrefPubMedSearch in Google Scholar
  • 9 International Narcotics Control Board. Report of the International Narcotics Control Board for 2017. Retrieved from https://www. incb.org/incb/en/publications/annual-reports/annual-report-2017.html Vienna: United Nations; 2018
  • 10 Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: apparent opioid-related deaths in Canada (January 2016 to June 2018), Public Health Agency of Canada, Ottawa 2018
    PubMed
  • 11 United Nations Office on Drugs and Crime World Drug Report., United Nations publication, Sales No. E.17.XI.6). 2017
    PubMedSearch in Google Scholar
  • 12 Theisen K, Jacobs B, Macleod L. et al. The United States opioid epidemic: a review of the surgeonʼs contribution to it and health policy initiatives. BJU Int 2018; 122: 754-759
    CrossrefPubMedSearch in Google Scholar
  • 13 Paulozzi LJ, Jones CM, Mack KA. et al. Vital signs: overdoses of prescription opioid pain relievers – United States, 1999–2008. MMWR Morb Mortal Wkly Rep Centers for Disease Control and Prevention 2011; 60: 1487-1492
    PubMedSearch in Google Scholar
  • 14 Tick H, Nielsen A, Pelletier K. et al. The Pain Task Force of the Academic Consortium for Integrative Medicine and Health. Evidencebased Non-pharmacologic Strategies for Comprehensive Pain Care. A Consortium Pain Task Force White Paper. 2017
    PubMedSearch in Google Scholar
  • 15 Häuser W, Wolfe F, Henningsen P. et al. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population – a cross-sectional survey. BMC Public Health 2014; 14: 352
    CrossrefPubMedSearch in Google Scholar
  • 16 Moulin DE, Clark AJ, Speechley M. et al. Chronic pain in Canada – prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag 2002; 7: 179-184
    PubMedSearch in Google Scholar
  • 17 Benzon HT, Anderson TA. Themed Issue on the Opioid Epidemic: What Have We Learned? Where Do We Go From Here?. Anesth Analg 2017; 125: 1435-1437
    CrossrefPubMedSearch in Google Scholar
  • 18 Rudd RA, Seth P, David F. et al. Increases in drug and opioid-involved overdose deaths – United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1445-1452
    CrossrefPubMedSearch in Google Scholar
  • 19 Chihuri S, Li G. Trends in prescription opioids detected in fatally injured drivers in 6 US states: 1995–2015. Am J Public Health 2017; 107: 1487-1492
    CrossrefPubMedSearch in Google Scholar
  • 20 Rudisill TM, Zhu M, Kelley GA. et al. Medication use and the risk of motor vehicle collisions among licensed drivers: a systematic review. Accid Anal Prev 2016; 96: 255-270
    CrossrefPubMedSearch in Google Scholar
  • 21 Paulozzi LJ, Mack KA, Hockenberry JM. Variation among states in prescribing of opioid pain relievers and benzodiazepines – United States, 2012. J Safety Res 2014; 51: 125-129
    CrossrefPubMedSearch in Google Scholar
  • 22 Levy B, Paulozzi L, Mack KA. et al. Trends in opioid analgesic- prescribing rates by specialty, U.S., 2007–2012. Am J Prev Med 2015; 49: 409-413
    CrossrefPubMedSearch in Google Scholar
  • 23 Schoenfeld AJ, Jiang W, Chaudhary MA. et al. Sustained opioid use among previously opioid naïve patients insured through TRICARE (20016–2014). JAMA Surg 2017; 152: 1175-1176
    CrossrefPubMedSearch in Google Scholar
  • 24 Porter JH. Addication rare in patients treated with narcotics. J Engl J Med 1980; 302: 123
    PubMedSearch in Google Scholar
  • 25 Alam A, Zheng H, Mamdani MM. et al. Long-term analgesic use after low risk surgery: a retrospective cohort study. Intern Med 2012; 172: 425-430
    PubMedSearch in Google Scholar
  • 26 Brummett CM, Goesling J, Moser S. et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017; 152: e170504
    CrossrefPubMedSearch in Google Scholar
  • 27 Goesling J, Zaidi B, Hassett AL. et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain 2016; 157: 1259-1265
    CrossrefPubMedSearch in Google Scholar
  • 28 Clarke H, Ko DT, Yun L. et al. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014; 348: 1251
    PubMedSearch in Google Scholar
  • 29 Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health 2009; 99: 221-227
    CrossrefPubMedSearch in Google Scholar
  • 30 Cicero TJ, Inciardi JA, Munoz A. Trends in abuse of OxyContin® and other opioid analgesics in the United States: 2002–2004. J Pain 2005; 6: 662-672
    CrossrefPubMedSearch in Google Scholar
  • 31 Hill MV, Stucke RS, Barth RJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 2017; 265: 709-714
    CrossrefPubMedSearch in Google Scholar
  • 32 Bartels K, Dingmann C, Bullard KJ. et al. Opioid use and storage patterns by patients after hospital discharge following surgery. PLoS ONE 2016; 11: e0147972
    CrossrefPubMedSearch in Google Scholar
  • 33 Lipari R. How people obtain the prescription pain relievers they misuse. The CBHSQ Report: January 12, 2017. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD. 2017
    PubMedSearch in Google Scholar
  • 34 Kennedy-Hendricks A, McDonald E, McGinty EE. et al. Medication sharing, storage, and disposal practices for opioid medications among US adults. JAMA Intern Med 2016; 176: 1027-1029
    CrossrefPubMedSearch in Google Scholar
  • 35 Pollini RA, Cuevas-Mota J, Metzner M. et al. Problematic use of prescription-type opioids prior to heroin use among young heroin injectors. Subst Abuse Rehabil 2011; 2: 173-180
    PubMedSearch in Google Scholar
  • 36 Muhuri PK, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Review, SAMHSA. 2013 Available at http://www.samhsa.gov/data/
    PubMedSearch in Google Scholar
  • 37 Cicero TJ, Ellis MS, Harney J. Shifting patterns of prescription opioid and heroin abuse in the United States. N Engl J Med 2015; 373: 1789-1790
    CrossrefPubMedSearch in Google Scholar
  • 38 Cicero TJ, Ellis MS, Kasper ZA. Increased use of heroin as an initiating opioid of abuse. Addict Behav. 2017; 74: 63-66
    CrossrefPubMedSearch in Google Scholar
  • 39 US Drug Enforcement Administration, Office of Diversion Control National Forensic Laboratory Information System Special Report: Opiates and related drugs reported in NFLIS, 2009–2014. Springfield, VA: US Drug Enforcement Administration. 2015
    PubMedSearch in Google Scholar
  • 40 Rose ME. Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts. Pain Med. 2018; 19: 793-807
    CrossrefPubMedSearch in Google Scholar
  • 41 Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid–involved overdose deaths – 27 states, 2013–2014. MMWR Morb Mortal Wkly Rep 2016; 65: 837-843
    PubMedSearch in Google Scholar
  • 42 Schuchat A, Houry D, Guy GP. New Data on Opioid Use and Prescribing in the United States. JAMA 2017; 318: 425-426 . doi: 10.1001/jama.2017.8913
    CrossrefPubMedSearch in Google Scholar
  • 43 Dowell D, Zhang K, Noonan RK. et al. Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates. Health Aff (Millwood) 2016; 35: 1876-1883
    CrossrefPubMedSearch in Google Scholar
  • 44 Guy GP Jr, Zhang K, Bohm MK et al. Vital Signs: Changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017; 66: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w
    PubMed
  • 45 Rudd RA, Seth P, David F. et al. Increases in drug and opioid-involved overdose deaths – United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016; 65: 1445-1452
    CrossrefPubMedSearch in Google Scholar
  • 46 Mercado MC, Sumner SA, Spelke MB. et al. Increase in drug overdose deaths involving fentanyl – Rhode Island, January 2012–March 2014. Pain Med. 2018 19. 511-523 doi: 10.1093/pm/pnx015
    PubMedSearch in Google Scholar
  • 47 Clark T, Kreiner P, Strickler G. Prescription drug monitoring programs: an assessment of the evidence for best practices. Philadelphia (PA): Pew Charitable Trusts; 2012. . Available at http://www.pewtrusts.org/~/media/assets/0001/pdmp_update_1312013.pdf. Accessed February 2018
    CrossrefSearch in Google Scholar
  • 48 Nam YH, Shi Y, Moran JR. State prescription drug monitoring programs and fatal drug overdoses. Am J Manag Care 2017; 23: 297-303
    PubMedSearch in Google Scholar
  • 49 Brady JE, DiMaggio C, Lang BH. et al. Prescription drug monitoring and dispensing of prescription opioids. Public Health Rep 2014; 129: 139-147
    CrossrefPubMedSearch in Google Scholar
  • 50 Reifler LM, Bailey JE, Schnoll SH. et al. Do prescription monitoring programs impact state trends in opioid abuse/ misuse?. Pain Med 2012; 13: 434-442
    CrossrefPubMedSearch in Google Scholar
  • 51 Skolnick P. The Opioid Epidemic: Crisis and Solutions. Annu Rev Pharmacol Toxicol 2018; 58: 143-159
    CrossrefPubMedSearch in Google Scholar
  • 52 Webster LR, Odinecs A, Herzog S. et al. 2012. Multiple dose pharmacokinetics and pharmacodynamics of the new oral opioid analgesic NKTR-181. Presented at Am. Acad. Pain Med., 28th Annu.Meet., Palm Springs, CA, Pain Med. Poster 282B.
    PubMed
  • 53 Jenkins T. 2016. Bio-activated opioid drugs with unprecedented oral and non-oral abuse-resistance. Presented at Am. Psychiat. Assoc. 169th Annu. Meet., Atlanta, May 15, Symposium 4307. https://www.sbir.gov/sbirsearch/detail/1046491
    PubMed
  • 54 Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis 2012; 31: 207-225
    CrossrefPubMedSearch in Google Scholar
  • 55 Thomas CP, Fullerton CA, Kim M. et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv 2014; 65: 158-170
    CrossrefPubMedSearch in Google Scholar
  • 56 Rosenblatt RA, Andrilla CHA, Catlin M. et al. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. The Annals of Family Medicine 2015; 13: 23-26 . doi:10.1370/afm.1735
    CrossrefPubMedSearch in Google Scholar
  • 57 Qaseem A, Wilt TJ, McLean RM. et al. Clinical Guidelines Committee of the American College of Physicians Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166: 514-530
    CrossrefPubMedSearch in Google Scholar
  • 58 Bonakdar R, Palanker D, Sweeney MM. Analysis of State Insurance Coverage for Nonpharmacologic Treatment of Low Back Pain as Recommended by the American College of Physicians Guidelines. Glob Adv Health Med 2019; 8: 2164956119855629
    CrossrefPubMedSearch in Google Scholar
  • 59 Doleac JL, Mukherjee A. The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime, 2016. SSRN. Available at: https://ssrn.com/abstract=3135264 Accessed March 2018
    PubMed
  • 60 Bosetti C, Santucci C, Radrezza S. et al. Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016. Eur J Pain 2019; 23: 697-707
    CrossrefPubMedSearch in Google Scholar
  • 61 Berterame S, Erthal J, Thomas J. et al. Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study. Lancet 2016; 387: 1644-1656
    CrossrefPubMedSearch in Google Scholar
  • 62 Hastie BA, Gilson AM, Maurer MA. et al. An examination of global and regional opioid consumption trends 1980–2011. Journal of Pain and Palliative Care Pharmacotherapy 2014; 28: 259-275
    PubMedSearch in Google Scholar
  • 63 International Narcotics Control Board. Report of the International Narcotics Control Board for 2017. Retrieved from https://www.incb.org/incb/en/publications/annual-reports/annual-report-2017.html Vienna: United Nations; 2018
  • 64 O'Brien T, Christrup LL, Drewes AM. et al. European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain 2017; 21: 3-19
    CrossrefPubMedSearch in Google Scholar
  • 65 Knaul FM, Farmer PE, Krakauer EL. et al Lancet Commission on Palliative Care and Pain Relief Study Group Alleviating the access abyss in palliative care and pain relief – an imperative of universal health coverage: The Lancet Commission report. Lancet 2018; 391: 1391-1454
    CrossrefPubMedSearch in Google Scholar
  • 66 Chenaf C, Kaboré JL, Delorme J. Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality. Eur J Pain 2019; 23: 124-134
    CrossrefPubMedSearch in Google Scholar
  • 67 Just J, Mucke M, Bleckwenn M. Dependence on prescription opioids. Deutsches Arzteblatt International 2016; 113: 213-220
    PubMedSearch in Google Scholar
  • 68 Werber A, Marschall U, L'Hoest H. et al. Opioid therapy in the treatment of chronic pain conditions in Germany. Pain Physician 2015; 18: E323-E331
    PubMedSearch in Google Scholar
  • 69 Cherny NI, Baselga J, de Conno F. et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: A report from the ESMO/EAPC Opioid Policy Initiative. Annals of Oncology 2010; 21: 615-626
    CrossrefPubMedSearch in Google Scholar
  • 70 Vranken MJ, Lisman JA, Mantel-Teeuwisse AK. et al. Barriers to access to opioid medicines: A review of national legislation and regulations of 11 central and eastern European countries. Lancet Oncol 2016; 17: e13-e22
    CrossrefPubMedSearch in Google Scholar
  • 71 ONS (Office for National Statistics) (2018), Drug-related deaths ‘deep dive’ into coroners’ records: an experimental ‘deep dive’ study investigating deaths related to drug misuse in 2014 and 2015 using available coroners’ records https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/drugrelateddeathsdeepdiveintocoronersrecords/2018-08-06 2018
    PubMed
  • 72 Pierce M, Millar T. Robertson Jr et al. Ageing opioid users’ increased risk of methadone-specific death in the UK. Int J Drug Policy 2018; 55: 121-127
    CrossrefPubMedSearch in Google Scholar
  • 73 Gao L, Dimitropoulou P. Robertson Jr et al. Risk-factors for methadone-specific deaths in Scotland’s methadone-prescription clients between 2009 and 2013. Drug Alcohol Depend 2016; 167: 214-223
    CrossrefPubMedSearch in Google Scholar
  • 74 Pierce M, Bird SM, Hickman M. et al. National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005–2009. Drug Alcohol Depend 2015; 146: 17-23
    CrossrefPubMedSearch in Google Scholar
  • 75 Muller AE, Clausen T, Sjogren P. et al. Prescribed opioid analgesic use developments in three Nordic countries, 2006–2017. Scand J Pain 2019; 19: 345-353
    CrossrefPubMedSearch in Google Scholar
  • 76 Buth S, Holzbach R, Martens MS. et al. Problematic medication with benzodiazepine, “Z-drugs”, and opioid analgesics – an analysis of national health insurance prescription data from 2006–2016. Dtsch Ärztebl Int 2019; 116: 607-614
    PubMedSearch in Google Scholar
  • 77 Häuser W, Bock F, Engeser P. et al. Clinical Practice guideline: long-term opioid use in non-cancer pain. Dtsch Ärztebl Inter 2014; 111: 732-740
    PubMedSearch in Google Scholar
  • 78 Deutscher Schmerzgesellschaft e.V. S3-Leitlinie „LONTS“ – Langzeitanwendung von Opioiden bei nicht tumorbedingten Schmerzen. Update 2020. https://www.schmerzgesellschaft.de/topnavi/patienteninformationen/leitlinien-zur-schmerzbehandlung/lonts
    PubMed
  • 79 White ND. Opioid abuse and overdose: prevention strategies. Am J Lifestyle Med 2015; 9: 412-415
    CrossrefPubMedSearch in Google Scholar
  • 80 Compton WM, Boyle M, Wargo E. Prescription opioid abuse: problems and responses. Prev Med 2015; 80: 5-9
    CrossrefPubMedSearch in Google Scholar
  • 81 Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the US: promises and perils. Pain 2013; 154: S94-S100
    CrossrefPubMedSearch in Google Scholar
  • 82 Häuser W, Petzke F, Radbruch L. et al. The opioid epidemic and the long-term opioid therapy for chronic noncancer pain revisited: a transatlantic perspective. Pain Manag 2016; 6: 249-263
    CrossrefPubMedSearch in Google Scholar
  • 83 Müller-Schwefe G. Action program pain. Schmerz. Z Angew Schmerzth 1998; 4: 1
    PubMedSearch in Google Scholar
  • 84 Nuckols TK, Anderson L, Popescu I. et al. Opioid prescribing: a systematic review and critical appraisal of guidelines forchronic pain. Ann Intern Med 2014; 160: 38-47
    PubMedSearch in Google Scholar
  • 85 Cheung CW, Qiu Q, Choi SW. et al. Chronic opioid therapy for chronic noncancer pain: a review and comparison of treatment guidelines. Pain Physician 2014; 17: 401-414
    PubMedSearch in Google Scholar
  • 86 Canada: National Opioid Use Guideline Group (NOUGG). Canadian guideline for safe and effective use of opioids for chronic noncancer pain (2010). http://nationalpaincentre.mcmaster.ca
    PubMed
  • 87 Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980; 302: 123
    PubMedSearch in Google Scholar
  • 88 World Health Organisation (WHO) Cancer pain relief, with a guide to opioid availability (1996), 2. edn. WHO; Geneva:
  • 89 OCEBM (Oxford Center of Evidence Based Medicine) Levels of Evidence Working Group, The Oxford Levels of Evidence 2. http://www.cebm.net/index.aspx?o=5653 (2011), 2 edn. Oxford Centre for Evidence-Based Medicine, London
    PubMed