That report shows that “U.S. opioid use is the highest of any country in
the world, and more than 50% higher than Germany, the second-ranked
country of the twenty most populous countries” (Kopf, 2018) .
Opioid Use in the United States vs. Other Countries
The United Nations 2017 Report on Narcotic Use reveals
that the U.S., stands alone when it comes to the volume of
opioids consumed by its population. That report shows that
“U.S. opioid use is the highest of any country in the world,
and more than 50% higher than Germany, the second-ranked
country of the twenty most populous countries” (Kopf, 2018).
How Can Clinicians Make a Difference?
• Ensure that all who interact with the patient are
working as an informed team member.
• Ensure patient engagement throughout options,
protocols, and plans in pain management.
• Practice precautionary pain prescribing: PDMP
check, urine test, benefit-risk discussion, start low/
go slow, reassessment.
• Have conversations about limits and risks of opioids in
chronic pain management.
• Counsel patients and caregivers regarding secure
storage and proper disposal of unused opioids.
• Emphasize that substance use disorders are treatable
neurologic conditions, requiring a sustained,
multifaceted approach like any disease.
• Reduce stigma: Emphasize and reinforce the disease
nature of addiction.
• Look for early signs of opioid use disorder and
candidates for naloxone co-prescription.
• Keep current on use of office-based treatments for
opioid use disorder (e.g., buprenorphine, suboxone).
• Keep current on cognitive behavioral treatments for
opioid use disorder.
• Promote individual and community awareness of
treatment needs, services, and access (National
Academy of Medicine, 2017).
16
DAILY DOSES OF OPIOIDS IN
THE 20 MOST POPULOUS COUNTRIES
per million people (2013-15)
US
Germany
Japan
Vietnam
Turkey
Iran
Brazil
China
Thailand
Mexico
Russia
Egypt
Ethiopia
Indonesia
Bangladesh
India
Phillipines
Pakistan
Nigeria
DR Congo
47,580
30,780
1,220
1,100
700
460
460
240
170
160
120
93
49
44
36
21
20
2
1
1
How Has CMS Responded?
Previously, CMS removed pain-focused questions from the
HCAHPS survey, which may have been sensitizing patients
and physicians to pain issues and encouraging increased
prescription. Now the agency is pursuing a three-pronged
approach to combating the epidemic:
• Prevention – Manage pain with a wide range of
treatment options, relying less on prescription opioids
• Treatment – Expand access to treatment for opioid
use disorder
• Data – Use data to understand prevention and
treatment success, as well as to pinpoint fraud and
abuse (CMS, 2018)