ABSTRACT
In the last decade there has been a substantial increase in the use of opioids for the treatment of chronic noncancer pain. In 1999, approximately 11% of individuals experiencing back or neck pain consumed opioid analgesics (Luo et al., 2004). Clark (2002) found that among U.S. military veterans, 44% of the individuals with chronic noncancer pain (CNCP) were receiving opioid analgesics. Sales of opioids in the United States have increased dramatically, with opioid analgesic revenues increasing 18% between 2001 and 2002, and 136% from 1998 (Savage, 2002). This increase in opioid usage parallels the success of national efforts to make opioid analgesics more available to individuals with cancer pain and terminal illnesses, coupled with changes in the accreditation standards for health care organizations (Joint Commission on Accreditation of Healthcare Organizations [JCAHO], 2000), recommendations by the Federation of State Medical Boards of the United States (FSMBUS, 1998), public statements by leading pain organizations and regulatory agencies (American Pain Society and American Academy of Pain Medicine, 1996; American Pain Society, American Academy of Pain Medicine, and American Society of Addiction Medicine, 2001, 2004), medical board actions (OR Medical Board v Paul Bilder, 1999, 2003), and civil suits (Bergman v Chin, 2001 and Tomlinson v Whitney, 2003) for the undertreatment of cancer-related pain. By the end of the 1990s and the beginning of the new millennium the “perfect storm” conditions existed to make long-term administration of opioid analgesics an acceptable part of the overall management of pain for hundreds of thousands of Americans. Yet, the routine use of opioid therapy (OT) in the treatment of chronic noncancer pain remains a controversial and contentious issue. The increasing abuse of opioids by people with and without long-term pain has resulted in growing national concern and even prosecution of practitioners deemed to have been lax in their prescribing practices. Proponents and opponents for OT now abound, often substituting their unique fervor for scientific evidence.
