Today's post from herbalhealthsystems.com (see link below) is an interesting look at a current hot topic of conversation across the world and that is the increasing dependence on pain killing drugs. It talks specifically about opioids as analgesics. The US authorities especially are trying to clamp down on misuse of these drugs, thinking that the problem is driven more by criminal intentions than genuine medical need. However, people living with severe neuropathy have known for years that there are very few effective alternatives and very often opioids are the only things that can get their nerve pain under control. There's little doubt that doctors are prescribing opioids more widely than ever but that doesn't necessarily mean that they are being misdiagnosed, especially with conditions such as neuropathy. Opioid abuse is clearly a problem but the authorities have to be able to separate the genuine cases of need from those trying to make money out of other people's misery. This story will run and run.
Drugs you get from a dark alley may be safer than drugs you get in a doctor’s office, according to a new study published in the journal Lancet. Researchers from School of Population Health at the University of Queensland, Australia found that prescription painkillers contribute to more illnesses and deaths worldwide than marijuana, cocaine or heroin — and experts say the problem is particularly worrisome in the United States. More than 15 million people around the world are addicted to opioid painkillers, such as Vicodin and OxyContin, compared to 13 million people who are addicted to marijuana, according to the study. Nicholas Kardaras, PhD, an addiction specialist and clinical assistant professor of health science at Stony Brook University in New York, said the findings are not surprising, as opioids are not only heavily addictive, but also very well marketed.
“Opiates have gotten much stronger over time and this creates more dependence,” Dr. Kardaras said. “In addition, pharmaceutical companies advertise these drugs heavily, and this creates a consumer market for powerful pain pills.”
Not only are prescription painkillers addictive, but they are also very deadly. Of the more than 78,000 people who died as a result of drug overdoses in 2010, 55 percent were due to painkiller overdoses, according to the study.
“Opiates are easy to overdose on,” Kardaras said. “When you take too many, your respiration slows down and your breathing stops. It’s very easy to reach that tipping point.”
Opioid addiction is rampant in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 12 million people use prescription painkillers for non-medical reasons in the United States, according to the CDC, and overdoses from them kill more than 14,000 people every year.
“Consumers have a very low pain threshold, so they opt for pain pills very quickly,” Kardaras said. The problem is only getting worse. In 2009, more than 475,000 people were admitted to emergency rooms due to painkiller abuse — five times the number of people from just five years earlier.
“The question is whether we’re in more pain over that period,” Kardaras said. “But I really don’t think we are.”
But if Americans aren’t in more pain, what’s driving the increase in opiate addiction? Kardaras said it comes down to a lack of education. “In medical school, they devote one day out of 6 years of training to talking about opioid addiction,” he said. “Many doctors will prescribe pain pills and not speak to their clients about taking them responsibly.”
Fixing the problem begins in the doctor’s office, said Jorg Pahl, MD, an addiction specialist in Oklahoma City, Okla. “It’s an issue of careful prescription of medications,” Dr. Pahl said. “Prescribing physicians need to be extra vigilant about evaluating patients for the possibility of drug addiction — for comorbid disorders including chronic pain, or history of addiction, depression, or anxiety disorders.”
In addition, Pahl said there needs to be more oversight around the prescriptions of these powerful drugs. “Data from Prescription Monitoring Programs, the databases through which state governments collect data on who prescribes and where and when patients and prescriptions get filled, needs to be made available to prescribing physicians nationwide,” he said. “If a patient goes and gets a prescription filled in another state, I as the physician would want to know that. But I really have no way to under the current system.” Finally, Kardaras said that keeping these drugs out of the reach of children can help cut down on the number of addicts as well.
“The gateway for a lot of young people into drug abuse is their parent’s medicine cabinet,” he said. “If a child is going to abuse drugs, they’re going to take what’s available and what they have access to, which is often painkillers.”
Unfortunately, Pahl said, the problem will likely get worse before it gets better.
“In decades past, doctors prescribed opioids mainly for cancer patients,” he said. “Now opioids are also commonly used for chronic non-cancer pain, especially chronic lower back pain. The U.S. has become overmedicated.”
http://www.herbalhealthsystems.com/news/painkiller-addiction-worse-than-marijuana-or-cocaine-study-finds/
Today's post from webmd.com (see link below) unfortunately adds somewhat to the hysteria currently surrounding opioid prescription for chronic pain. Yes the statistics are alarming and yes the potential for addiction is high if doctors don't have a serious follow-up program of control but the vast majority of patients with chronic pain, don't take opioids because they want to, they take them because all other alternatives have been exhausted and are not working. In that respect, opioids are an extremely useful and effective painkiller. They do require careful monitoring and that needs to be an active partnership between doctor and patient but the current assumption is that patients can't be trusted to do things properly and that is insulting to say the least. Nobody with chronic pain such as neuropathy wants to be addicted to a drug but everybody wants their symptoms to be reduced so that a normal life is possible. Under the right conditions, opioids can be very effective in doing that. Hopefully, common sense and not hysteria will rule the day.
While 99 percent exceed the recommended 3-day dosage limit, a quarter write prescriptions for a full month
-- When American doctors give their patients narcotic painkillers, 99 percent of them hand out prescriptions that exceed the federally recommended three-day dosage limit, new research suggests.
And some doctors exceeded that limit by a lot: Nearly one-quarter gave out month-long dosages, despite the fact that research has shown that a month's use of prescription narcotic painkillers can cause brain changes, the National Safety Council survey found.
"Opioids do not kill pain. They kill people," Dr. Donald Teater, a medical advisor at the safety council, said in a news release. "Doctors are well-intentioned and want to help their patients, but these findings are further proof that we need more education and training if we want to treat pain most effectively."
The problem has reached the point where these highly addictive painkillers, which include commonly prescribed drugs such as Oxycontin, Percocet and Vicodin, now account for more drug overdose deaths than heroin and cocaine combined, according to the report.
Unfortunately, the survey further revealed that while almost 85 percent of doctors screen for signs of prior narcotic painkiller abuse, just one-third ask about a family history of addiction. Only 5 percent offer direct help to patients when signs of abuse are uncovered, and less than 40 percent refer such patients for treatment elsewhere, the survey found.
The survey results, conducted in early March and released Thursday, come at a time when drug overdoses have reached record highs in the United States. Just this month, two federal agencies proposed measures to try to curb the narcotic painkiller abuse epidemic.
On Tuesday, the U.S. Food and Drug Administration ordered that warning labels be used for prescription narcotic painkillers. And last week, the U.S. Centers for Disease Control and Prevention issued tough new guidelines for doctors on prescribing these medications.
In December, the CDC announced that fatal drug overdoses had reached record highs in the United States -- driven largely by the abuse of prescription painkillers and another opioid, heroin. Many abusers use both.
According to that December report, more than 47,000 Americans lost their lives to drug overdose in 2014, a 14 percent jump from the previous year.
The safety council survey, of 200 doctors, found other troubling trends: Roughly three-quarters of doctors indicated that they believed that pain relief is best achieved by offering patients one of two opioids: morphine or oxycodone (Oxycontin). But experts from the safety council noted that over-the-counter pain relievers (including ibuprofen and acetaminophen) are more effective at providing short-term pain relief.
Misinformation particularly seems to be at play when it comes to tackling back pain and dental pain. While more than 70 percent and 55 percent of doctors say they prescribe narcotic painkillers for back pain and dental pain, respectively, these drugs are not considered the ideal treatment for either condition, according to the safety council.
Interestingly, the safety council found in an earlier survey that roughly half of all patients are actually more inclined to see their doctor again if non-narcotic painkillers are offered.
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http://www.webmd.com/mental-health/addiction/news/20160325/nearly-all-us-doctors-overprescribe-addictive-narcotic-painkillers-survey
Today's post from practicalpainmanagement.com (see link below) shows the results of a relatively small-scale study of people using long term opioids for chronic pain. The author points out that despite the current hysteria surrounding opioid treatment for chronic pain, there's no evidence that these pain patients perform any differently than if they use other strong analgesics. The point is that if doctors and patients work together with opioid treatment and there is recurrent and consistent control, there's no reason why opioids can't be as effective (or more) than other pain medications. Patients don't take opioids by choice; they take them because there is literally no alternative and most other options have already been exhausted. Labeling all opioid patients as some sort of menace to society, is grossly unfair, as is denying patients opioid treatment as a result. Of course, we all accept that a minority abuse the system but as usual the media and political lobbies use a sledgehammer to crack a nut and punishes all as a result. Thank goodness there are sensible commentators out there who see opioids as a tool in the armory against pain - neuropathy patients the world over are grateful that opioids exist but don't let anybody tell you that they enjoy taking them - they're a last resort. 
Patients in this study were found to be functioning quite well after 10 or more years on generally stable opioid dosages—with the vast majority able to care for themselves and even drive.
About eighteen months ago, I approached the publisher of Practical Pain Management to assist in a survey of long-term, opioid-treated pain patients. Rightly, as any good publisher, he asked why should I go to the time and expense to do a longevity survey? I then presented him my laundry list of reasons for doing the survey. Some explanations of my reasons for doing this survey are given here. Quite frankly this survey was needed, since we simply have little data on opioid long-term treatment.1,2 Also, opioid treatment is constantly under attack, so it seems logical to see if the popularity of this treatment is justified.
Reasons for the Survey
First, recall that we have just finished the “Decade of Pain.” Ushering in this decade were many laws, regulations, and guidelines—promulgated in many states—that encouraged physicians to prescribe opioids without fear of legal reprisal. Did anyone get help this decade? Did this political and humanitarian effort pay off?
Secondly, my own experience in practice was the predominant factor. I started my pain practice in 1975 while serving as a Public Health Physician in East Los Angeles County. Cancer and post-polio patients needed ‘narcotics’ (the common name prior to the more correct usage ‘opioids’) treatment for their severe chronic pain. I’ve now followed some chronic pain patients still taking opioids after 25 to 30 years.1 Also, I was a government consultant in the 1970s on Howard Hughes who managed to survive 30 years with intractable pain after a 1946 plane crash. His average opioid dosage over that time period was about 200 mg of morphine equivalence. But are my patients unusual or simply responsive to an overzealous clinician? Do opioid-treated patients in the hands of other physicians do just as well over a long period?
A little over a year ago there was another reason to do a longevity survey. At that time there was a vitriolic, anti-opioid propaganda campaign being waged. Some prominent academic institutions, pharmaceutical companies, professional organizations, and journals, almost in unison, essentially claimed that opioids shouldn’t be prescribed due to hyperalgesia or other as-yet unnamed complications. Some parties stated that opioids, if prescribed at all, should have a dosage restricted to some arbitrary number such as 200mg of morphine equivalence a day. Some claims fundamentally suggested that pain should only be treated with non-opioids, because opioids actually “cause pain.” Amazingly, some detoxification centers actually advertised for “clients” on the basis that the person’s pain would be cured if the patient spent $10K or $20K to detoxify from opioids. Needless to say, the anti-opioid campaign was hardly backed by bonafide medical management pain practitioners or scientific studies. So what was needed was a simple survey to see if there are long-term opioid-treated patients who are still doing well.
What the Survey Can’t Determine
This survey was not intended or designed to answer some ancillary questions. Not answered is which opioids are superior or could patients have done as well without opioids? Also, it wasn’t intended to determine optimal dosage or complications. The intent was clear and simple: Do some opioid-treated patients improve pain control, function better, and enhance their quality of life over a 10-year period?
Survey Methods
In early 2009, an advertisement was placed in this publication to identify any physician who had a cohort of chronic pain patients they had treated with opioids for 10 or more years and were willing to share outcome data. Three physicians, one each from Kentucky, Louisiana, and California, reported a total of 76 patients who have been treated with opioids for 10 or more years. These, together with the 24 patients treated by this author,1 provide a cohort of 100 patients who have been treated with opioids for 10 or more years and serve as subjects for this survey. Physicians completed a survey questionnaire for each patient that inquired about demographic status, cause of pain, opioids currently used, basic physical functions, activities of daily living, and stability of opioid dosage.
Results and Findings
Patients in this study appeared typical of most chronic pain patients in that they are primarily middle age or older and have degenerative diseases of the spine, joints, or peripheral nerves (see Tables 1 and 2). Most have maintained on one opioid, although some patients required two or three. The majority have been on stable dosages for many years (see Table 3). Despite the longevity of treatment, most function quite well. The vast majority of patients report good function in that they can dress, read, attend social functions, drive, and ambulate without assistance (see Table 4). Almost half (45%) reported they had been on a stable opioid dosage for at least 3 years.
Table 1. Demographics of 10-Year Opioid Patients
Age (Yrs) Range 30-83
Males 61 (61%)
Females 39 (39%)
Length of time in opioid treatment 10 – 35 yrs
Stable opioid dosage without significant escalation 3mos – 31 yrs
Table 2. Causes of Chronic Pain in This Population (N=100)
Spine disease 51
Arthritis 16
Peripheral neuropathy 14
Headache 10
Knee diseases 5
Abdominal adhesions 5
Hip diseases 4
Shoulder/arm diseases 4
Fibromyalgia 4
113*
*Adds up to more than 100 as some patients had more than 1 diagnosis.
Table 3. Opioids Currently Used by These 100 Patients
No. of Opioids Currently Used N(%)
1 62
2 26
3 12
Opioids Currently Used
Hydrocodone 56
Oxycodone 25
Fentanyl 15
Morphine 13
Methadone 8
Propoxyphene 8
Hydromorphone 5
Other 6
Table 4. Activities and Functions in These 10-Year+ Opioid Patients (N=100)
N(%)
Dress without assistance 82
Attend church/social events 89
Read newspapers, books, magazines 97
Gainful employment 25
Care for family 61
Ambulate unassisted 85
Ambulate with cane 5
Drive a car 74
Discussion
Recent epidemiologic studies indicate that about 10 million Americans now take opioid drugs for chronic pain control. This relatively recent and dramatic occurrence has had little outcome study.1,2 The author recently reported 24 Southern California chronic pain patients who were treated with opioids over 10 years and who had positive social, physical, and functional results.1 Outcomes from other patients treated by other physicians in other geographic areas were needed to confirm or deny the positive outcomes found with one physician in one geographic area. As stated above, this survey was not intended and doesn’t imply that there are patients who may have done as well or better if treated differently. Also this survey does not include patients who did not respond to opioids or stopped them due to complications.
This survey doesn’t lay claim to any sophisticated epidemiogic methodology or randomization. All this survey intended to do was meet one fundamental goal: “Are there chronic pain patients in the United States who have taken opioids over 10 years and report less pain, better function and have a better quality of life?” This survey satisfies this simple goal.
Conclusion
Patients reported here are functioning quite well after 10 or more years in opioid treatment. The vast majority can care for themselves and even drive. Opioid dosages have generally remained stable for long periods without significant escalation. Given the findings here, there is no obvious reason to discourage opioid use or encourage pain patients to cease opioids.References
1. Tennant F. A 10-year evaluation of chronic pain patients treated with opioids. Heroin Addict Relat Clin Probl. 2009. 11: 31-34.
2. Portenoy RK, Farrar JT, Bakonjam M, et al. Long term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pharm. 2007. 23: 287-299.
https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/opioid-treatment-10-year-longevity-survey-final-report
