{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T07:52:56Z","timestamp":1770450776173,"version":"3.49.0"},"reference-count":49,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T00:00:00Z","timestamp":1490227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A decade ago, we queried the unfolding of a \u2018paradigm shift\u2019 in illicit opioid use in North America, specifically involving a shift away from heroin to prescription opioid (PO) use. Today, this situation is more acute than ever, with prescription opioid misuse, morbidity and mortality amounting to one of the most severe substance use\u2010related public health crises ever, now even impacting life expectancy in key population segments. Despite medical system\u2010based PO dispensing and practices being recognised as core drivers of the PO crisis, effective policy measures have been long absent or limited\u2014including those to reduce medical PO use to levels supported by best evidence for pain care. At the same time, heroin use has been increasing again, now commonly tied into interdependent opioid use trajectories, initiated with POs yet shifting to heroin as influenced by economic or availability factors. For policy, there are now two major and urgent\u2014yet partly conflicting\u2014tasks: one is to reduce the determinants of PO misuse and harms by reducing medical prescribing to levels supported by good evidence, while the other is to effectively protect those many active problematic PO users from acute harms (including overdose mortality) by providing effective treatment and survival aids (e.g. naloxone). Surprisingly, it appears that a major \u2018homemade\u2019 and medical system\u2010induced drug crisis has been at least as challenging for North American policy systems to address as other, more conventional illicit drug problems. Lessons for policy hence need to be urgently identified and applied for the future. [Fischer B, Rehm J. Revisiting the \u2018paradigm shift\u2019 in opioid use: Developments and implications 10 years later. <jats:italic>Drug Alcohol Rev<\/jats:italic> 2017;00:000\u2010000]<\/jats:p>","DOI":"10.1111\/dar.12539","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T10:32:45Z","timestamp":1490351565000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Revisiting the \u2018paradigm shift\u2019 in opioid use: Developments and implications 10\u00a0years later"],"prefix":"10.1111","volume":"37","author":[{"given":"Benedikt","family":"Fischer","sequence":"first","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Department of Psychiatry, Institute of Medical Science; and Centre for Criminology and Sociolegal Studies University of Toronto  Toronto Canada"},{"name":"Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences Simon Fraser University  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Rehm","sequence":"additional","affiliation":[{"name":"Institute for Mental Health Policy Research, Centre for Addiction and Mental Health  Toronto Canada"},{"name":"Department of Psychiatry, Institute of Medical Science; and Centre for Criminology and Sociolegal Studies University of Toronto  Toronto Canada"},{"name":"Institute of Medical Science University of Toronto  Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Canada"},{"name":"Institut f\u00fcr Klinische Psychologie und Psychotherapie TU Dresden  Dresden Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,3,23]]},"reference":[{"key":"e_1_2_2_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2006.01738.x"},{"key":"e_1_2_2_3_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/ES191"},{"key":"e_1_2_2_4_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/ES9"},{"key":"e_1_2_2_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.369"},{"key":"e_1_2_2_6_1","volume-title":"Hospitalizations and Emergency Department Visits Due to Opioid Poisoning in Canada","author":"Canadian Institute for Health Information and Canadian Centre on Substance Abuse","year":"2016"},{"key":"e_1_2_2_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/15360288.2015.1037521"},{"key":"e_1_2_2_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm655051e1"},{"key":"e_1_2_2_9_1","volume-title":"Overdose Death Rates","author":"National Institute of Drug Abuse (NIDA)","year":"2015"},{"key":"e_1_2_2_10_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518393112"},{"key":"e_1_2_2_11_1","first-page":"1","article-title":"Deaths: Final Data for 2014","volume":"65","author":"Kochanek KD","year":"2016","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_2_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12446"},{"key":"e_1_2_2_13_1","volume-title":"European Drug Report 2016: Trends and Developments","author":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)","year":"2016"},{"key":"e_1_2_2_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.12224"},{"key":"e_1_2_2_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011512"},{"key":"e_1_2_2_16_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.160356"},{"key":"e_1_2_2_17_1","volume-title":"Availability of Internationally Controlled Drugs: Ensuring Adequate Access for Medical and Scientific Purposes","author":"International Narcotics Control Board (INCB)","year":"2016"},{"key":"e_1_2_2_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-8-8"},{"key":"e_1_2_2_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3404"},{"key":"e_1_2_2_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.01.006"},{"key":"e_1_2_2_21_1","doi-asserted-by":"publisher","DOI":"10.1300\/J069v27n01_01"},{"key":"e_1_2_2_22_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2559"},{"key":"e_1_2_2_23_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000839"},{"key":"e_1_2_2_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000249"},{"key":"e_1_2_2_25_1","volume-title":"America's Addiction to Opioids: Heroin and Prescription Drug Abuse","author":"Volkow ND","year":"2014"},{"key":"e_1_2_2_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1508490"},{"key":"e_1_2_2_27_1","volume-title":"Treatment Episode Data Set (TEDS) 2004\u20132014","author":"Substance Abuse and Mental Health Services Administration (SAMHSA)","year":"2016"},{"key":"e_1_2_2_28_1","volume-title":"Number and Age\u2010Adjusted Rates of Drug\u2010Poisoning Deaths Involving Opioid Analgesics and Heroin: United States, 1999\u20132014","author":"Centers for Disease Control and Prevention (CDC)","year":"2015"},{"key":"e_1_2_2_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2011.05.014"},{"key":"e_1_2_2_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.10.017"},{"key":"e_1_2_2_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2013.10.004"},{"key":"e_1_2_2_32_1","first-page":"719","article-title":"Vital signs: demographic and substance use trends among heroin users \u2010 United States, 2002\u20102013","volume":"64","author":"Jones CM","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_2_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.01.007"},{"key":"e_1_2_2_34_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1406143"},{"key":"e_1_2_2_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.09.026"},{"key":"e_1_2_2_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.EEM.0000508281.75514.70"},{"key":"e_1_2_2_37_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5142"},{"key":"e_1_2_2_38_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2007.131714"},{"key":"e_1_2_2_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-016-0590-x"},{"key":"e_1_2_2_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-016-0055-4"},{"key":"e_1_2_2_41_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1402780"},{"key":"e_1_2_2_42_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f174"},{"key":"e_1_2_2_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp581"},{"key":"e_1_2_2_44_1","doi-asserted-by":"publisher","DOI":"10.2174\/187447370801150611184218"},{"key":"e_1_2_2_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2014.07.009"},{"key":"e_1_2_2_46_1","volume-title":"Narcotic Drugs: Estimated World Requirements for 2016, Statistics for 2014","author":"International Narcotics Control Board (INCB)","year":"2015"},{"key":"e_1_2_2_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1161-5"},{"key":"e_1_2_2_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt500"},{"key":"e_1_2_2_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ajp.0000210909.49923.df"},{"key":"e_1_2_2_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780198759836.001.0001"}],"container-title":["Drug and Alcohol Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdar.12539","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.12539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T20:55:38Z","timestamp":1695502538000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dar.12539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,23]]},"references-count":49,"journal-issue":{"issue":"S1","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1111\/dar.12539"],"URL":"https:\/\/doi.org\/10.1111\/dar.12539","archive":["Portico"],"relation":{},"ISSN":["0959-5236","1465-3362"],"issn-type":[{"value":"0959-5236","type":"print"},{"value":"1465-3362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,23]]},"assertion":[{"value":"2017-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-02-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-03-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}