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      The Opioid Epidemic: Crisis and Solutions

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      Annual Review of Pharmacology and Toxicology
      Annual Reviews

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          Abstract

          The widespread abuse of prescription opioids and a dramatic increase in the availability of illicit opioids have created what is commonly referred to as the opioid epidemic. The magnitude of this epidemic is startling: About 4% of the adult US population misuses prescription opioids, and in 2015, more than 33,000 deaths were attributable to overdose with licit and illicit opioids. Increasing the availability of medication-assisted treatments (such as buprenorphine and naltrexone), the use of abuse-deterrent formulations, and the adoption of US Centers for Disease Control and Prevention prescribing guidelines all constitute short-term approaches to quell this epidemic. However, with more than 125 million Americans suffering from either acute or chronic pain, the development of effective alternatives to opioids, enabled at least in part by a fuller understanding of the neurobiological bases of pain, offers the best long-term solution for controlling and ultimately eradicating this epidemic.

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          Most cited references56

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          Relationship between Nonmedical Prescription-Opioid Use and Heroin Use

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            Loss of morphine-induced analgesia, reward effect and withdrawal symptoms in mice lacking the mu-opioid-receptor gene.

            Despite tremendous efforts in the search for safe, efficacious and non-addictive opioids for pain treatment, morphine remains the most valuable painkiller in contemporary medicine. Opioids exert their pharmacological actions through three opioid-receptor classes, mu, delta and kappa, whose genes have been cloned. Genetic approaches are now available to delineate the contribution of each receptor in opioid function in vivo. Here we disrupt the mu-opioid-receptor gene in mice by homologous recombination and find that there are no overt behavioural abnormalities or major compensatory changes within the opioid system in these animals. Investigation of the behavioural effects of morphine reveals that a lack of mu receptors abolishes the analgesic effect of morphine, as well as place-preference activity and physical dependence. We observed no behavioural responses related to delta- or kappa-receptor activation with morphine, although these receptors are present and bind opioid ligands. We conclude that the mu-opioid-receptor gene product is the molecular target of morphine in vivo and that it is a mandatory component of the opioid system for morphine action.
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              The promotion and marketing of oxycontin: commercial triumph, public health tragedy.

              I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues. Modifications of the promotion and marketing of controlled drugs by the pharmaceutical industry and an enhanced capacity of the Food and Drug Administration to regulate and monitor such promotion can have a positive impact on the public health.
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                Author and article information

                Journal
                Annual Review of Pharmacology and Toxicology
                Annu. Rev. Pharmacol. Toxicol.
                Annual Reviews
                0362-1642
                1545-4304
                January 06 2018
                January 06 2018
                : 58
                : 1
                : 143-159
                Affiliations
                [1 ]Opiant Pharmaceuticals, Santa Monica, California 09401, USA;
                Article
                10.1146/annurev-pharmtox-010617-052534
                28968188
                fdd3b35f-bafc-440c-b07e-024a38217879
                © 2018
                History

                Social policy & Welfare,Medicine,Psychology,Engineering,Public health,Life sciences
                Social policy & Welfare, Medicine, Psychology, Engineering, Public health, Life sciences

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