Many pharmacists have noticed an increase in the use of opioids over recent years. But the numbers might still surprise you.
I was reading the weekend edition of The Wall Street Journal the other day when I came across this interesting article. It describes how a pain management expert that once lobbied for the expanded use of opioids is now questioning that logic.
The pain specialist, Dr. Russell Portenoy, years ago argued that opioid pain medications weren’t as addictive or dangerous as previously thought. Now he’s apparently changed his tune.
The numbers are difficult to argue. In the United States, the use of opioid derivatives has skyrocketed in the last decade. According to the WSJ article, the amount of opioids used in the U.S. has over tripled since 2000 (from 2 kg sold per 10000 people in 2000 to 7.1 kg per 10000 in 2010).
In the same decade, opioid related deaths went up over four fold while admissions for opioid addiction treatment was up over five fold. All this happened as doctors began prescribing these medications for all sorts of chronic and acute pain.
The WSJ reports that opioid overdoses are responsible for more deaths in the U.S. than all illegal drugs combined. Thousands of people die each year as a direct result of an overdose. Are these deaths a result of opioid over-prescribing?
Dr. Portenoy now questions the widespread use of these pain relievers and cautions other prescribers to use them sparingly. The addiction potential is seemingly much greater that prescribers were aware of years ago.
The dilemma becomes how do you treat chronic pain suffers effectively while still minimizing the risk of abuse? Some patients can effectively manage a long term opioid pain regimen without falling into the addiction trap. But practitioners don’t have a reliable means to identify who is at risk for abuse and who is not before starting patients on opioid therapy.
I think modern medicine needs to learn more about the process of abuse and who falls into the addiction cycle. Learning key facts like what causes some patients to become addicted might answer questions like how do you use drugs effectively without creating more abuse.
I also think our drug abuse culture is an indictment on our inadequate metal health treatment in the United States. I would argue that a significant percentage of our drug abuse problem is rooted in untreated or under-treated mental health issues.
Tackling those mental health problems, understanding the addiction process with opioids, and developing newer pain relievers with less addiction potential are the keys to effective pain treatment going forward. But first the medical community must address the abuse potential of opioids and realize that their widespread use does come with severe consequences.
The WSJ article was very telling. You have a physician who once was on the forefront of expanding the use of opioids now questioning that decision. If a pain management expert can question opioid use and argue that their risks are being overlooked, we should all stop and pay attention.
I’m not saying chronic pain patients should needlessly suffer if there are effective treatment options available. What I’m arguing is that we are now facing an epidemic of abuse that will not resolve itself without some serious changes to how modern medicine treats pain.
It’s time for all of us to open our eyes to what opioids really are and use these drugs appropriately. It’s also time for a serious look at drug addiction and it’s root causes so we can identify at risk patients.
Opioids are not bad drugs if they are used properly. But extending their use to a large percentage of pain patients does have negative consequences.
I think it’s time we really look at how we’re using these medications for pain management. I’m just afraid that if we do we won’t like what we find.
The Redheaded Pharmacist