Recent changes in prescription regulations for certain opioid pain-killer medications have sparked debate. Over the past year, the topic of opioid dependence, abuse and overdose has become fairly popular. Medical professionals, and now the general public, have begun taking note of the increasing rate of opioid prescriptions, rising rates of opioid-related deaths and higher rates of heroin addiction believed to be associated with initial medication addiction.
But some fear that tighter restrictions on these drugs will irrefutably and negatively affect patients with chronic pain who legitimately take the medications to improve their quality of life. This raises the question: Just how common are opioid dependence and abuse?
Studies yield a range of results concerning the percentage of patients using opioids that develop dependency or abuse the medications. In one large study from 2011, entitled “Prevalence of Prescription Opioid-Use Disorder Among Chronic Pain Patients,” researchers evaluated 705 patients taking opioids for non-cancer pain long-term. They found that 21.7% met criteria for moderate drug-use disorder and 13.2% met criteria for severe disorder.
Taking those numbers together, that's about one-third of patients involved in the study. A more recent and smaller study into 35 back pain patients, entitled “Pharmacological and toxicological profile of opioid-treated, chronic low back pain patients entering a mindfulness intervention randomized controlled trial,” found that 16 drug-tested positive for illicit or unprescribed drugs.
Based on these (and other) studies, it would seem that the rate of problematic use and dependence among chronic pain patients is certainly notable.
Questionable Effectiveness for Long-Term Pain
One of the most upsetting facts about the rate of opioid prescription for chronic non-cancer pain is the questionable usefulness of this class of drugs for this application. In 2013, a systematic review was published to summarize the available scientific evidence in favor of or against the use of opioids in long-term back pain treatment. The researchers noted a few significant things:
1. There were no place-controlled long-term trials supporting the use of opioids for back pain;
2. The few trials that compared opioids to NSAIDs or antidepressants yielded no significant differences in effects;
3. There is low- to moderate-quality evidence for the use of opioids short-term.
See more on this review at http://www.ncbi.nlm.nih.gov/pubmed/23983011 .
Patients should be fully aware of how opioids work in the body, that they target the brain's reward system in a way that can encourage dependency, addiction and abuse. Whenever possible, alternatives to opioids – including NSAIDs, exercise therapy, massage therapy, acupuncture, chiropractic care and cognitive behavioral therapy – should be pursued to manage pain with fewer risks.