El aumento del consumo de opioides, riesgos y medidas en Estados UnidosReflexión sobre cómo evitar una situación de epidemia en España

Resumen

The subject of this thesis was raised by the deep concern and recent controversy about the over-use of opioids in the United States, currently considered a real "epidemic" that has been associated with serious consequences in the form of addictions and mortality, as well as increased costs. Although the abusive use of opioids is a problem that has not yet spread to Europe, it has been considered convenient to study the impact of this epidemic in the United States to, through this experience, identify and propose the appropriate prevention measures in Europe and, more specifically, in Spain. The opioid epidemic in the United States has had a great impact, not only on the amount and way of prescribing these drugs, but also on the stigmatization of patients treated with these drugs, mainly due to the belief that they are drugs associated with a great risk of addiction. The measures taken by American agencies and governments have generated a new era of opiophobia that is generating a climate of "blocking access to pain control, stigma and hostility in the health system". Opioid analgesics are essential and irreplaceable drugs in the treatment of pain and pain control is also an internationally recognized human right, however, the fear and rejection of the use of opioids as a result of the epidemic situation experienced in the United States, has led to an under treatment of patients. The risk of addiction is opposed to the risk of under-treatment of pain, so it is essential to find the optimal balance between both forces. One of the most important mistakes made in addressing the opioid epidemic in the United States was not differentiating between prescription opioids and illegal opioids. This error led to over-estimating the problem attributed to the prescription and to focusing all measures in that area. Our analysis of data seems to confirm that the actual mortality associated with the use of analgesics is not well quantified and, in any case, is much lower than the 30-40% that some authors and the American authorities have assigned to it. It would be closer to 15% and it would be much lower if we consider that at least 60-70% of these people were users of other illegal drugs at the same time. We have also stablished the crucial differentiation between: Good medical use, addicts after medical use, medical misuse, abuse of the patient of a prescription, abuse of a non-patient of a prescription (either directly or through third parties). Each component must be quantified accurately. Our data seem to suggest the direct relationship between dependence on prescription analgesics and the use of a pain reliever (PR) without a prescription or in a way different from that prescribed by the doctor. The detailed analysis of why people used a prescription opioid without own prescription shows that the majority (57%) used it to relieve pain. In Spain, 3.2 million annual prescriptions of opioid medicines have been quantified being the primary care doctor the one who concentrates the vast majority of opioid prescriptions in Spain (73% in 2020). 77% of the prescriptions were made in 3 molecules (tapentadol, fentanyl and oxycodone-naloxone). 64% of prescriptions were concentrated in traumatology-rheumatology indications versus a 11% in Oncology indications. It is important to note that 92% of patients had had their own prescription for this type of medicine and, therefore, only 8% had obtained this medicine outside of direct medical control. We recommended 5 areas of improvement in Spain in relation to prescription of opioids: 1.Continuous measurement of opioid use, dependence, abuse… 2.Improve digital dispensing control 3.Updated and extent Treatment and follow-up guidelines for opioid treatment 4.Multidisciplinary coordination 5.Homogeneity of messages