Opiate analgesics have been used by humans for thousands of years and are the longest continuously used class of medications. The recent increased interest in opiates (drugs derived from opium) and opioids (more generally, any natural or synthetic drug that binds to an opioid receptor) has evolved largely from 5 directions: (1) advances in the design of new opioid receptor agonist and antagonist drugs; (2) expansion and innovation in methods of drug delivery; (3) increased public awareness of pain management options and the appropriateness of aggressively treating pain (eg, declaration of pain as the "fifth vital sign" and pain relief as a fundamental human right); (4) growing recognition of the serious consequences of opioid misuse, misadventure, and addiction; and (5) medicolegal aspects of practitioners' prescribing practices and legal prosecution for "overprescribing." These and related issues are addressed in 4 articles and 1 additional editorial in the current issue of Mayo Clinic Proceedings. Specifically, Passik discusses long-term prescription opioid therapy; Argoff and Silver-shein address the use of long- vs short-acting opioids for treating chronic noncancer pain; Smith reviews opioid metabolism; and Berge et al discuss chemical dependency in physicians, with a focus on opioids. In their editorial, Oreskovich and Caldeiro7 discuss whether select groups of health care professionals, such as anesthesiologists, have unacceptably poor outcomes after initial opioid addiction and whether this should dictate policies of rehabilitation and possible return to clinical practice.
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