Specializing in Spine, Sports & Physical Medicine

Deaths From Prescription Opioids on the Rise

Deaths from opioids prescribed for chronic non-cancer pain tripled in the United States between 1999 and 2007. The same trend is occurring in Canada, the United Kingdom and Australia writes Irfan Dhalla, MD, from the University of Toronto, Ontario, Canada, and colleagues in the British Medical Journal.

There are more than 12,000 deaths a year in the United States alone as a result of opioid overdose. These numbers are staggering! Over an 8-year period from 1999 to 2007, the number or deaths from prescription narcotics rose from 4,041 to 14,459. That is over a 300% increase. Such deaths are now more common than deaths from multiple myeloma, HIV, and alcoholic liver disease. Another way to look at it is that far more people are killed by prescription opioids than all those killed by heroin and cocaine combined.

Oxycodone is a major culprit in the staggering rise in opioid related deaths. In the Canadian province of Ontario, between the years of 1991 and 2004, oxycodone prescriptions increased by more than 850 percent, representing about one-third of all the opioid prescriptions given in 2006. In Canada the number of deaths due to prescription opioid use doubled between 1991 and 2004. Following the introduction of oxycodone into Toronto’s drug formulary in 2000, there was a 500% increase in deaths due to the drugs. Sadly, the vast majority of people who died from opioids had visited their doctor and received a prescription for the drug within a month of their death.

Dr. Dhalla believes that physicians have been misled to some degree by experts and pharmaceutical companies into believing that opioids are very effective for chronic non-cancer pain. They have also been misled about the risk for addiction, he says.

“In reality, the evidence for effectiveness is very thin. Our sense anecdotally is that many patients do not end up having significant relief from their pain. When you combine that with the fact that the risk of addiction is much higher than the pharmaceutical companies initially led physicians to believe, that creates a scenario where patients are being exposed to significant risks without certain benefits.”

For many years the pharmaceutical companies and experts suggested that the risk for addiction was less than 1%. Dr. Dhalla said.

“That’s the number you will see in a lot of papers in the 1990s, and even in the early 2000s. But in fact, we know that the risk of addiction for patients who are being treated for chronic pain for several months or longer is 35% — much higher than 1%. So addiction is a much bigger problem than physicians think it is,” he said.

Dr. Jerry Sobel in Phoenix, AZ, maintains that physicians need to be very careful in their prescribing of narcotics on a long-term basis for chronic non-cancer pain. Unfortunately, doctors have little high quality research to go on when writing prescriptions for these drugs. Considering that most patients on long-term opioids get limited relief of their pain, should we be prescribing them at all, especially when the addiction rate is as high as 35%? What are the medical and societal costs for chronic pain patients that get hooked on these drugs? These questions and many others need to be answered. Dr. Sobel at Sobel Spine at Sports is an expert in pain management and strongly favors non-narcotic treatments for chronic low back and other pain related conditions. He does assert that there are patients that can benefit from long-term narcotic use. Those are individuals that clearly have a significant improvement in their function and are working full-time. Further, their drug dose has not increased over time, i.e., development of tolerance to narcotics.

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