The Ineffectiveness of Opioids for Chronic Pain
Let me first say that I am not a medical doctor. However, as the founder and CEO of a leading addiction treatment center, I sit on the front-lines of the prescription painkiller epidemic. From this vantage point, by working with addicts and their families and the physicians who treat addiction, I have come to learn a great deal about opioids, both when they are useful and when they may cause more harm than good. In reading the recent research on the efficacy of opioids for treating non-cancer related pain, I am dismayed at the ease with which these medications are prescribed.
Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author of the book Ending Addiction for Good.
Editor: Saad Shaheed
The use of opioids for chronic non-cancer pain has increased dramatically over the past several decades. This has been accompanied by a major increase in opioid addiction and overdose deaths. The evidence does not support the safety and effectiveness of opioids for chronic pain and is causing an epidemic of tragic drug overdoses. The consequences of this abuse have been devastating and are on the rise.
An estimated 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.
The high risks associated with long-term opioid use are clearly shown by the climbing numbers of reported overdoses. Over 100,000 individuals have died, directly or indirectly, from prescribed opioids in the United States since the late 1990s. People aged 35–54 years have higher poisoning death rates involving opioid analgesics as compared with those in other age groups. Furthermore, substance abuse rates in those over the age of 55 are predicted to double in the next few years according to research predicting future trends from past and current research data.
A major reason why opioids are over prescribed is the misinformed belief that addiction is a rare consequence of long-term opioid therapy. The limited data supporting this outdated belief is of poor quality. Dependence arises in virtually all patients who are treated with long-term opioid therapy, and serious addiction occurs in up to one-third of patients.
The long-term use of opioids may not be beneficial even in patients with more severe pain conditions, including sickle-cell disease, destructive rheumatoid arthritis and severe neuropathic pain. The American Academy of Neurologists in a newly released position statement claimed :
Studies show that roughly half of patients taking opioids for at least three months are still on opioids five years later. Research shows that in many cases, those patients’ doses have increased and their level of function has not improved. In addition, the premise that tolerance can be overcome by dose escalation is now seriously questioned.
A relationship between prescribed opioid dose and overdose events was verified in three separate high quality studies. A nine time increased risk of overdose was noted in amounts exceeding 100 mg/d compared to doses below 20 mg/d in patients. Unfortunately, prescribed doses are common at 120-200 mg/d. Many patients suffer serious opioid-related harm, including death, despite never misusing an opioid prescription.
Addiction withdrawals from opioids, when not treated by a detoxification specialist, are extremely unpleasant lasting several days, and sometimes compared to severe influenza, including abdominal pain, nausea, diarrhea, and generalized malaise. The emergence of these symptoms following abrupt reductions in the dose of opioids, and their resolution following re-administration of the drug is common. This makes it difficult for even highly motivated individuals who are dependent on opioids to reduce or eliminate use without careful medical oversight and support.
If a patient’s pain is not under control, they should seek the help of a pain specialist and consider more successful alternative therapies than opioid medication on its own. Evidence now supports several holistic treatment options that are effective to help alleviate pain. We are able to promote mental, physical and spiritual healing without the need for what are now being regarded as generally ineffective opioid medications. Talk to a medical professional specializing in pain management for help with a long-term personal plan for managing pain.