Kroll Care is dedicated to helping our patients with chronic pain manage the impact of pain on their lives. In our practice we almost never are able to eliminate the pain. Our motto is “make pain a fact of life, not the focus”. Many patients are conflicted because of so much negative, mostly false, information which they encounter every day. This opinion piece addresses many of the false “truths” about opioids used in a controlled manner.
In the midst of the “opioid crisis and epidemic” there has been a concerted attempt by some anti-opioid doctors and too many politicians to blame the tragic overdose deaths of drug abusers on patients taking prescribed medications to manage their chronic pain.
Claim #1: 80% of heroin addicts began by abusing prescription opioids. This is unfortunately true but the inferences being drawn are the problem. Fewer than 6% of people who misuse prescription opioids go on to use heroin, and, the number of people who start heroin without taking prescription opioids first has been rising in the past year.
Claim #2: Addiction starts with a prescription. This claim persists despite decades of data to the contrary. A 2010 study found that only one-third of 1% of chronic pain patients without a history of substance abuse became addicted to opioids during treatment. Most abuse begins when people take medication that was not prescribed to them, using pills that were stolen, purchased illegally, or obtained from friends and family members.
Claim#3: Opioid overdoses are killing 64,000 people per year. If a person dies in the United States from any drug overdose, and has an opioid in their system it is classified as an opioid death even if they were taking many other drugs of abuse including benzodiazepines (Xanax, etc.) and muscle relaxants (Soma, Flexeril, etc.). Over 70% of opioid related deaths are currently due to heroin and imported Fentanyl, NOT to prescription medications. For deaths associated with prescription medications (most often NOT prescribed for the victim) more than 95% have multiple medications involved.
Claim #4: Reduced opioid prescribing will end the overdose crisis.
Reduced prescribing is clearly not working.The number of opioid prescriptions has been in steady decline since 2010, yet fatal overdoses have risen sharply ever since.
Claim #5: Medical cannabis will cure the opioid crisis.
This is a recurring myth. Unfortunately, not only does the recent data show that medical cannabis is not helping to reduce the drug overdose deaths in states where it is legal, the underlying assumption of this falsehood is that chronic pain care is fueling the opioid crisis. This faulty reasoning is at the core of the misguided attempts to curtail opioid prescribing.
Claim#6: Limiting the amount of medication that can be prescribed to a patient with chronic non-cancer pain is a requirement that will decrease opioid drug deaths
in spite of the suffering that will ensue for those patients who are inadequately treated. This is promulgated by the “experts” who view the CDC Guidelines for safe opioid prescribing as the definitive doctrine. (Please see my opinion article about the CDC Guidelines elsewhere on this website). I doubt that most of you know there are 3 categories of chronic pain treatment: cancer pain, non-cancer pain, and palliative care pain. For those with “cancer pain” there is no limit to the amount of prescribed opioids.
Claim #7: Opioids are ineffective for chronic pain.
This is the biggest lie of all. There is an abundance of high-quality research showing that opioids can be effective for some forms of chronic pain. This is a claim made in the aforementioned CDC Guidelines which is cited as being definitive.
Here’s a partial list of recent studies:
- Opioids for chronic pain: new evidence, new strategies, safe prescribing
- The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain
- Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects
Adding to these studies is a recent review in Medscape, in which Charles Argoff, MD, a professor of neurology at Albany Medical College, said that “in multiple guidelines and in multiple communications, we have a sense that chronic opioid therapy can be effective."
Well, this is my opinion. I hope it will pique your interest to explore the issues further.
Michael Kroll, M.D.