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Do We Really Need Opioids for Pain?

The U.S. is in the midst of an opioid crisis, with more than 91 Americans fatally overdosing on the powerful drugs every day.1 The statistic includes prescription opioids, heroin and fentanyl, but many of the deaths stem from prescription drug use. In fact, of the more than 33,000 Americans killed by opioids in 2015, nearly half of them involved a prescription for the drugs.2 Even the U.S. National Institute on Drug Abuse (NIDA) states:3

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive."

Fast-forward about two decades later, and it was estimated that, in 2015, 2 million Americans suffered from substance use disorders related to prescription opioid pain relievers.4

The U.S. Centers for Disease Control and Prevention (CDC) also highlights the fact that overdoses from prescription opioids, in particular, "are a driving factor in the 15-year increase in opioid overdose deaths," noting, "The amount of prescription opioids sold to pharmacies, hospitals, and doctors' offices nearly quadrupled from 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported."5

Prescription opioids are considered standard care for treating severe pain following surgery or injury or due to illnesses such as cancer, although they're now increasingly prescribed for many types of pain, including chronic back pain or pain from osteoarthritis. Even in the former case, however, research is now questioning whether the dangerous drugs work better than safer options.

Non-Opioid Pain Relievers Work Just as Well to Treat Pain in ER Patients

If a person comes to the emergency room with severe acute pain, most physicians would prescribe them an opioid to relieve pain. Research published in the Journal of the American Medical Association (JAMA) suggests, however, that less risky opioid-free options may work just as well.6

The study evaluated the effects of four different combinations of pain relievers — three with different opioids and one opioid-free option composed of ibuprofen (i.e., Advil) and acetaminophen (i.e., Tylenol) — on people with moderate to severe pain in an extremity, due to bone fractures, shoulder dislocation and other injuries. The patients had an average pain score of 8.7 (on a scale of zero to 10) when they arrived.

Two hours later, after receiving one of the pain-relief combinations, their pain levels decreased similarly, regardless of which drug-combo they received. Specifically, pain scores fell by:7

  • 4.3 in the ibuprofen and acetaminophen group
  • 4.4 in the oxycodone and acetaminophen group
  • 3.5 in the hydrocodone and acetaminophen group
  • 3.9 in the codeine and acetaminophen group

"For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics," the researchers concluded.8

Speaking to Vox, the study's lead author, Andrew Chang of the department of emergency medicine at Albany Medical College, Albany, New York, said, "Some (not all) physicians reflexively think fractures require opioids, but this study lends evidence that opioids are not always necessary even in the presence of fractures."9

Even Non-Opioid Pain Relievers Come With Risks

It's worth noting that while ibuprofen and acetaminophen are generally safer options than opioids, they're not without risk. So when choosing an option for pain relief, it's important not to assume that, because a drug is available over the counter, it's automatically safe. Ibuprofen, for instance, is a non-steroidal anti-inflammatory drug (NSAID), which have been linked to kidney problems, heart attack, stroke, gastrointestinal disorders, miscarriage and hearing problems.

Acetaminophen, meanwhile, is the leading cause of acute liver failure in the U.S.10 and can also cause kidney dysfunction, especially if taken with alcohol.11 Unbeknownst to many, acetaminophen may also cause three serious skin reactions, two of which typically require hospitalization and can be fatal. This isn't to say that ibuprofen and acetaminophen aren't generally safer than opioids, but rather to point out that caution is warranted no matter what type of drug you take.

Pain relievers are clearly valuable medications in many instances, and even opioids have their place (such as for treating severe pain in end of life care), but do use caution, no matter which kind you take. And if you do use an opioid, be aware that there's a high risk for addiction and, with that, overdose death.

Drug Overdose Is the Leading Cause of Death in Americans Under 50

Up to 29 percent of people prescribed opioids for chronic pain end up misusing them, and 4 percent to 6 percent of them will transition to using heroin.12 Even when taken as directed, prescription opioids can lead to addiction as well as tolerance, which means you need an increasingly stronger dose to get the pain-relieving effects.

Physical dependence, in which you suffer withdrawal symptoms if you stop taking the drugs, can also result along with other issues like increased sensitivity to pain, depression, low levels of testosterone and more.13

"Anyone who takes prescription opioids can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction. Once addicted, it can be hard to stop," the CDC notes.14 Alarmingly, drug overdoses are now the leading cause of death for Americans under the age of 50, with the deaths being driven by synthetic opioids like fentanyl, which can be anywhere from 500 percent to 1,000 percent more potent than morphine.15

Did You Know Some Doctors Get Bonuses for Prescribing Opioids?

It's shocking that, in the midst of this epidemic of opioid overdose deaths, the pharmaceutical industry would be making payments to physicians to prescribe more opioid products, but this is precisely what's occurring, according to a study published in the American Journal of Public Health.16 More than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling more than $46 million, between August 2013 and December 2015.

This amounts to 1 in 12 U.S. physicians who have received money from drug companies producing prescription opioids. The top 1 percent of physicians received nearly 83 percent of the payments, and fentanyl was associated with the highest payments. Many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, were also those showing the most opioid-related payments to physicians.17

Also unsettling, family physicians received the most payments (close to 1 in 5 family medicine doctors were recipients18), which is "an indicator that opioids are being really heavily marketed for pain," Scott Hadland, the study's author, told The Washington Post.19 "The next step is to understand these links between payments … and prescribing practices and overdose deaths," he said. "It's very common that the first opioid … [many people are] ever exposed to is from a prescription."20

Adding insult to injury, with the opioid epidemic being declared a public health emergency, it allows state governments to access certain resources that might otherwise be out of reach outside of a declared emergency.

In some cases, such as in Arizona, the emergency declaration allows for increased funding, which the state has used to train law enforcement officers on how to administer naloxone, the lifesaving opioid antidote.21 So, in essence, taxpayer funds are now being used to pay drug companies to fight the epidemic that they created.

Opioid Testing Scam Is Another Goldmine for the Medical Industry

The opioid epidemic has created a cash cow in the form of urine drug tests. According to data compiled by Kaiser Health News and researchers at the Mayo Clinic, reported by Bloomberg, "[S]pending on urine screens and related genetic tests quadrupled from 2011 to 2014, to an estimated $8.5 billion a year — more than the entire budget of the Environmental Protection Agency.

The federal government paid providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined."22 With the rising rates of opioid abuse and overdose, entrepreneurs targeted doctors to increase urine testing for the drugs, resulting in a lucrative business for all parties involved:

"As alarm spread about opioid deaths and overdoses in the past decade, doctors who prescribed the pills were looking for ways to prevent abuse and avert liability. Entrepreneurs saw a lucrative business model: persuade doctors that testing would keep them out of trouble with licensing boards or law enforcement and protect their patients from harm. Some companies offered doctors technical help opening up their own labs."23

Bloomberg highlights a network of pain clinics to show just how much money is at stake from the seemingly innocuous task of conducting urine tests on opioid patients. While its founder claims the tests are medically necessary to protect patients from addiction and be sure the patients are taking the drugs instead of selling them on the streets, you'll quickly see that there are many people making a hefty profit all linked back to the prescription of drugs that are claiming far too many people's lives:

"This [urine] testing process, driven by the nation's epidemic of painkiller addiction, generates profits across the doctor-owned network of 54 clinics, the largest pain-treatment practice in the Southeast.

Medicare paid the company at least $11 million for urine and related tests in 2014, when five of its professionals stood among the nation's top billers. One nurse practitioner at the company's clinic in Cleveland, Tennessee, single-handedly generated $1.1 million in Medicare billings for urine tests that year, according to Medicare records."24

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