Opioids for Chronic Pain: Addiction is NOT Rare

Opioids for Chronic Pain: Addiction is NOT Rare


Long-term Opioid Therapy Reconsidered
Addiction is NOT Rare in Pain Patients Brought to you by: Physicians for Responsible
Opioid Prescribing Myth: Addiction to opioids is rare in chronic
pain patients who receive long-term opioid therapy. RUSSELL PORTENOY, MD
So many doctors were taught in school that if patients had real pain— by that typically
means pain related to some lesion in the body that you could palpate or see on an X-ray—that
if they had real pain of that type, then they could take a potentially abusable drug, and
the risk of abuse and addiction is minimal to nil. That’s completely incorrect. NATHANIEL KATZ, MD
Even my fellowship director was so bold as to say, “Pain soaks up the euphoria and
therefore you can’t become addicted to opiates.” That wasn’t what I was seeing in my own
practice. ANDREW KOLODNY, MD
If patients had legitimate pain, we were taught that they don’t become addicted to these
medicines, and that instead of allowing people to suffer needlessly, we should be much more
liberal in our prescribing of opioids. TEXT
The following clip is from a video used by Purdue Pharma, L.P. to market OxyContin. OxyContin Promotional Video
“I got my life back.” Purdue Pharma L.P. 1998 ALAN SPANOS, MD
There’s no question that our best, strongest pain medicines are the opioids. But these
are the same drugs that have a reputation for causing addiction and other terrible things.
Now, in fact, the rate of addiction amongst pain patients who are treated by doctors is
much less than one percent. They don’t wear out; they go on working; they do not have
serious medical side effects. And so these drugs, which I repeat, are our best, strongest
pain medications should be used much more than they are for patients in pain. NATHANIEL KATZ, MD
If you look at marketing pieces where that statement is made: “Less than one percent
will become addicted,” you’ll often see the Porter and Jick study, and a couple of
other similar quality studies used as a reference. But one has nothing to do with the other.
It was a gross misinterpretation. Not just by the manufacturer, by the way, but by the
so-called thought leaders who were in positions of eminence in some of our professional organizations
and in the pain management community, who allowed that myth to perpetuate itself by
misinterpretation of those data. RUSSELL PORTENOY, MD
I gave so many lectures to primary care audiences in which the Porter and Jick article was just
one piece of data that I would then cite, and I would cite six, seven maybe ten different
avenues of thought or avenues of evidence, none of which represented real evidence, and
yet what I was trying to do was to create a narrative so that the primary care audience
would look at this information in total {total? 2:35} and feel more comfortable about opioids
in a way they hadn’t before. In essence, this was education to destigmatize, and because
the primary goal was to destigmatize, we often left evidence behind. TEXT
The campaign to make physicians feel comfortable prescribing opioids for chronic pain was very
effective. Over the past 10 years, per capita sales for
opioid analgesics in the United States increased by 600%. The increased prescribing of opioids has led
to the worst drug epidemic in United States history. THOMAS R. FRIEDEN, MD, MPH
DIRECTOR, CDC CDC Grand Rounds Lecture on February 17, 2011
Prescription Drug Overdoses: An American Epidemic And I heard about an increased number of deaths
from opiates now exceeding, with prescription opiates, deaths from heroin and cocaine combined.
I heard from a birth defects center about more babies being born at risk for congenital
heart defects because their mothers had been taking prescription opiates. I learned about
more falls among the elderly who were taking prescription opiates. About more drugged-driving
crashes. And just about the only mortality statistic getting worse is the increase in
death from prescription opiate abuse. This is a major public health problem, and it’s
getting worse and getting worse rapidly. RUSSELL PORTENOY, MD
Clearly, if I had an inkling of what I know now then, I wouldn’t have spoken in the
way that I spoke. It was clearly the wrong thing to do. And to the extent that some of
the adverse outcomes now are as bad as they have become in terms of endemic occurrences,
of addiction, and unintentional overdose deaths, it’s quite scary to think about how the
growth in that prescribing driven by people like me led, in part, to that occurring. TEXT
Fact: Patients treated with opioids can become addicted. Aberrant drug use behaviors are common in
patients treated with opioids. THOMAS KOSTEN, MD
When you look through that literature, you can find a lowest rate of perhaps five percent,
but the higher rates are more typical, going up to 43 percent of patients who get chronic
back pain medications with opiates that are, in fact, have aberrant drug-abuse related
behaviors, and the average was in the high 20 percent, 28 percent or so. So a quarter
of patients having a complication as severe as addiction and aberrant behaviors makes
it the most common adverse event, and relatively serious adverse event, that can occur with
chronic opiate treatment. TEXT
Brought to you by: Physicians for Responsible Opioid Prescribing
www.responsibleopioidprescribing.org

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