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The Korean Journal of Pain 2019; 32(4): 243-244

Published online October 1, 2019 https://doi.org/10.3344/kjp.2019.32.4.243

Copyright © The Korean Pain Society.

The opioid epidemic and crisis in US: how about Korea?

Joon-Ho Lee

Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Correspondence to:Joon-Ho Lee
Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea
Tel: +82-32-621-5340, Fax: +82-32-621-5322, E-mail: anpjuno@schmc.ac.kr

Received: September 3, 2019; Revised: September 9, 2019; Accepted: September 10, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

In May, 2019, the American Pain Society (APS) officially shutdown and filed for bankruptcy due to issues regarding opioid prescription and abuse [1]. Also, several big pharmaceutical companies have been charged and ordered to pay millions of dollars due to their liability in the opioid epidemic. Even individual physicians were sentenced to several years in prison for over-prescription of opioid analgesics.

The present opioid crisis has developed over decades. However, if you look closely, its details continuously changed in relation to each other. In the 1980s, opioid prescription was starting to increase after the consensus statement from the American academy of pain medicine and the American pain society about opioid use in non-cancer pain [2]. After the end of the 1990s, an increase in chronic pain patients further accelerated the prescription of opioid analgesics, and it was after this that the real problem began [3]. In the 2010s, federal and state governments’ efforts to regulate opioid overprescription seemed to stabilize these problems, but this led to those already addicted finding cheaper illegal opioids, such as heroin [4,5]. More recently, over 70,000 people died due to drug overdose in 2017, with opioids being the leading cause [6]. The numbers are still increasing [6]. Numerous articles have been published about the cause of the current opioid crisis, and several solutions have been suggested. Detailed accounts of the individual articles will be omitted here, but this crisis is still ongoing and the US consumes over 80% of the opioids used worldwide [5].

The opioid medications which caused this crisis mostly can be prescribed in Korea. So, how about Korea? Is Korea safe from the opioid epidemic? Actually, this opioid epidemic and crisis could be only US issues. The US only makes up about 4% of world population but about 27% of deaths due to drug overdose occur in the US [7,8]. However, there is nothing wrong with being prepared. Although there have been no issues with opioid prescription and use so far, recognizing some key points and problems can prevent the crisis if we analyze the suggested solutions for stopping the US epidemic.

First, the need for a national healthcare system (NHS) is stated. In the absence of a national health care system, it is difficult to strictly monitor or uniformly control problems such as the opioid crisis. And the individuals responsible for instances of abuse are ambiguous under a private healthcare system which is, in turn, under control of private insurance companies [7]. Fortunately, this has nothing to do with Korea. The Korean NHS already restricts the quantity of opioid medications prescribed and the duration of these prescriptions, and the Narcotics Information Management System is operating under government control. Nevertheless, nonmedical use of prescribed opioids and identity theft are potential problems that can occur.

Second, on the other hand, the Korean NHS has a natural weak point in regards to analgesic overuse. Since low medical insurance fees force physicians to treat a greater number of patients, there is not enough time to properly inquire into the details of a patient’s pain. Simply prescribing an opioid is a fast and easy method to satisfy a patient’s complaint, and also saves time [5]. Thorough evaluation is much more important than prescribing medications for treatment of chronic pain but it takes a lot of time, and there is no payment system for this in Korea, even in very rare but complex diseases such as complex regional pain syndrome. Prescribing opioids is not the only way to control chronic pain.

Third, a large number of patients with opioid addiction have concomitant psychological disorders. As most opioid-addicted patients have chronic pain, this is no surprise. In Korea, there are no data about the prevalence of concomitant psychiatric disease in opioid addicted patients, but also many chronic pain patients have chronic depressive disorders [9]. Obviously, treatment of coexisting psychological problems should accompany pain treatment, but in Korea, the entry barrier to meeting a psychiatrist is still high for several reasons [10].

Finally, the importance of the physician’s education system should be emphasized. Although it is not mandatory, not by pharmaceutical companies but academic organization driven education should be taken [5]. To my knowledge, most physicians in Korea who prescribe opioids have almost never been educated about opioid use from an academic perspective. Also, most academic associations do not have educational programs about prescribing opioids (even simple analgesic medications), with the exception of the Korean Pain Society. Mandatory training is needed for those prescribing opioid.

To date, Korea is relatively safe from opioid overdoses and other opioid-related harms. However, as mentioned above, there are some potential pitfalls we can fall prey to. Further national data-based research about the current state of opioid medication are needed in the near future.

References

  1. McNamara D, . American Pain Society officially shuttered [Internet]. New York: Medscape; 2019 Available at: https://www.medscape.com/viewarticle/915141.
  2. Haddox JD, Joranson D, Angarola RT, Brady A, Carr DB, Blonsky R, et al. The use of opioids for the treatment of chronic pain: a consensus statement from the American Academy of Pain Medicine and the American Pain Society. Clin J Pain 1997;13:6-8.
  3. Dasgupta N, Beletsky L, Ciccarone D. Opioid crisis: no easy fix to its social and economic determinants. Am J Public Health 2018;108:182-6.
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  4. Rummans TA, Burton MC, Dawson NL. How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clin Proc 2018;93:344-50.
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  5. Brown RE Jr, Sloan PA. The opioid crisis in the united states: chronic pain physicians are the answer, not the cause. Anesth Analg 2017;125:1432-4.
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  6. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the united states, 1999–2017. NCHS Data Brief 2018;329:1-8.
  7. Corcoran M, . Why a national health system is needed to slow the opioid crisis [Internet]. Sacramento: Truthout; 2018 Available at: https://truthout.org/articles/why-a-national-health-system-is-needed-to-slow-the-opioid-crisis/.
  8. United Nations Office on Drugs and Crime. World drug report 2018 (United nations publication, sales No. E.18.XI.9). Vienna, United Nations. 2018. pp 1-31.
  9. Lee HJ, Choi EJ, Nahm FS, Yoon IY, Lee PB. Prevalence of unrecognized depression in patients with chronic pain without a history of psychiatric diseases. Korean J Pain 2018;31:116-24.
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  10. Lee JH. Mental health stigma: another enemy for defeat chronic pain. Korean J Pain 2018;31:71-2.
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