Nonmedical Use of Prescription Opioids: What Is the Real Problem?

Controversies abound concerning the use and misuse of prescription opioid analgesics (POAs). It is important to further define the issue of what has come to be known as nonmedical prescription opioid use (NMPOU). This is exactly what Shield et al (1) have done in their article, ‘Use and nonmedical use of prescription opioid analgesics in the general population of Canada and correlations with dispensing levels in 2009’, published in the current issue of Pain Research & Management (pages 69-74). The key new findings are that the misuse of POAs “to get high” is 0.4%, and that there is no association between the general use of POAs and the misuse of POAs. A major strength of this article is that the questions used in the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) are presented clearly. This is critical to understanding the findings. In the CADUMS, NMPOU included individuals who acknowledged using their pain relievers more than they were supposed to, obtaining the pain reliever from a family member or friend, obtaining the medication from the Internet, from a pharmacist without a prescription or from any other source without a prescription. Nonmedical use also included using a pain reliever to get high. The CADUMS was one of the few surveys that enabled a clear distinction between using an opioid for pain relief versus for a recreational purpose (ie, to get high). The findings indicate that the prevalence of any use of POAs in Canada in 2009 was 19.2%; 4.8% of respondents acknowledged NMPOU (4.5% of men and 5.1% of women) and 0.4% indicated they had used the POA “to get high”. Use of POAs to get high varied sig