Fewer Than 5% of People Prescribed Opioids for Chronic Pain Become Addicted

Karen Lee Richards Health Guide November 09, 2012
  • A systematic review, published in the October 2012 issue of the journal Addiction, found that only 4.5% of people who are prescribed opioid painkillers for chronic pain develop a problem with addiction.   Study Design and Results   Researchers reviewed 17 studies, which involved a total of ...

8 Comments
  • Christina Lasich, MD
    Health Pro
    Nov. 12, 2012

    Years ago doctors did take comfort in the prevailing notion that chronic pain patients were not a high risk for developing addiction. For some, that meant that they would freely prescribe to anyone that had complaints of pain without any worries. Those prescribing policies did not work out very well. As access to prescription drugs grew so to did the epidemic...

    RHMLucky777

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    Years ago doctors did take comfort in the prevailing notion that chronic pain patients were not a high risk for developing addiction. For some, that meant that they would freely prescribe to anyone that had complaints of pain without any worries. Those prescribing policies did not work out very well. As access to prescription drugs grew so to did the epidemic of prescription drug abuse.

     

    As Karen points out, the range of opioid addiction found in these studies ranged from 0% to 31%. Why such a big range? Selection criteria is the reason why scientific studies can paint very different pictures. Those that have very stringent selection criteria are going to present a very different set of statistics than those with less stringent selection criterias.

     

    Getting back to the way doctors used to prescribe opioids; those doctors that where not highly selective about when opioid pain management was appropriate or when it was contraindicated experienced high rates of addiction in their practice in the neighborhood of 30-40% as seen by one of the studies reviewed here. Using today's practice guidelines as outlined in this study, we are able to acheive the low, single-digit rates of addiction while treating those with chronic pain. As the authors of this study reminded us all:

     

    "Clinical practice guidelines recommend that: ‘Adherence monitoring is crucial to avoid abuse of the drugs and at the same time to encourage appropriate use, and involves the initiation of drug screening, pill counts, and patient care agreements, with the motto of “trust but verify” ’ [50]. Moreover, guidelines recommend screening for potential comorbitities and risk factor for abuse and dependence such as anxiety, depression, psychotic disorders and current or past substance abuse"

     

    I cannot speak for all doctors but I can say that I do follow the practice guidelines with the hope of adequately treating those that truely can benefit from the opioid medications and preventing harm to those who are not candidates for opioids. The trouble is that I do not have a "truth detector" in my office. And in the past decade of treating pain and addiction, I have heard many lies. The only way to be certain that opioid pain management will have a good outcome is to monitor for abuse, verify the information presented and trust in the selection criteria.

     

    So although this review suggestions that low rates of addiction are seen in those with chronic pain,  that was only in the presence of a highly selective criteria. However, they also hedged their conclusion by saying, "The present data on the incidence and prevalence of dependence following the prescription of opioids to treat chronic and acute pain cannot be considered conclusive." 

     

    Yes, it is possible that fewer than 5% of people with chronic pain will become addicted when adequate screening and monitoring is taking place. Today's doctors are becoming more selective now, not because we fear the DEA or Medical Boards, but because we are fully recognizing our responsiblity to do no harm.

     


  • helene
    Nov. 10, 2012

    Thank you for writing this article and for all of the other great work that you do for so many people.

     

    Opiods are still the gold standard for medicating pain. Despite what Christina Lasich, M.D.  the self-proclaimed "expert" continues to erroneously allege, they have the best side effect/adverse reaction profile for the greatest number of patients...

    RHMLucky777

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    Thank you for writing this article and for all of the other great work that you do for so many people.

     

    Opiods are still the gold standard for medicating pain. Despite what Christina Lasich, M.D.  the self-proclaimed "expert" continues to erroneously allege, they have the best side effect/adverse reaction profile for the greatest number of patients and rates of addiction are, absent a personal and/or pervasive family history,  as your review of these studies indicates, actually lower than 4.5%.  Some solid research, that is unbiased by the addiction industry, puts it at about 3%.

     

    Do chronic pain patients develop a tolerance to opiods?  Yes.  Will their dosages need to be increased as time goes on? Yes.  Do patients who have taken opiods daily for a prolonged period of time need to be tapered off of them when they no longer need them?  Yes. However, the huge difference between this tolerance/dependance and actual addiction is that if the pain ceases, and the  pain patients are slowly and appropriately tapered off,  their desire to take opiods ceases too.   Their patterns of usage and behavior are very different from those of addicts.

     

    The reluctance of doctors to appropriately medicate pain patients with opiods is primarily due to their fear of local medical boards revoking their licenses and local and state prosecutors and the federal DEA charging them as criminals, fining them and even potentially incarcerating them.  Far too often the health of pain patients, who would best be treated with opiods, is not even considered during a medical appointment.  Instead, the anger and fears, both legitmate and completely irrational, of doctors have become the true basis of doctor/patient interaction.  What used to be a mutually beneficial, or at least neutral, doctor/patient relationship has devolved into a punitive ritual that includes drug testing formerly reserved for convicted criminals, fraudulent "contracts" based upon a  model misappropriated from the non-medical field of behavorial modification, threats of discontinuation of treatment for the smallest infraction of some arbitrary, nonsensical set of rules and, perhaps most harmful of all, the complete withholding of any opiod treatment.

     

    Doctors need to organize and fight their true enemy, the DEA, instead of taking the cowardly, easy way out of their problems by punishing and depriving their vulnerable  patients.

    • Lydia
      Nov. 10, 2012

      Hi

      as some patients are intolerant to anti-inflammatory medication, opioids are the only viable option. I think it depends on the individual Dr as to how helpful at preventing pain they wish to be. Many see it as the lesser of two evils - if you are out of pain then you are more likely to resume normal activities, work ,etc.

      However you could be sat in...

      RHMLucky777

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      Hi

      as some patients are intolerant to anti-inflammatory medication, opioids are the only viable option. I think it depends on the individual Dr as to how helpful at preventing pain they wish to be. Many see it as the lesser of two evils - if you are out of pain then you are more likely to resume normal activities, work ,etc.

      However you could be sat in the DR's chair with both your legs amputated in the case of some GP's and they would send you away with a cold compress and paracetamol,

      Or so it seems!

    • Julie
      Nov. 12, 2012

      You hit the nail on the head! You cannot imagine the suprise and SHAME I felt when I arrived at my pain clinic to find that I was being drug tested! I told them, laughingly, that I would be "dirty" because of the opioids I am prescribed by them, for my pain. I was also told that I had broken my "contract" with them because after recieving my last prescription,...

      RHMLucky777

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      You hit the nail on the head! You cannot imagine the suprise and SHAME I felt when I arrived at my pain clinic to find that I was being drug tested! I told them, laughingly, that I would be "dirty" because of the opioids I am prescribed by them, for my pain. I was also told that I had broken my "contract" with them because after recieving my last prescription, my husband and I went shopping at Walmart and decided that, rather than going to our usual pharmacy and having to wait there, we would get my prescription filled while we shopped. I didn't realize that I could only go to ONE specific pharmacy because it was the one I usually used. I professed my ignorance, was given another copy of my contract and was given a warning. I felt like a criminal. There has to be a better way to monitor those of us who have a medical need for these types of medication!

  • cindi
    Nov. 10, 2012

    I have always felt .."i am addicted" to pain medications.because without them, i cannot function..as well as I would without them...this makes me feel "depressed" because of the feeling of being addicted..i now, feel , maybe that I am not "addicted" but ..oh, crap, yes, i DO feel like I am addictted to pain medication...because without them, I am not able to...

    RHMLucky777

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    I have always felt .."i am addicted" to pain medications.because without them, i cannot function..as well as I would without them...this makes me feel "depressed" because of the feeling of being addicted..i now, feel , maybe that I am not "addicted" but ..oh, crap, yes, i DO feel like I am addictted to pain medication...because without them, I am not able to function..it is a horrible feeling, and i wish i had never been prescribed any kind of opiates..maybe my life and my well being, would be different..it is so hard, to live a day without them..that is why i feel "addicted"..i am not going to lie on here, this is just how i feel...my husband KNOWS i could not function without the pain medications..i wish..i wish..thier was just another way of getting rid of chronic pain..i feel my life is going to be shortened because of the pain medication, i take...and sometimes ..i feel that is a good thing..who wants to live in pain..24/7..i try hard to keep my thoughts about "trying to get out of pain"..but, when the pain is so bad and you cannot even try and psyche yourself out..i just sometimes want to give up...

    • Julie
      Nov. 12, 2012

      I too have felt this way. I have been prescribed pain medications for several years now and have always thought that even though my doctor felt that this was the right prescription and the right amount of pills for me to be taking per month, I should take less so i would not become an addict. I worried that because my condition is not going to go away, I am...

      RHMLucky777

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      I too have felt this way. I have been prescribed pain medications for several years now and have always thought that even though my doctor felt that this was the right prescription and the right amount of pills for me to be taking per month, I should take less so i would not become an addict. I worried that because my condition is not going to go away, I am going to be taking these medications for an extended period of time and should try very hard to NOT need to increase my dosage or change to a higher type of medication. I now realise how foolish I have been. I have spent years sitting in a chair, not being able to even clean my house regularly or properly because of this idea. I have recently decided that if I continue to underdose myself because of fear of addiction, I am not even living my life. I am wasting precious time, life is too short to spend it sitting here in pain when I have the ability to lessen it enough to do the things I want to do. So, I now make sure that I take my medication when I should, I receive steroid injections and oral steroids on occasion to help me ease my pain and I do all I can to enjoy the life I was given. The other day I was able to take my own clothes downstairs to the laundry room, do my laundry, fold it and carry it back upstairs! To those without severe chronic pain, this may seem like a silly thing to be proud of, but to those of us who live in pain, this is HUGE! I was so proud of myself that I called family and friends to tell them!! I even had enough pain-free time after that to take a long hot shower. It was wonderful!! Do not fear the doctor directed usage of pain medications or your life won't be worth living anyway!!  Good luck!!

    • cindi
      Nov. 13, 2012

      thanks, julie, I too have underdosed myself, thinking, this would be better..but ended up doing the same thing you did..just sitting in pain..it is NOT how I want to live...your comment about going down the stairs to your laundry room..and doing your laundry, so hit home..my laundry room is also , downstairs in my basement..so, I know the feeling, of being...

      RHMLucky777

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      thanks, julie, I too have underdosed myself, thinking, this would be better..but ended up doing the same thing you did..just sitting in pain..it is NOT how I want to live...your comment about going down the stairs to your laundry room..and doing your laundry, so hit home..my laundry room is also , downstairs in my basement..so, I know the feeling, of being able to "complete" such an easy chore to others..but for us in chronic pain, it is such an accomplishment..keep up the good work..you made me smile..and I plan on smiling the rest of the day..because of you...make it a good one..cindi...

  • Mariepi
    Nov. 09, 2012

    Very interresting and good article. We always can count on you to explain in plain english these heavy studies.

    Marie