Fakery could reduce opioid addiction
Italian professor suggests mixing placebos with painkillers
An international expert on the “placebo effect” says with addiction and abuse of opioid prescription drugs on the rise, it may be time for doctors treating patients with chronic conditions or addictions to consider intermittently substituting substances like morphine with dummy pills. With or without telling patients. Speaking to about 300 delegates attending the Canadian Pain Society conference in Vancouver, Dr. Fabrizio Benedetti said an everexpanding body of research on the biological and psychological effects of placebos shows that when patients anticipate treatments will help, they often do, at times to the same or near degree as prescription medications.
Placebo drugs have effects on the same brain chemical pathways as true medications and in certain patients — especially those who optimistically anticipate the success of treatment — an inert placebo pill may work nearly as well as real drugs in such conditions as pain, headaches, anxiety and depression. But the duration of action may be shorter and weaker.
Benedetti, a professor of physiology and neuroscience at the University of Turin Medical School, said in an interview after his talk that while placebos are typically used in research trials, in some countries (Israel, Denmark and the U.S.), doctors are commonly interspersing dummy drugs into pill regimens so patients won’t get so addicted to such drugs.
“One approach is you tell the truth, saying: ‘I’m going to give you a placebo that will still make you feel better.’ Another approach is you deceive the patient. From an ethical point of view, the first approach is ethical while the other is not.
“Placebos are being used in routine medical practice now by many doctors in many circumstances, but the main goal is to reduce intake of drugs. If we are talking about narcotics and other drugs of abuse, the approach is, for example, give morphine on six consecutive days and then a placebo on the seventh day. There are three or four studies with good scientific approaches to this and in those three countries I mentioned, placebo prescribing is more common.”
Asked about the ethics of substituting pills, he said: “If you want to reduce intake of certain drugs, why not? I think that’s perfectly ethical, but if you want to prescribe placebos so you aren’t bothered by hospital patients in the middle of the night, that’s a different situation.”
Benedetti told delegates that researchers now understand more about the psychosocial context for real drug or placebo treatment effects. Certain words spoken by the health professional (“This pill is really going to help you”), the rituals associated with treatment (such as needle injections) and other sensory experiences all influence whether patients have positive expectations of health improvement. Personality traits can be important factors in who responds to placebos; optimists are more susceptible to having a placebo response while skeptics may have a nil effect.
“We don’t know exactly why some people respond to placebos and others do not. What also matters are things like verbal suggestions, what you tell patients, like: “I’m giving you a powerful painkiller so your pain should decrease in the next few minutes.”
On a biological level, patients who take a narcotic drug, for example, will see their pain reduced when certain opioid brain receptors are activated. But the same receptors might also be engaged by a dummy pill, so even a dummy pill can have an analgesic effect in certain “good placebo responders” since the same biochemical pathways are being used.
Benedetti said the interest in placebo effects is growing, especially from pharmaceutical companies keen to be able to predict who will respond to dummy pills in clinical trials so they can eliminate such positive placebo responders from drug trials.