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Experiment With Opioid Pain Killers Failed
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Posted on: 12/31/2008
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Opioid (narcotic) medications for pain relief have been in the center of an ongoing controversy for years now. Yes, they provide pain relief for pain sufferers. But they are potentially addictive. And one of the most severe adverse side effects is death from unintentional overdose.
Despite this knowledge, the use of opioids as a treatment for chronic (noncancerous) pain has risen dramatically in the last few years. Along with that increase has been an obvious spike in the number of overdose deaths. The Centers for Disease Control and Prevention report as much as a 371 per cent increase in these kinds of deaths.
A closer look at that figure revealed a large difference based on demographics such as geographical location (urban versus rural), gender (male versus female), and age. What they found was a much higher incidence of opioid-related deaths in rural areas. West Virginia had the highest rates of opioid use in the entire United States. And the rate of unintentional drug overdose was more than twice the national average.
Men were twice as likely to die of a drug overdose than women. And individuals between the ages of 18 and 54 were affected most often. A closer look at the people who died of unintentional opioid overdose revealed a few important facts:
Drug abuse was the common denominator in 95 per cent of all deaths caused by drug overdose.
More than half of the deaths involved prescription opiates. But less than half of those deaths occurred in people for whom the prescription was written. Giving other people drugs prescribed for yourself is called drug diversion.
Almost 80 per cent of the opiate-related deaths involved alcohol and other drugs.
One in five people obtained their opioids by doctor shopping (going from doctor to doctor getting prescriptions for the drugs).
Has the great experiment to extend opioid treatment to people in chronic pain failed? Not necessarily. It may just be there's a need to adopt a more reasonable approach. Limit the number of prescriptions written to avoid drug diversion. Monitor patient use. That means use urine screening for anyone taking opiates over a long period of time. Assess for a history of alcohol and other drug abuse before prescribing narcotic medications.
At the same time, we need studies that look for ways to predict two things: 1) prediction of opioid abuse and 2) prediction of opioid effectiveness. Along with these two items, researchers need to identify patients who are well-suited for opioid therapy. Factors that might affect opioid use should be identified. This may include patient age, family history (hereditary factors), gender (male versus female), pain beliefs, psychologic or mental status, and many others.
For now, it's a step in the right direction to know that there's a broad pattern of drug overdose deaths related to drug diversion and/or drug abuse. Such a finding makes everyone take a step back and re-evaluate the use of prescription opiates. No one wants patients to suffer unnecessarily. But death as a potential side effect is not an acceptable outcome either.
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References:
The Epidemic of Opioid Overdoses. In The BACK Letter. January 2009. Vol. 24. No. 1. Pp. 8-9.
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