Chronic Pain Patients Did Not Cause Opioid Epidemic – by Roger Chriss – May 2017 (Re-post)
By carefully cross-checking the numbers, Mr. Chriss proves it impossible to find patients responsible for the “illicit opioid crisis”.
Contrary to common belief, chronic pain patients are not all opioid addicts and did not cause the opioid crisis. The vast majority of patients who are prescribed opioids rarely misuse or abuse them.
Opioid addiction is real and should not be ignored or downplayed, but we need to identify its true causes. Despite the growing number of restrictions on prescription opioids, overdoses and related deaths continue to rise, which strongly indicates that pain patients have very little to do with the so-called epidemic.
Some recent articles bear this out:
- Science Daily reports that while the national death toll from opioid overdoses is soaring, only “a small minority of pain patients are represented in the mortality data.”
- The journal Pain Medicine published research showing that most pain patients on low doses of short-acting opioids “have a low risk for developing a substance use disorder.”
- Similarly, chronic pain patients generally do not experience dose escalation, but often remain stable at the same dose for months or even years. And according to the National Institute of Drug Abuse, doctor shopping by pain patients is rare.
For most chronic pain patients, opioid medications are part of a larger daily routine of pain management, and opioids are not craved any more than an athlete craves a vitamin supplement.
Thus, the risks of opioid addiction among chronic pain patients is quite low overall, and there are well-established protocols such as the Opioid Risk Tool to screen patients and monitor those whose risk may be higher.
But all this evidence does not seem to convince regulators, politicians, the news media, and anti-opioid activists like Physicians for Responsible Opioid Prescribing (PROP).
- First, there simply are not enough chronic pain patients on opioid therapy to account for the number of opioid and heroin addicts.
Here, Mr. Chriss uses the data from publicly available sources to show the impossibility of the frightening numbers cited by anti-opioid activists.
The American Society of Addiction Medicine estimates that in 2016 there were over 2.5 million people addicted to prescription pain relievers or heroin.
There are at most 11.5 million chronic pain patients on opioid therapy.Even if 5 percent of them develop a substance abuse disorder, that would give us 575,000 opioid addicts. Where did the other 2 million addicts come from?
- Second, people who suffer from chronic pain disorders are no longer prescribed opioids lightly or quickly.
Instead, they start with NSAIDs like ibuprofen or naproxen, then ontoanti-seizure medications like gabapentin or anti-depressants like amitriptyline or duloxetine, all the while also trying physical therapy, injections or other modalities
- Third, media coverage of the opioid epidemic and case literature on opioid use disorder routinely describe people becoming addicted to opioids after recreational use, trauma or surgery.
for many, the addiction starts with someone else’s prescription, perhaps taken from a family member or obtained from a friend.
Therefore, the treatment of chronic pain conditions can at most have only minimally contributed to the opioid epidemic.
Chronic pain patients are not opioid addicts any more than a diabetic is an insulin addict, and in fact insulin is abused.
I found this so remarkable that I added a few excerpts from that article below this one.
Unfortunately, chronic pain patients are often treated like addicts and the doctors who prescribe to them are even called “drug dealers.” This is harming chronic pain patients, doctors and people suffering from opioid addiction.
Opioid therapy helps people with chronic pain disorders remain employed, care for themselves and their families, and contribute to and participate in their communities. They are achieving what modern medicine and society wants: people who can work, pay taxes, avoid becoming a burden, and enjoy some quality of life.
The increased availability of naloxone and improved care by first responders and emergency departments is helping to reduce fatalities, but opioid addiction still needs treatment and at present there is not enough of it.
To be clear, chronic pain patients and opioid addicts are two distinct groups, both of which deserve care and support.
Treating pain patients as addicts can lead to denial of care, which may actually increase the number of opioid addicts. And conflating chronic pain with opioid addiction may be delaying care for people struggling to find addiction treatment.
Just to make the point that it’s a “drug crisis”, not an “opioid crisis”, this article deals with the life-saving drug for diabetics, insulin, now also being abused.
It is well publicised that a substantial proportion of professional and amateur body builders have been, or actively are, engaged in pharmacological manipulation of their physiological status in order to become more competitive in their field.
A 31 year old man presented to the emergency department having been found unconscious at home. On arrival he was diaphoretic, breathing spontaneously, with a Glasgow coma score of 6/15 (no eye opening, no speech, withdrawing to pain).
After the improvement in his clinical condition, we established that he was not a diabetic but was in fact a body builder who was dieting before a competition.
He stated that he regularly used insulin three times a week to help increase his muscle bulk,
An extensive literature search identified very few cases of insulin abuse. However, from the few cases that have been published, it is apparent that the problem of insulin abuse may be much more widespread than these few isolated cases.
As insulin has a half life of four minutes in the human body, it vanishes rapidly and would be very difficult to detect. Even when detected it is impossible to distinguish from the athlete’s own insulin. It is thus a very attractive potential drug of abuse.
Author: Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.