Specializing in Spine, Sports & Physical Medicine

The Pain Pill Epidemic, Who is Responsible?

The Pain Pill Epidemic

The article linked below is a very good review that was written in the New Yorker magazine in November of 2013. In the article to author discusses what we know about long term narcotic usage for chronic pain and what we do not know. He also outlines some of the contributing factors that lead to an explosion of narcotic use in the United States over a 10 year time frame. I want to highlight a few key points from the article.

  1. “By 2010, the United States, with about five per cent of the world’s population, was consuming ninety-nine per cent of the world’s hydrocodone (the narcotic in Vicodin), along with eighty per cent of the oxycodone (in Percocet and OxyContin), and sixty-five per cent of the hydromorphone (in Dilaudid).”
  2. “As narcotics prescriptions surged, so did deaths from opioid-analgesic overdoses—from about four thousand to almost seventeen thousand.”
  3. “Studies have shown that patients who receive narcotics for chronic pain are less likely to recover function, and are less likely to go back to work.”
  4. “The potential side effects of prescription narcotics include constipation, sexual dysfunction, cognitive impairment, addiction, and overdosing.”
  5. “When patients receive narcotics for long periods, they can even become more sensitive to pain, a condition called hyperalgesia.”

This last item I believe is a very important one to consider. It is believed that pain medication reduces a person’s pain. However, in up to 10% if not more, the more pain medication someone takes the greater their pain level becomes. This is an under appreciated problem when prescribing narcotics.

There is not strong medical evidence that the prescription of narcotics to treat chronic, non-cancer pain is effective over long periods: most studies of prescription narcotics last only twelve to sixteen weeks. It is not possible to extrapolate to long term usage when the studies only ran four months. Recent studies point to the fact that over the long term narcotics at best lead to a small improvement in pain levels but also lead to a worsening of function as well as increased disability. My specialty is Physical Medicine and Rehabilitation and I was taught that improvement in functional capacity and reduction in disability are the most important things to address. If the use of narcotics results in a worsening of these two then why prescribe them at all on a long-term basis?

Finally, the author talks about two articles published in major medical journals in the 1980s that started to notion that it was okay to prescribe narcotics long-term. The first was a one hundred word letter to the editor piece in the New England Journal of Medicine in 1980 in which it was “reported that less than one per cent of patients at Boston University Medical Center who received narcotics while hospitalized became addicted.” This was followed up by a paper published in the journal Pain in 1986 that concluded that, for non-cancer pain, narcotics “can be safely and effectively prescribed to selected patients with relatively little risk of producing the maladaptive behaviors which define opioid abuse.” It was estimated that only a very small percentage of people that are prescribed narcotics become addicted. More recent studies suggest that the numbers in the general population can be as high as 35%.

 

I welcome you to read this very good article-

http://www.newyorker.com/online/blogs/currency/2013/11/who-is-responsible-for-the-pain-pill-epidemic.html

 

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