19Jan . - Mar 2022recognized as an epidemic in the U.S. but to compare our opioid situation with other countries, in particular Taiwan, where I was born and where some of my family and friends still reside and see if there are any differences. I had the fortunate opportunity to participate in an exchange program with the Division of Pain Medicine, a part of the Department of Anesthesia at the National Taiwan University Medical Center (NTUMC) in Taipei, Taiwan. National Taiwan University is one of the most prestigious universities in Taiwan, and their Medical Center is the most well respected and serves as the leader and the standard of medical care in the country. Part of my exchange experience is to rotate through various clinics, and I was introduced to Dr. Chih-Peng Lin, the Division Chief of Pain Medicine at NTUMC. Dr. Lin manages patients with cancer and/or non-cancer pain with both interventional techniques and medications. I began to notice a major difference in how his patients were being managed compared to pain practices in the United States, particularly in the realm of opioids. It is astounding how small the proportion of his patients are on opioid medications, and when they are, the doses were much lower than what we typically see in the United States. Dr. Lin was kind enough to answer some questions on the topic of opioid prescribing in Taiwan during my time at NTUMC.Taiwan has a nationalized healthcare system; hence they can monitor all prescriptions, including opioids. In Taiwan, like the U.S., opioids are categorized as controlled substances with similar regulations and restrictions, with some minor differences in the categorization. For example, morphine is listed as a Schedule I controlled substance along with heroin and opium in Taiwan.8 Medications like methadone, oxycodone, amphetamines are schedule II.8In the U.S., morphine is a schedule II medication along with other opioid medications. These medicines are highly regulated in Taiwan, and prescribers of scheduled medications will need to go through arduous registration and certification processes, and their prescribing habits are closely monitored through a national database. In addition to the government, these medicines are also monitored by drug manufacturers, and importation and distribution of these medications are reported to governing agencies. Under these nationally mandated statutes, Taiwan keeps an accurate account of the number of patients who were prescribed and dispensed of these opioids and what their diagnoses were. Taiwan's population is around 23,160,000 (according to the 2011-2012 census), and around 500,000 patients have a diagnosis of cancer. Around 25percent or 125,000 patients were prescribed opioid medication.9In contrast, for patients with a chronic pain diagnosis but without a cancer diagnosis, only 644 people are on Schedule I or II medications9. The difference in the ratio of cancer vs Joseph Tu
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