The regulation of prescription opioids: walking the tight rope

Prescription opioid misuse is widely rampant and increasing worldwide. Similar rising trends with reports of patients suffering from prescription opioid dependence are being reported from India. Unregulated prescription of opioids as pain-killers in the US contributed to onset of the ‘epidemic’ of prescription opioid misuse. Pain is a multidimensional and complex experience that has physical, social, spiritual and psychological aspects. Ensuring availability of opioids for treatment of chronic pain conditions is crucial. WHO estimates that 20 million people required end-of-life palliative care, of whom 78 % lived in low and middle income countries. India ranks among the lowest, with only 0.22% citizens having access to opioids for pain relief. While ensuring availability of prescription opioids for pain relief is crucial, it needs close monitoring and regulation as epidemic of prescription opioid misuse was fuelled by illicit marketing of pharmaceutical opioids. Enforcing stricter control has shown plateauing of the misuse and consequences in the US. However, various pros and cons are associated with strict control of opioids like shift to more illicit opioid use (like heroin, fentanyl from illicit drug market) and harmful routes of administration like injecting or insufflating. Stricter enforcement of control of pharmaceutical opioids (licit and illicit marketing) with regular monitoring of the outcomes is necessary, also simultaneous ensuring increased availability and accessibility of treatment for opioid dependent individuals. So the debate on prescription opioid control is ongoing and calls for further discussion in how to regulate the control as well as ensure availability to those who are in genuine need of the same.