The opioid addiction issue in the United States is called an epidemic for a reason. It’s a growing public health and safety concern and is even beginning to impact life expectancy due to the high rate of drug overdoses attributable to opioids.
In 2016, deaths from drug overdoses hit an all-time high of 63, 600. Of those overdose deaths, just over 42,000 of them were from opiates. The 2016 report represents a 21% increase in drug deaths and is the largest single-year jump ever. The CDC estimates that more than 11 million Americans are struggling with addiction to opioids and that number is more than likely low since many who are addicted do not seek treatment.
A recent research study published last week in the Journal of the American Medical Association looked at the use of opioid medications to treat chronic pain. Conducted by scientists at the Minneapolis Veterans Administration, the research was clear in its conclusion that for long-term pain, that is chronic and likely permanent, opioid use is not the most effective treatment. Many healthcare providers are looking to opioid alternatives not only for better treatment but because of the risk of addiction.
Study participants were 240 VA patients being treated at 62 different VA primary care clinics. All of the study volunteers were diagnosed with chronic pain, the definition of which was pain that occurs on a daily basis for 6 or more months. The patients were divided into two groups, non-opioid pain medications, and opioids. For a year each group was treated in a three-step process and then followed after the initial study period. While opioids are powerful, the results that they were not that effective were a surprise to some.
The patients treated in the study all had chronic pain related to hip or knee arthritis or chronic back pain. The opioid drugs used were all generic and included hydrocodone, oxycodone and fentanyl patches. Non-opioids included OTC acetaminophen, ibuprofen, and some prescription non-narcotics. Patients were randomly assigned to their groups. Out of the original 240, 234 patients completed the trial. The results showed that the nonopioid group of patients reported slightly better pain scores, meaning they reported less pain than those patients taking the stronger medications. When describing pain intensity, the group taking non-narcotics was also better off with less intense pain. Regarding improving function, movement and sleep quality there was no significant difference between the two groups.
In 2016, the guidelines set forth by the FDA advised against the use of opioids for chronic pain, recommending the use of NSAIDs or OTC analgesics. Only when those options didn’t work, should practitioners move to opioid remedies. In summary, the researchers wrote, “Treatment with opioids was not superior to treatment with non-opioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain." Given the high risk for addiction and now this evidence as well as other studies that show a limited benefit to the use of opioids, it seems clear that the treatment model for chronic pain should move away from opioids and towards more useful options. The researchers pointed out that physical therapy and rehab exercises along with NSAIDs and non-narcotics showed the best results for patients suffering chronic pain.
Sources: Veterans Administration, JAMA, UPI
