The benefits of prescribing opioids to patients with some chronic noncancer pain conditions such as headache, fibromyalgia, and chronic low back pain are offset by the severity of the risks inherent to taking those drugs, according to new position paper published by the American Academy of Neurology.
Opioids such as morphine, codeine, oxycodone, methadone, fentanyl, and hydrocodone have become commonly associated with a high risk of addiction, overdosing, and sometimes death. These are key reasons why new protocols are urgently needed to help curb the growing problem, said Dr. Gary M. Franklin, a neurologist and research professor in the department of environmental and occupational health sciences at the University of Washington, Seattle.
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About half of all patients who take opioids for 3 months to treat chronic pain continue to use the drugs as much as 5 years later.
“The language in these [opioid] laws implying no ceiling on dose, or placing no limits on dispensing controlled substances from prescriber offices, should be revisited in the context of the benefits, morbidity, and mortality,” Dr. Franklin wrote (Neurology 2014;83:1277-84).
Since the late 1990s, when policy changes allowed for more liberal long-term use, there have been more than 100,000 deaths related to prescription opioids. At Washington State Hospital alone, hospitalizations due to opioid overdoses skyrocketed between 1995 and 2008, growing from well under 100 per year to over 400.
Studies also indicate that about half of all patients who take opioids for 3 months to treat chronic pain continue to use the drugs as much as 5 years later. In fact, within the age group of 35-54 years, opioid-related mortality has exceeded deaths caused by both motor vehicle accidents and firearms since the late 1990s.
In an interview, Dr. Franklin advised physicians to be very careful about using opioid therapy as a first-line treatment for mild to moderate pain conditions. If it is used at all, it should be for only a few days. For patients who are already on high doses of opioids, Dr. Franklin recommended that physicians consult guidelines on tapering and help patients find a therapy without the risks of chronic opioid treatment.
“You should not abandon your patients,” he said. “You might decide not to keep using opioids, but don’t abandon the patient. Offer them some other things that might help them.”