US experts have reported that there is little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the recent explosive growth in their use.
Also, many of the studies which have been used to justify the prescribing of opioid drugs for long-term chronic pain have been either poorly conducted or of insufficient duration, according to a report issued by the National Institute of Health (NIH). When it comes to long-term pain, “there’s no research-based evidence that these medicines are helpful,” said Dr David Steffens, chair of the psychiatry department at UConn Health and one of the study’s authors.
Yet US prescriptions for opioid drugs have more than tripled in the past 20 years, with over 219 million prescriptions written in 2011. At the same time, abuse of these drugs has skyrocketed - more than 16,000 Americans died from prescription opioid overdoses in 2012, and such overdosing now causes more deaths than motor accidents among people in the US aged 25-64.
This is “a peculiarly American problem,” Dr Steffens added, pointing out that while the US has just 4.6% of the global population, the nation consumes 80% of the world’s opioid drugs.
The NIH paper constitutes the final report of a seven-member panel convened by the NIH last September, and which has been published in the Annals of Internal Medicine. It finds that one of the great challenges in dealing with this issue is the fact that opioid drugs are clearly an effective treatment for some people dealing with pain, but it is hard to predict when problems will present.
Part of the issue is the need for better communication about best practices to physicians who are prescribing opioid drugs, said Dr Steffens.
“There are certain syndromes, like fibromyalgia, where opioids are less likely to be effective and patients are more likely to get into trouble with abuse,” he said.
Another issue for both patients and society is the process of medicines being sold or given away, known as diversion, which has long been identified as a key driver in the rise of prescription drug abuse.
“I wish doctors treating people for sports or workplace injuries would be cautious with the amount of pills they dispense,” said Dr Steffens.