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10 Opioid Myths and Facts

10 Opioid Myths and Facts

Among current viewpoints on opioid analgesics, there are those who adopt one of these two: either physicians are over- prescribing opioids, contributing to an epidemic of abuse of these drugs or these drugs are being over-regulated, leading to suffering among patients who have legitimate pain problems and cannot receive appropriate and needed therapies.

Unfortunately, there are many myths perpetuated about opioid drugs themselves and how they are used and misused. The slides above present 10 statements that are either one of the most common myths in circulation or a fact about opioid analgesics and their use.

We hope the slide show will perhaps challenge an assumption you hold or confirm your knowledge around this sensitive issue. References to support statements are below.

References: 

1. Dowell D, Haegerich, et al. CDC Guideline for prescribing opioids for chronic pain - United States, 2016.  MMWR. 2016;65:1-150. https://www.ncbi.nlm.nih.gov/pubmed/?term=mmwr+recomm+rep+2016+Mar+18%3B65(1)%3A1-49.

2. Vowles KE, McEntee ML, Julnes PS , et al. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015:156:569-576 https://www.ncbi.nlm.nih.gov/pubmed/?term=Pain.+2015%3A156%3A569-576

3. Shaheed CA, Maher CG, Williams KA, et al. Efficacy, tolerability and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016:176:958-968. http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2522397

4. Smith HS. Opioid metabolism. Mayo Clin Proc. 2009;84:613-624. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/

5. Compton WM, Jones CM, et al. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med;2016374:154-163. http://www.nejm.org/doi/full/10.1056/NEJMra1508490

6. Roselle N, Holquist C, Phillips J. FDA Safety Page. Confusion between methylphenidate and methadone. Available at:
http://www.fda.gov/downloads/drugs/drugsafety/medicationerrors/ucm080651.pdf

7. Gilron I, Dongshen T, Holder RR, et al. Combination of morphine with nortriptyline for neuropathic pain. Pain. 2015;156:1440-1448. https://www.ncbi.nlm.nih.gov/pubmed/?term=Pain.+2015%3B156%3A1440-1448. https://www.ncbi.nlm.nih.gov/pubmed/?term=Pain.+2015%3B156%3A1440-1448.

8. Morasco BJ, O'Hearn D, Turk DC, et al. Associations between prescription opioid use and sleep impairment among veterans with chronic pain. Pain Med. 2014;15:1902-1910. http://painmedicine.oxfordjournals.org/content/15/11/1902.long

 

 

Comments

I was a practicing Physians Assistant for over 25 years working in different settings over the years and teaching part time at several different PA programs. I had suffered for most of my life since age 19 from low back and left leg pains. Eventually being put on disability by my employer though it was not what I really wanted, but told so I could take narcotic pain meds as nothing else NSAIDs , injection , physical therapy , acupuncture etc was of any relief. I have been on long acting narcotics for years which has enabled me to have a functioning life, I have gone off of them and left in pain where I could not do very much , so went back on narcotics. I would have like to go back to work but constantly told I cannot because of the narcotics . I have been able to spend a lot of time in volunteer service that I could not do without pain control from narcotics. I have read and researched pain management for years and agree there is abuse by many patients but for those of us that have received great benefits to make it unavailable to patients goes against what a physician should be doing, yes first do no harm, but by not giving a patient a medication that can change their life is wrong. There will always be patients that will abuse medications , sorry for those but that is not a reason to not use the medication for others that might benefit . Why should those that are suffering in pain not have narcotics as an option because others abuse it ? That to me is wrong. I fell when clinicians themselves suffer from chronic pain , they too will believe as I do that chronic narcotic use in the right cases is acceptable practice , that no patient should be denied this treatment . We " addict" patients to meds for diabetes, because they need it, for those of us that need narcotics to have a"life " is that wrong? I'm sure many will say yes , it's not the same, well I've suffered for years ( due to a missed diagnosis of Slipped capital femoral epiphysis when I was 6) and with long acting narcotics I can have a productive life, without it , well not much I can do.

STEVEN @

I was a practicing Physians Assistant for over 25 years working in different settings over the years and teaching part time at several different PA programs. I had suffered for most of my life since age 19 from low back and left leg pains. Eventually being put on disability by my employer though it was not what I really wanted, but told so I could take narcotic pain meds as nothing else NSAIDs , injection , physical therapy , acupuncture etc was of any relief. I have been on long acting narcotics for years which has enabled me to have a functioning life, I have gone off of them and left in pain where I could not do very much , so went back on narcotics. I would have like to go back to work but constantly told I cannot because of the narcotics . I have been able to spend a lot of time in volunteer service that I could not do without pain control from narcotics. I have read and researched pain management for years and agree there is abuse by many patients but for those of us that have received great benefits to make it unavailable to patients goes against what a physician should be doing, yes first do no harm, but by not giving a patient a medication that can change their life is wrong. There will always be patients that will abuse medications , sorry for those but that is not a reason to not use the medication for others that might benefit . Why should those that are suffering in pain not have narcotics as an option because others abuse it ? That to me is wrong. I fell when clinicians themselves suffer from chronic pain , they too will believe as I do that chronic narcotic use in the right cases is acceptable practice , that no patient should be denied this treatment . We " addict" patients to meds for diabetes, because they need it, for those of us that need narcotics to have a"life " is that wrong? I'm sure many will say yes , it's not the same, well I've suffered for years ( due to a missed diagnosis of Slipped capital femoral epiphysis when I was 6) and with long acting narcotics I can have a productive life, without it , well not much I can do.

STEVEN @

interesting article

Michelle @

The very first myth about the lack of evidence for placebo-based studies of the beneficial effect of opioids is perhaps the largest myth of misdirection and falsehood. There are also no placebo-based studies that prove that opioids are NOT effective in the treatment of chronic pain. I believe this is the case because, based on my more than 500 current patients who are able to live meaningful lives due to the use of opioids for their pain, I believe it is impossible to design such a study. If there were two comparable groups and one was given opioids for pain and the other given anything else it is my deeply held belief based on years of experience that the control group would not last more than a week because of the inability for anything else to control their pain. This is true even for so many of my patients who have been subjected to in excess of 10 epidural steroid injections with no effective relief.
I will continue to prescribe what allows my patients meaningful lives until someone PROVES that opioids do not work for chronic pain

michael @

I dont know who paid you to post this misinformation...because hydrocodone does in fact help immensly with chronic degenerarive disk disease. There were addicts before hydrocodone...there will always be addicts. alcoholics, pot heads, gamblers, etc....I have been working steadily as an ER doc for 12 years and I might have had 4 cases of opiod overdose...and all of them were elderly who could not afford their Fentanyl so they would leave the old patches on for 2 weks instead of removing it when applying a new one...instead of buying 2 boxes and applying the patch every 3 day, they would only buy one box and apply 1 every 7 days and leave the old patches on also. They also add other drugs to help eith pain relief. These are not addicts these are people in pain who can not afford the high price of doctors visits and increasing prices for pain medication...they are suffering in pain and they just want relief. You wouldn't need an "anti-depressant" if you treated their pain...they get depressed because they are in chronic pain. FYI most of these anti depressant are very physically addicting, and they can cause irreversable physiological effects to the brain...some recepters are permanently effected and now the patient can't live without the added expensive anti-depressant.

Robin @

God bless you.
We need facts not fiction.
I have been a suffering since I broke my back 20 years ago.
I take myself off my pain meds for 2 weeks out of every 6,so I can maintain an effective and affordable dose.
I have been on effexor for that same length of time and cannot miss a single dose because of serious side effects.
M.Hughes
Austin Texas

Maury @

I caught several nursing home staff stealing the hydrocodone from the pyxis and instead giving the patients Tylenol which they brought from home. That is how a lot of these drugs make it to the street.

Robin @

Should those of us who suffer from chronic pain not be able to have access to these meds because of these people , or should they be caught and punished . The harder these medications are for patients who benefit from them to be able to get them , the higher the cost goes up for the illegal ones . Punished the criminals , those of us in pain are suffering enough m don't need th medical community making it harder for us

STEVEN @

Should those of us who suffer from chronic pain not be able to have access to these meds because of these people , or should they be caught and punished . The harder these medications are for patients who benefit from them to be able to get them , the higher the cost goes up for the illegal ones . Punished the criminals , those of us in pain are suffering enough m don't need th medical community making it harder for us

STEVEN @

Should those of us who suffer from chronic pain not be able to have access to these meds because of these people , or should they be caught and punished . The harder these medications are for patients who benefit from them to be able to get them , the higher the cost goes up for the illegal ones . Punished the criminals , those of us in pain are suffering enough m don't need th medical community making it harder for us

STEVEN @

Should those of us who suffer from chronic pain not be able to have access to these meds because of these people , or should they be caught and punished . The harder these medications are for patients who benefit from them to be able to get them , the higher the cost goes up for the illegal ones . Punished the criminals , those of us in pain are suffering enough m don't need th medical community making it harder for us

STEVEN @

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