I read with interest the recent editorial published in this journal regarding the overuse of opioids, which has resulted in a worldwide public health issue, including in Korea. As the editor rightfully highlighted the contribution of the two studies in the journal issue, he emphasized the dire need for the reduction of opioid prescriptions in patients with chronic pain. This includes the concurrent introduction and promotion of optional methods of pain management to prevent opioid use disorder [1]. This reminder is indeed essential for pain management and public health in general. In light of this, I recognize the necessity to present the current situation of opioid use in the Philippines, which has gradually escalated into uncontrollable drug addiction over several years. Additionally, I aim to draw the attention of the government and other relevant institutions to the adoption of Opioid Stewardship Programs (OSPs), similar to those implemented in Korea, which could significantly contribute to addressing this issue.

Opioids are effective pain relievers and have been widely used for severe pains, such as post-surgical pain or cancer pain, especially because, unlike other non-narcotic analgesics, they do not have a ceiling effect. Despite their efficacy as pain relievers, opioids carry risks that can lead to addiction. The misuse and overuse of opioids are key reasons why they should be prescribed by health professionals, with the form and strength tailored to each patient's specific situation and level of pain [2]. According to the National Institute on Drug Abuse, the severity of opioid abuse in the United States is alarming, with more than 2 million Americans abusing these substances. Additionally, on average, more than 90 Americans die daily due to opioid overdoses. According to the Centers for Disease Control and Prevention, more than 108,000 drug overdose casualties occurred in the whole year ending in April 2022. Almost 75% of all drug overdose deaths in 2020 were also attributed to opioids. On October 26, 2017, a nationwide Public Health Emergency was declared in the United States. By June 2021, an estimated 87% of opioid deaths and 65% of all drug overdose deaths were associated to synthetic opioids [3].

In the Philippines, the Department of Health stressed that nonmedical prescription of opioids is rapidly becoming a serious problem in public health. Since 1999, the accidental overdose deaths from opioid pain relievers have quadrupled [4]. In a series of reports by the Dangerous Drug Board, starting in 2009, benzodiazepines, ketamine, cough and cold preparations containing phenylpropanolamine/codeine, and nalbuphine hydrochloride are all being utilized for nonmedical purposes. The simultaneous use of both stimulant and depressant drugs, known as “speedballing" and the “milkshake effect”, which is performed by injecting intravenously the diluted methamphetamine hydrochloride with nalbuphine, was among the ways in which nalbuphine HCL was misused [5]. After ten years, in 2019, “Shabu” or methamphetamine hydrochloride, remains the most abused drug, comprising almost 93.72% of the total admission to drug facilities. This is followed by “marijuana” or cannabis at 22.59% and “Rugby”, or contact cement,0 at 0.73%. This ranking of most commonly abused drugs did not change until the latest data in 2022 [6]. Currently, President Ferdinand Marcos Jr. claimed that there are approximately four and a half million actual drug addicts in the country [7].

OSPs are coordinated programs that advocate for the proper use of opioid drugs, aimed to improve outcomes for patients and reduce the misuse of opioids [8]. The Korean National Health Insurance Service database, along with the data utilized by the Korean Narcotics Information Management System, which meticulously monitors Korea's narcotic production, prescription, and distribution, could also be applied in the Philippine context. This approach could significantly enhance the overall management of all narcotic affairs in the Philippines [1]. The national officials in the Philippines can benchmark with Korea to gain insights into recent trends and updates on the latest management systems regarding narcotics. It can also strengthen its previously initiated advocacy programs that promotes youth empowerment through the organization of small communities which will lead towards the adoption of a healthy lifestyle that is drug-free and productive. Additionally, the government should consistently conduct extensive information campaigns about opioid use, focusing on both its benefits and adverse effects. Utilizing social media could be particularly effective, given the Filipino population's high level of engagement with these platforms. Lastly, to ensure appropriate prescription of opioids in the country, strict monitoring is essential. This includes overseeing compliance among numerous drugstores to guarantee the correct sale and dispensing of opioids.