Medical and Public Health Challenges of Addiction

• DOI: http://doi.org/10.1002/wmh3.285
• Author: Bonnie Stabile,Otmar Kloiber,Edward J. Septimus,Arnauld Nicogossian
• Date: 01 December 2018
• Published date: 01 December 2018

Editorial

Medical and Public Health Challenges of Addiction

Arnauld Nicogossian, Bonnie Stabile, Otmar Kloiber, and Edward J. Septimus

In 2014, the editors of World Medical & Health Policy discussed the medical and

socioeconomic implications of prescription drugs and illicit substance abuse

(Nicogossian,Stabile,Kloiber,&Zimmerman,2014).Thisisanupdateonthecurrent

progress made in the f‌ight against addiction and mortality due to overdose.

For centuries opiates and psychoactive substances were used for religious,

medicinal, and recreational purposes. In the nineteenth century, advances in

chemistry opened the way to the production of synthetic opioid and other

psychoactive compounds. The net result is the global availability of large

quantities of low-cost preparations. In the twentieth century, with the increasing

aging population and associated degenerative musculoskeletal disorders, an

estimated 20 percent of the population suffers from chronic pain (Goldberg &

McGee, 2011), leading to the rise in the number of pain medication users.

Earlier claims that pain medications did not cause major complications or

dependence, together with aggressive pharmaceutical industry promotion cam-

paigns, ramped up prescribing practices and subsequently increased drug

dependency (Van Zee, 2009). Patients with chronic lower back pain are more

likely to switch to illegally acquired heroin preparations, especially when they do

not have access to prescription “pain killers” (Shmagel, Krebs, Ensrud, & Foley,

2016). The rise in the manufacturing of drugs for chronic pain relief (such as

fentanyl, oxycodone, and tramadol) fuel a global illegal market. While overuse of

opioid and opiate preparations in North America is prevalent, there is a critical

undersupply of such drugs in many developing economy and middle-income

countries, which is attributed to the prevailing narcotic use and prescription laws.

The U.S. Centers for Disease Control and Prevention f‌ind that economic costs

and mortality rates from the use of opioids are on the rise and continue to be

underestimated (The Council of Economic Advisers, 2017). A 2016 U.S. epidemio-

logical survey suggests that the opioid epidemic is spreading geographically and

increasing across demographic groups (CDC, 2018), while overdose mortalities

World Medical & Health Policy, Vol. 10, No. 4, 2018

328

doi: 10.1002/wmh3.285

#2018 Policy Studies Organization