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In the past twenty years, the number of deaths caused by opioid overdose has tripled in the United States. There is, in literature, a scarcity of up-to-date evidence regarding opioids consumption in the Brazilian scenario. The objectives of this study was to know, through a literary review, the pattern of opioid analgesics consumption in Brazil. Inclusion criteria: published in the last five years; studies on humans. Exclusion criteria: studies not related to the objective of this review; letters, editorials, commentaries and secondary studies. The practice of analgesic self-medication is frequent in patients with chronic diseases, which may be the cause of the low prescription of opioid analgesics by health professionals. It is noteworthy that there is a lack of data related to the prescription and use of opioids in Brazil. Further studies should be conducted to assess the use of opioids in general medical practice. Statistical data from the United States shows that in the last 20 years the number of deaths from opioid overdose has tripled due to increased prescription and an imbalance in the regulation and access to these drugs by the population 1 1 Krawczyk N, Greene MC, Zorzanelli R, Bastos FI. Rising trends of prescription opioid sales in contemporary Brazil, Am J Public Health. Rev Bras Anestesiol. In addition, the increase in life expectancy and better treatments that permit survival in previously lethal diseases increase the demand for analgesia, alerting to the possibility of reverberation of the phenomenon in Brazil. In the medical literature, little updated information and data overall is available on the use of opioids in the Brazilian scenario and possible developments, such as dependence and deviation of function. Considering the palpable possibility of a reflection of the North American opioid epidemic, this study is justified and aimed to comprehend, through a literature review, the pattern of opioid analgesic use in Brazil and disorders related to its use. An integrative literature review, with systematized search, performed by five reviewers, the method consists of gathering and synthesizing the results of a literature search on a specific topic, in an orderly and systematic way, in order to contribute to the scientific knowledge previously elaborated on the subject 3 3 Souza, MT, Silva MD, Carvalho R. PMID: The well-built clinical question: a key to evidence-based decisions. ACP J Club. The search strategy used was:. Nine results were found and then additional filters were added: Portuguese or English 9 results language, last 5 years 3 results. A total of results were found. Next, the following filters were added: full text available; publication date in the last 5 years; English or Portuguese language. At the end of the search, results were found, and 8 were used. For the selection, the inclusion criteria used in the studies found were composed by the publication date of studies between and , available in full in English or Portuguese, admitting publication bias, in addition to the content that addressed epidemiological, preventive, and social aspects of opioids in Brazil. In general, information on title, author, date of publication, number of participants, and results about prescription and use of opioids in Brazil were collected. Exclusion criteria were: studies not related to the objective of the present review; letters, editorials, commentaries, and secondary studies. Figure 1 illustrates the path followed for the selection of studies. The number of articles found in Scielo, BVS, and Pubmed databases were 9, , and , respectively, totaling After exclusion of duplicates, articles remained. Next, articles were excluded because they were not related to the PICO question of this systematic review. Subsequently, 6 articles were excluded due to the eligibility criteria. Finally, 8 articles remained and were included in the integrative review. Figure 1 Study selection. The characteristics of the studies used to assist in data extraction were presented, and are shown in table 1. The studies were listed as A1, A2, A3, consecutively, until the last article. To combine the results of the different studies, each one was read individually and, through descriptive methods, the results presented reveal that there is a scarcity of data related to the prescription and use of opioids in Brazil. Undertreatment of pain and low use of opioids in Latin America. Pain Manag. Glob Public Health. The great problem on this issue is that patients show dissatisfaction with pain management, especially when compared to patients in developed countries, where the prescription of opioid analgesics is higher. Furthermore, the practice of self-medication with analgesics is frequent among individuals with chronic diseases, which can cause professionals to fear prescribing more potent analgesics. Self-medication with analgesics is practiced by The most common analgesic treatment today consists of nonsteroidal anti-inflammatory drugs dipyrone and paracetamol. Weak opioids are rarely used and only 2. However, even without access to these drugs, many Brazilians of all ages use analgesics to treat their pain, especially women, adults, and the seniors, opting for non-opioid analgesics, followed by NSAIDs, knowing that they may not be effective. A national study on the use of opioid analgesics in dentistry. Braz Oral Res. PLoS One. Curr Med Res Opin. Analyzing the risk of bias among studies, it was stated that there is the risk of publication bias, since publications in Portuguese and English were selected. However, the studies brought information that allows the conclusion that Brazil does not have recreational opioid use. No additional analyses were done in the present study. From the results obtained, four justifications for the deficiency in opioid consumption in Brazil were elaborated: the Brazilian legislation, lack of knowledge of health professionals, public misunderstanding, and low priority of chronic pain as a public policy. The right of pain patients to receive adequate treatment is a basic premise of medicine, however, when assessing the Latin American scenario, one perceives that this right is not as well protected as it should be. A survey conducted in the state of Minas Gerais with dentist-surgeons showed that those who know, even if superficially, the legislation, have 2. However, it is evident that In another analysis, among the factors that lead to the precariousness of opioid drug prescription in low-income countries, the fear of potential addiction, limited financial resources, bureaucracy of supply, and the low availability of opioid analgesics for application stand out. Still in this context, it is noteworthy that the restricted resources and infrastructure, associated with the costs of regulation, taxation and importation in low-income countries act as impediments to the correct analgesia of patients by infating the prices of these drugs. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. The perception of health professionals about pain management and opioid use: a qualitative study. In Brazil, opioids are used mainly in the treatment of severe acute pain and chronic pain in oncologic patients, but they have been underused by health professionals in clinical practice in general. There is few data in the literature on the pattern of analgesic use in Latin America. In Latin America, tramadol is unanimously accepted in the treatment of patients with severe acute pain, such as postoperative, post-traumatic pain and low back pain, moderate to severe chronic pain in neuropathic conditions, osteoarthritis, moderate pain in senior patients unable to be treated with nonsteroidal analgesics, in patients with cancer pain, and fibromyalgia. However, unlike what is recommended, in these countries the opioid is used almost as a solo drug and not as a member of a therapeutic arsenal for adequate analgesia in patients. There are some factors that explain its acceptability unlike other opioids, such as lower incidence of respiratory depression, lower risk of dependence and addiction, and lower immunosuppressive effect when compared to the others. This aversion to opioids is understood as opioid-phobia, that is, adversity to the prescription of opioids resulting from misinformation, fear of generating dependence, lack of knowledge, and inadequate training of health professionals regarding the use of these drugs 14 14 Maia LO, Daldegan-Bueno D, Fischer B. Opioid use, regulation, and harms in Brazil: a comprehensive narrative overview of available data and indicators. Subst Abuse Treat Prev Policy. Therefore, the guidelines are not followed by the professionals, and the treatment is influenced by prejudices and previous personal experiences. In the interview with nursing professionals, the authors report that there was also a lack of knowledge of these professionals in some aspects, inferring that the little knowledge tends to underestimate the experiences of intense pain of their patients. It is important to emphasized that, in addition to the reasons already mentioned above, this topic is generally neglected in the training curricula of health professionals. Other difficulties encountered involve bureaucracy and the lack of multidisciplinary action of health professionals focused on pain management 13 13 Kulkamp IC, Barbosa CG, Bianchini KC. Thus, in many situations where there is a suggestion of analgesic opioid treatment, patients are reluctant to accept it because they do not understand the clinical applications of the drug. In addition, due to the significant adverse effects of this class of drugs, many patients are limited to seeing the possible harm of its use instead of considering the cost-benefit relation of its use. The Brazilian population culturally uses analgesic drugs for pain control, especially non-opioids, having an increased prevalence of its use in women, seniors, individuals with higher education, individuals with chronic diseases, and polydrug users. The use of opioid analgesics in Brazil has a low incidence due to the low level of prescription of these drugs by health areas other than dentistry and oncology, services in which there is a large prescription of codeine, especially associated with paracetamol. In opposition to what happens in the United States of America, the consumption of opioids in Brazil is historically limited mainly due to the structural bottleneck and low budget of most public health services, the lack of integration between health care and the uneven incorporation of palliative care in the various health services. When evaluating the absolute values, oxycodone, a drug sold under prescription retention regime with the objective of controlling its use in the country, showed the highest increase in consumption during this period, reflecting the growing use of opioids with more potent analgesic action and traditionally diverted for recreational use 7 7 Lino PA, Sohn W, Singhal A, Martins MAP, Silva MESE, Abreu MHNG. Despite this, there is a need for further investigation in order to improve the regulation and monitoring of prescription standards in the country, considering the importance of a clear direction in the education of professionals in order to enable access to adequate treatment by the patient without increasing the risk of misuse of opioids and the consequences that result from this 1 1 Krawczyk N, Greene MC, Zorzanelli R, Bastos FI. Another important aspect to be evaluated is the influence of socioeconomic factors related to health and to the Brazilian states, reflecting the existence of differences in access to these drugs according to geographical distribution. Albeit contradictory, the Brazilian National Household Survey on Substance Use showed an opioid analgesic use higher in older age individuals and lower among people from higher income groups, which may be related to distinct socioeconomic conditions 1 1 Krawczyk N, Greene MC, Zorzanelli R, Bastos FI. Although heroin consumption seems to be insignificant, other opioids seem to be on the rise in Brazil either through legal or illegal means. It is important to discern whether the current numbers reflect an important emerging public health problem and to ensure appropriate policies. Finally, although it is plausible to assume a deficiency of health policy regarding chronic pain control, it is not possible to infer an association with economic conditions. Lack of medical training, insufficient education, and low priority of chronic pain as a health policy are growing concerns and result in unequal access to opioids and therefore inadequate treatment of patients. However, the authors highlight the shortage of data on opioid prescribing and consumption in Brazil. Further studies are needed in order to evaluate opioid use in general clinical practice. Open menu Brazil. Open menu. Abstract Resumo English Resumo Portuguese. Keywords: Analgesics; Drug prescriptions; Opioids. METHODS An integrative literature review, with systematized search, performed by five reviewers, the method consists of gathering and synthesizing the results of a literature search on a specific topic, in an orderly and systematic way, in order to contribute to the scientific knowledge previously elaborated on the subject 3 3 Souza, MT, Silva MD, Carvalho R. Table 1 Description of selected studies. History Received 10 May Accepted 01 Nov This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Marcelo Piovezan Data Collection. Correspondence to : Marcelo Piovezan E-mail : marcelo. Figures 1 Tables 1. Source: Prepared by the authors. Authors Studied sample Main outcomes Santos Garcia et al. Tramadol is used to treat a broad spectrum of non-oncologic pain conditions such as post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia as well as oncologic pain. Its relevance when treating special patient groups e. In Latin America, undertreatment of pain seems to be frequent, and a substantial number of patients feel that their pain is not adequately controlled. There is a scarcity of data related to pain management and opioid use in Latin America. Many chronic pain patients do not have access to effective opioid treatment. A variety of reasons lead to undertreatment of pain, including opioid-ignorance and opiophobia, use of nonsteroidal anti-inflammatory drugs NSAIDs and other non-opioid analgesics in patients with moderate to severe pain, limited access to health care, and regulatory barriers. Krawczyk et al. Opioid sales increased nationwide from 1,, prescriptions in to 9, Oxycodone had the largest relative increase, and fentanyl products had the smallest absolute and relative increase. Silva et al. The majority of the population was represented by women between 20 and 59 years old, with 1 to 8 years of schooling. The majority of individuals were female The overall prevalence of analgesic use was The use of analgesics was significantly higher among women, adults and seniors 20 years or more , individuals with high schooling and respondents who reported: diagnosis of one or more chronic diseases, use of three or more drugs, with health insurance and with one or more admissions for emergency care or hospitalizations in the last year. Non-opioid analgesics were the most commonly used agents The most commonly used drugs were metamizole Lino et al. A total of , opioid analgesics prescriptions were made by 36, dentists. Avelar et al. Opioid analgesics are the most prescribed drugs. The specialists are the ones who prescribe the most psychotropic drugs, and those who prescribe anxiolytics know the legislation more often. Oral and maxillofacial surgeons and temporomandibular joint disorder specialists are the most familiar with the legislation and prescribe psychotropic drugs. Intense pain and fear are the two main reasons for prescription. The prevalence in Brazil of non-medical use of opioid analgesics throughout life, in the last year, and in the last month was 2. Barros et al. Of those with chronic pain, were self-medicating with analgesics. The most common analgesic treatment currently consists of nonsteroidal anti-inflammatory drugs dipyrone and paracetamol. None of the individuals were taking potent opioids. Sociedade Brasileira para o Estudo da Dor Av. Stay informed of issues for this journal through your RSS reader. PDF English Portuguese. Google Google Scholar. Opioid consumption and prescription in Brazil: integrative review. Santos Garcia et al.

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Buying MDMA pills Lech