New research has found little to no evidence that opioid drugs are effective for long-term chronic pain, despite explosive growth in their use, according to a new paper released by the National Institutes of Health (NIH).
The findings reveal that many of the studies used to justify the prescription of these drugs were either poorly conducted or of insufficient duration.
“The prolific use of these drugs is surprising,” said study author David Steffens, M.D., M.H.S., chair of the psychiatry department at University of Connecticut Health.
“When it comes to long-term pain,” he says, “there’s no research-based evidence that these medicines are helpful.”
In the U.S., prescriptions for opioid drugs have more than tripled in the past 20 years, with more than 219 million prescriptions written in 2011, according to the study. Abuse of these drugs has also skyrocketed, leading some to label it an epidemic.
More than 16,000 people died from prescription opioid overdoses in 2012, according to the Centers for Disease Control, and drug overdose now causes more deaths than motor vehicle accidents for people ages 25-64.
This level of opioid use and abuse is unprecedented in the world. The U.S., which is just 4.6 percent of the world’s population, consumes 80 percent of the world’s opioid drugs. That, said Steffens, makes this “a peculiarly American problem.”
Steffens, like the other members of the panel, was surprised by many of these findings, since he is not an expert in opioid drugs, in drug abuse, or in pain management; Steffens’ specialty is geriatric psychiatry.
In fact, all members of the panel were experienced clinicians from other fields. “The NIH intentionally invited people from other fields of medicine,” he said, “in order to avoid potential conflicts of interest, and to get a fresh perspective on the issue.”
Over two days, the panel listened to evidence presented by an independent agency, which had conducted an exhaustive search of all the available studies about the use of opioid drugs. The final report is published in the Annals of Internal Medicine.
One of the greatest challenges, noted Steffens, is the fact that opioid drugs clearly are an effective treatment for some people dealing with pain, but it is hard to predict where trouble will crop up. There is a strong need for better communication about best practices to physicians who are prescribing these drugs, he notes.
“There are certain syndromes, like fibromyalgia, where opioids are less likely to be effective and patients are more likely get into trouble with abuse,” he said.
Another pressing issue is that pills from the pharmacy don’t always end up with the person for which they were prescribed. The phenomenon of medicine being sold or given away (known as diversion) has long been known as a key driver in the rise of prescription drug abuse.
“I wish that doctors treating people for sports or workplace injuries would be cautious with the amount of pills they dispense,” says Steffens.
Source: University of Connecticut