Opioids’ side effects may outweigh benefits
Despite risks, drugs often don’t aid pain patients’ ability to function, study says.
Patients taking opioid painkillers for chronic pain not associated with cancer, such as from fibromyalgia and low- back pain, are more likely to risk overdose, addiction and a range of debilitating side effects than they are to improve their ability to function, a leading physicians group declared.
The long- term use of opioids may not be beneficial even in patients with severe pain conditions, including sickle- cell disease and destructive rheumatoid arthritis, the American Academy of Neurologists said in a position statement published Tuesday.
For patients who do appear to benefit from opioid narcotics, the neurology group warned, physicians should diligently track dose increases, screen patients for a history of depression or substance abuse and insist as a condition of use that the drugs improve a patient’s function.
The academy appears to be the first physicians group to lay out a comprehensive set of research- based guidelines that outline which patients are most ( and least) likely to benefit from the ongoing use of opioids — and what practices a physician should follow.
The statement covers the prescribing of morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone or a combination of those drugs with acetaminophen.
The academy’s statement urges physicians to work with officials to reverse state laws and policies enacted in the late 1990s that made prescribing opioids more commonplace.
The statement notes that despite a national epidemic of painkiller addiction that has claimed more than 100,000 lives in just over a decade, many of those laws and practices remain unchanged.
It adds that prescription drug monitoring programs — online databases that allow physicians to quickly check on all controlled substances dispensed to a patient—“are currently under funded, underutilized and not interoperable across state lines or healthcare systems.”
The result is that patients’ tendency to develop a tolerance for opioid drugs— and to require everhigher doses to achieve pain relief — often goes unnoticed.
That has led to not only addiction and misuse, but an escalating risk of accidental overdose.
In the age group at highest risk for overdose— those between 35 and 54 — opioid use has vaulted ahead of firearms and motor vehicle crashes as a cause of death.
The academy statement cites studies showing that roughly half of patients taking opioids for at least three months are still on the drugs five years later.
Research shows that in many cases, those patients’ doses have increased and their level of function has not improved.