Opioid painkillers’ benefits might not be worth their risks, according to a recent report, and the medical community intends to start monitoring the prescription and use of these drugs much more closely.
The American Academy of Neurology (AAN) has released a report revealing that addictive opioid painkillers do not provide sufficient help to patients to offset the risk of possible addiction. “This is the first position paper by a major American specialty society saying that there is a real problem here and the risk might not be worth the benefit for certain conditions,” Dr. Gary M. Franklin wrote in the AAN’s publication Neurology.
Opioids, or narcotics, are pain medications including morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone or a combination of one of these drugs and acetaminophen. Patients taking narcotic painkillers are more likely to risk overdose, addiction, and various debilitating side effects, than they are to actually be cured of the pain they are taking the drug for. Opioid addiction has become a real problem over the last decade. In the late ’90s, state laws and policies were enacted that made prescribing opioid pain medication much more commonplace. The statistics that have followed are unsettling. The group with highest risk of overdose, those ages 35-54, sees more deaths resulting from opioid use than firearms or motor vehicle crashes. In total, more than 100,000 people have died from prescription opioid use since the 1990s.
Even for severe pain conditions, such as sickle-cell disease, destructive rheumatoid arthritis, and severe neuropathic pain, the long-term use of opioid painkillers may not be enough of a beneficial pain treatment to make it work the risks.
But opioids are also prescribed for conditions as simple as headaches and lower back pain. These conditioned are commonly suffered by many different Americans from all walks of life, and are two of the most common medical complaints among office workers. In fact, the U.S. Bureau of Labor Statistics reported 650,000 work-related musculoskeletal disorders in 2010 alone.
This new study supports a 2003 study by the New England Journal of Medicine, which said that despite high levels of opioid prescriptions, people with chronic pain were not improving.
The problem for many opioid users is that the body builds up a tolerance to the drug, requiring an increased dose for effectiveness. As the dosage is increased, the patient is more and more likely to become addicted to the drug, or even accidentally overdose. The new study states that about 50% of patients who take opioid painkillers for at least three months are still taking them five years later, but their level of function has not improved.
The AAN has released some suggested practices for physicians prescribing these narcotic painkillers. In addition to screening patients for depression and prior drug abuse, they recommend that physicians draw up an “opioid treatment agreement” outlining the responsibilities of both the patient and the prescribing physician.
Physicians should track any dosage increases and assess changes in the patient’s level of function. Additionally, the AAN recommends that once a particular dosage is reached, and the patient’s pain is not under control, a pain specialist should be consulted.
The AAN’s study also encourages physicians to find other ways to approach pain management than these dangerous drugs. “For 20 years they have been taught that everybody deserves an opiate, because they really don’t know what else to do,” says Dr. Jane Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington. “It’s a cultural thing and it’s hard to reverse that…a lot of chronic pain isn’t appropriate for opiates.”