October 8, 2014
Risks Outweigh Benefits If Opioids Prescribed for Some Chronic Conditions

Minneapolis—Using prescription opioids to treat chronic, noncancer ailments such as headaches, fibromyalgia, and chronic low back pain is not justified, considering the risk of death, overdose, addiction, or serious side effects, according to a new position statement from the American Academy of Neurology (AAN).

The position paper was published recently in Neurology, the AAN’s medical journal.

“More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use,” said lead author Gary M. Franklin, MD, MPH, research professor in the Department of Environmental & Occupational Health Sciences at the University of Washington School of Public Health in Seattle. “There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions and patients need to work together to stop this epidemic.”

Half of patients taking opioids—including morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone, or a combination of the drugs with acetaminophen—for at least 3 months are still on the drugs 5 years later, according to a review of the available studies. In addition, the position paper notes, while opioids may provide significant short-term pain relief, the research offers no substantial evidence for maintaining pain relief or improved function over long periods of time without serious risk of overdose, dependence, or addiction.

The Minneapolis-based AAN recommends that prescribers consult with pain management specialists if dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day, especially if pain and function have not substantially improved in their patients.

To prescribe opioids more safety and effectively, the association also recommends that healthcare providers:

• Create an opioid treatment agreement
• Screen for current or past drug abuse
• Screen for depression
• Use random urine drug screenings
• Not prescribe medications such as sedative-hypnotics or benzodiazepines with opioids
• Assess pain and function for tolerance and effectiveness
• Track daily morphine equivalent dose using an online dosing calculator
• Use the state Prescription Drug Monitoring Program to monitor all prescription drugs the patient may be taking

“More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs,” Franklin said.

U.S. Pharmacist Social Connect