Painkiller addiction and accidental overdoses have become common in the U.S. In an effort to identify who is at most risk, researchers from the Mayo Clinic studied how many patients prescribed an opioid painkiller for the first time progressed to long-term prescriptions.
Their study found that the answer is one in four.
It also found that people with a history of tobacco use and substance abuse were likeliest to use painkillers long-term.
Discovering who is likeliest to end up using the drugs long-term is important due to the widespread problems associated with their misuse, according to lead author W. Michael Hooten, M.D., an anesthesiologist at Mayo Clinic in Rochester.
“Many people will suggest it’s actually a national epidemic,” he said. “More people now are experiencing fatal overdoses related to opioid use than compared to heroin and cocaine combined.”
Researchers used the National Institutes of Health-funded Rochester Epidemiology Project to get a random sample of 293 patients who received a new prescription in 2009 for an opioid painkiller such as oxycodone, morphine, hydromorphone, oxymorphone, hydrocodone, fentanyl, meperidine, codeine, or methadone.
They found that 21 percent, or 61 people, progressed from short-term use to prescriptions lasting three to four months, and six percent, or 19, ended up with more than a four-month supply of the drugs.
The identification of nicotine use and substance abuse as top risk factors for long-term use of opioids suggests that doctors should be particularly careful about prescribing painkillers to patients with such histories, according to Hooten.
What’s behind the connection? The neurobiology related to chronic pain, chronic opioid use, and addiction is similar, he explained. For example, nicotine activates a group of receptors, or brain structures, in a way very similar to how opioids and chronic pain may activate them.
While the study identified past or present nicotine use and substance abuse as top risk factors for long-term use of opioids, all patients should proceed with caution when offered opioid painkiller prescriptions, Hooten advised.
“From a patient perspective, it is important to recognize the potential risks associated with these medications,” he said. “I encourage use of alternative methods to manage pain, including non-opioid analgesics or other nonmedication approaches. That reduces or even eliminates the risk of these medications transitioning to another problem that was never intended.”
He added that long-term opioid use may actually make people more sensitive to pain — a condition called opioid-induced hyperalgesia.
If opioids must be used, as is usually the case with surgery or traumatic injuries, reducing the dose and limiting the duration is important, Hooten said.
“The next step in this research is to drill down and find more detailed information about the potential role of dose and quantity of medication prescribed,” he says. “It is possible that higher dose or greater quantities of the drug with each prescription are important predictors of longer-term use.”
The study was published in the Mayo Clinic Proceedings.
Source: Mayo Clinic