Creating Coherent Strategies to Combat the Crises of Opioid Scarcity and Abuse

Andrew Hantel; Stacie Levine; Mark Siegler


J Clin Oncol. 2018;36(25):2575-2577. 

In This Article

Abstract and Introduction


The opioid abuse crisis in the United States has caused > 600,000 deaths, and 180,000 more are expected by 2020.[1] Opioids are now the leading cause of injury-related fatality in the United States, surpassing automobile- and gun-related deaths.[2] This public health emergency is driven by numerous factors, including inappropriate prescription, unscrupulous drug promotion, regulatory lapses, and lack of reimbursement for nonpharmacologic pain control methods.[3,4] It is not, however, the only opioid crisis. A less publicized shortage crisis of inpatient intravenous opioids is occurring simultaneously and affecting the care of all patients, in particular those with cancer. Severe shortages of these appropriately prescribed analgesics are part of ongoing scarcities of injectable medications that include chemotherapeutics and antibiotics.[4,5] Until the existence of concomitant opioid crises is acknowledged, efforts to control the abuse crisis are likely to worsen those of the intravenous formulations shortage and further degrade inpatient pain control for those with cancer who are receiving treatment or hospice care. In this paper, we discuss the etiology and state of the opioid shortage crisis and suggest strategies to ensure that both crises are addressed and simultaneously improved.