Chronic pain is one of the nation’s most pervasive health problems, affecting about 100 million people. To alleviate patients’ suffering, pain medicine doctors have over the last few decades frequently prescribed opioids, a class of powerful and dangerously addictive medications. As the number of prescriptions has piled up, so have the rates of addiction and related deaths. Now, the medical community — and pain medicine doctors especially — are growing aware of opioid safety concerns. The tide is turning against the dangerous pills that, as new research shows, may not even be effective against long-term pain.
How did opioids become so popular?
When opioids first came on the market, they were typically offered to people experiencing acute pain. Patients recovering from surgery or a short-term medical condition were given the pills for short durations of time until the condition causing pain ended.
Then, in 1986, a study published in the medical journal Pain characterized opioids as safe for long-term use in “selected patients” with limited risk of addiction, reports The New Yorker. Six years earlier, the New England Journal of Medicine had published a short letter to the editor reporting that a slim percentage of patients receiving narcotics became addicted.
These two incidences created a fertile ground for drug manufacturers, who began marketing opioids as safe for patients with chronic pain, including back pain, which is very common and a leading cause of disability. The drug companies also funded industry non-profits, including the American Pain Society and American Academy of Pain Management, to further the idea that opioids were safe for long-term use. Doctors, trying to treat incredibly complex pain conditions against a backdrop of ever-tightening schedules, had little time to devote to patients with confounding, chronic medical conditions.
Opioids seemed like an easy, effective method to help patients, and the limited research available seemed to support the idea that the medicines were relatively safe. Then the number of people addicted to narcotics began skyrocketing, along with opioid-related deaths.
What are current opioid overdose rates?
Since 1990, the rates of death from drug overdose have tripled, reaching the highest they’ve ever been, according to PsychCentral. In 2011, 17,000 people died from opioid overdoses. And from 2007 to 2010, the number of people hospitalized for opioid addiction jumped by four times. In 2015, according to the most recent research from the CDC, 15,000 people died from overdoses involving prescription opioids.
Widespread opioid addiction has also contributed to a rise in heroin addiction since those addicted sometimes turn to street drugs that are cheaper and don’t require prescriptions, reports Time.
U.S. accounts for the majority of global opioid use
Opioid use is a huge problem in the U.S., and it seems to affect the nation more than it does other countries worldwide. The U.S. accounts for about 80% of global opioid use and 99% of all globally used hydrocodone—a commonly prescribed opioid, according to The Journal of the American Academy of Orthopaedic Surgeons.
Orthopedic surgery is the branch of medicine related to the musculoskeletal system, and orthopedic surgeons rank third in types of doctors who prescribe opioids, according to the study. Much of chronic pain emanates from the musculoskeletal system, and so while it makes logical sense for orthopedic doctors to prescribe opioids and other pain pills, doctors are concerned about the widespread rates of misuse and overdose.
Detrimental effects include patients’ growing tolerance for the drugs, which means patients require increasingly high dosages to achieve the same amount of pain relief. Another concern is the burgeoning black market for opioids, which often results when patients with prescriptions sell or give the pills to people without prescriptions.
Additionally, researchers have found that many patients who have undergone surgery for their spine or to replace a joint and who take opioids may face worse health outcomes than if they didn’t take the pain pills. Researchers said that in the face of mounting data, the medical community must come together and find a way to limit the number of opioids used to treat musculoskeletal pain.
Why are opioids so dangerous?
Opioids are powerfully addictive, not just mentally, but physically. Every time a person takes an opioid, the body becomes accustomed to it, which means ever-higher dosages are required to achieve the same effect. Narcotics also provide a relaxed, euphoric feeling that frequently hooks people to the drug.
No medication, not even opioids, can completely make pain go away, and so people often take more and more of the drug to stop their pain, feel that drug-induced euphoria, or possibly because the body needs the drug to operate normally—a situation known as physical dependence.
As the public health impacts of opioid addiction have risen, public awareness has also grown and doctors now say they are less likely to prescribe the medications.
Why do people misuse opioids?
As many as 25% of all people who take opioids misuse the pills, according to research published in the journal Pain. Meanwhile, about 10% of those taking opioids grow addicted to the drugs. The harmful impacts are so pronounced that researchers questioned whether so many people should be receiving prescriptions for these potentially lethal drugs.
Opioids kill pain by attaching to the brain’s opioid receptors, which alleviates suffering but can also create a sense of euphoria. This sometimes leads to patients taking the pills not only to reduce pain, but also to escape the struggles of daily life and enjoy a peaceful sense of wellbeing.
Meanwhile, opioids can also create a physical dependency, which means the body becomes accustomed to operating with a certain level of drug in its system. When a person stops taking the pills, the body may go into withdrawal. The brain produces a natural type of opioid, but taking the pill form alters production levels. This can lead to physical withdrawal symptoms after opioid use stops, according to the National Institute on Drug Abuse.
Other types of misuse include snorting crushed pills, injecting the powder, or mixing opioids and alcohol—a potentially lethal mix.
Pain researchers are calling for additional studies to further flesh out the risk factors for opioid misuse and dependency so doctors can have a better idea of who they should avoid prescribing the medications to. Study authors write:
“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”
Why fewer pain medicine doctors are prescribing opioids
Part of the problem, and a huge factor in the rise of opioid prescriptions, is that there are no effective, safe medications to help people living with chronic pain. There has been a shortage of research into potential medications not in the opioid class of drugs, and doctors aren’t well prepared to safely handle chronic pain, says NIH. Pain medicine doctors, who are specialists in the care for chronic pain, must be at the forefront of efforts to find new alternatives to opioid medicines.
Chronic pain is not one condition, but an umbrella term for a sensation that can be caused by anything from a slipped spinal disc to disruptions in nervous system functioning. Not all pain is created equal, and the treatment should reflect that, NIH concluded.
The agency recommended increasingly individualized care for chronic pain that focuses on the whole person, the physical and emotional, since pain affects both of these aspects.
The report also encouraged greater use of alternative and complementary therapies for chronic pain from pain medicine doctors including physical therapy, massage, acupuncture, and chiropractic treatment. These modalities are becoming more common, but are still difficult for many patients to access. According to the New Yorker:
“Health insurers are part of the problem here: they reliably cover prescription narcotics, but not necessarily these other medical tools.”
Opioids don’t help most types of chronic pain
While opioids may be a common way of treating chronic pain, emerging research casts doubt on whether the pills even work.
A research paper from the National Institutes of Health (NIH) has concluded that opioids have little to no benefit for treating chronic pain. In the past, several studies have found the opposite, but NIH says those studies lacked rigorous methodology or didn’t last long enough to collect accurate data. Dr. David Steffens with the University of Connecticut says bluntly,
“There’s no research-based evidence that [opioids] are helpful.”
Our pain doctors discuss how a team-based, comprehensive approach is best for treating chronic pain.
Emergency programs join fight
While deaths related to opioid overdose rose to 16,651 in 2010, up from 4,041 in 1999, researchers believe they have uncovered new ways that emergency departments could help reduce these startling statistics.
Research published in the Western Journal of Emergency Medicine found that emergency departments have the ability to save lives through educating patients and distributing rescue kits with naloxone, a nasal spray that counteracts the effects of opioids.
The study evaluated the success of a program from Boston Medical Center (BMC), which has, since 1993, referred eligible emergency department patients for drug interventions and treatment. In 2009, BMC also began distributing naloxone kits to those patients who were at risk for overdosing on opioids.
Researchers from Boston University, in concert with BMC, analyzed data from the patients and found 73% of those surveyed had received a naloxone rescue kit. More than 50% of patients receiving kits called 911 after witnessing an overdose, and 33% of those patients administered the naloxone kits in an attempt to save a life.
Researchers said the sheer number of people reached through this targeted program, and who through it understood how to react in an emergency, offered hope for curtailing rising overdose death rates among opioid users. Study author Dr. Kristin Dwyer says:
“Our program reached a high-risk population that commonly witnessed overdoses, called for help, and used naloxone to rescue people, when available.”
Doctors hope additional, larger studies will shed further light on how many lives can be saved through outreach efforts.
What are the current rates of opioid prescriptions?
After decades of increasingly common opioid use, data now emerging paints a scary picture of rising addiction and overdose rates. Meanwhile, pain medicine doctors aren’t even sure if these dangerous pills are helping patients reduce pain. With the risks clear and benefits uncertain, the medical community is committed to helping people find new ways of fighting pain and fending off addiction.
Knowledge is power, and understanding the truly devastating effects of opioid use and abuse is the first step in helping those whose lives have been impacted by the powerful narcotics. With pain medicine doctors increasingly aware of both opioid dangers and the addiction epidemic, experts say more are exercising greater caution before filling out a prescription.
About half of all doctors surveyed by Johns Hopkins Bloomberg School of Public Health said they were less likely to write an opioid prescription today than they were a year ago, according to PsychCentral. Nine out of ten doctors said a prescription drug abuse problem plagues their communities, driving home the risk of taking the drugs long-term. Caleb Alexander, a Johns Hopkins epidemiologist says:
“The health care community has long been part of the problem, and now they appear to be part of the solution to this complex epidemic.”
A study by Columbia University corroborated the Johns Hopkins research, finding that rates of opioid prescriptions have stabilized over the past ten years after peaking in 2007. Interestingly, most doctors surveyed believed in their own ability to safely write opioid prescriptions all while agreeing that the drugs are over-prescribed, reports Forbes. Pain medicine doctors must continue to lead this charge of finding safer, more reliable alternatives of pain management for their patients.
To learn more about other options you have for pain management, talk to one of our pain medicine doctors today.