Are the Benefits of Opioid Prescriptions Worth the Risks?
A Nation in Crisis
In the midst of a nation-wide opioid epidemic, new science shows that opioids are no better than non-opioid medications when it comes to treating chronic pain.
In the summer of 2017, the nation saw a 30 percent increase in the number of emergency room visits due to opioid overdoses.
Although opioid prescriptions showed an overall decrease of 18% between 2010 and 2015, the US still has an opioid prescription rate that is three times higher than it was when opioids were first prescribed for persistent pain and four times higher than the rate in Europe.
Even though prescription rates have decreased over the years, the length of prescriptions has steadily increased. In 2015, six times more opioids per resident were dispensed in the highest-prescribing counties than in the lowest-prescribing counties.
The number one contributor to the risk of opioid addiction, overdose, and death is the length of time a user takes it. As prescription lengths have gone up, overdose death rates increased for all age groups, the greatest increase was in adults aged 55-64 and the highest overall rates of fatal overdose was slightly younger—adults aged 45-54.
As the nation faces this opioid crisis, a new study reveals that the cost of opioid prescription may far outweigh the benefits of their analgesic effects.
A Brief History of Opioid Prescriptions
Healthcare providers began prescribing opioids for chronic pain not related to cancer back in the late-90s. The idea was that opioids could do a better job of managing the persistent pain experienced by people with arthritis and back pain.
The rise in opiate prescriptions in the late-90s was preceded by a slow change in thought in the mid- to late-70s when Vicodin and Percocet hit the market.
Before then, opioids had been thought to be too risky to prescribe to patients, with many providers seeing it as old medicine harkening back to the late when heroin was used to treat something as benign as a sore throat.
Opioid prescriptions were hotly debated in scientific community from the 70s through the 90s, with the final consensus being that opioid use was not as risky as people thought and that alleviating pain was worth any remaining risk.
By the time OxyContin came on the market in 1996, opioids were seen as life-restoring miracle drugs that could erase persistent pain. Doctors began pushing the drug, and patients were more than willing to accept.
Prescription rates went up, doses got stronger, and prescription lengths were extended. Addiction rates went up, ER visits jumped, and a lot of people started dying.
What the New Science Says About Our Old Way of Thinking
Now that we’re staring in the face of real, national health crisis, this new study reveals that using opioids to treat the pain associated with arthritis and back pain may have been a huge overreach.
On March 6, 2018, JAMA: The Journal of the American Medical Association published a study entitled “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain.”
This randomized clinical trial that included 240 patients, and it showed that the use of opioid vs non-opioid medication therapy did not result in significantly better pain relief over a one-year period.
One group was given opiates such as morphine, oxycodone, or hydrocodone/acetaminophen, and the other group took acetaminophen or a nonsteroidal anti-inflammatory drug.
The authors of the study stated conclusively that their “Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
These results will likely be the subject of another heated scientific exchange in the months and years that follow. For now, however, the study’s conclusion should call us to reconsider the benefits of an extended opioid regimen when the risks and consequences have been so clearly defined in the current national conversation.
Whatever conclusion the scientific community reaches, what is certain is that there are more options for treating persistent and chronic pain than heavy narcotics.
If you’d like to learn about safe and highly effective approaches to the treatment of chronic back pain, talk to a Patient Care Manager at Onward Orthopedics. These dedicated professionals are reachable any time: call (888) 205-5451 today!