Proof prescriptions not fueling “opioid crisis”

Our tireless advocate, Dr. Richard Lawhern, has pointed out two recent studies which clearly show that prescriptions aren’t what’s fueling the “opioid crisis”:

1. Gabriel A Brat, Denis Agniel, Andrew Beam, Brian Yorkgitis, Mark Bicket, Mark Homer, Kathe P Fox, Daniel B Knecht, Cheryl N McMahill-Walraven, Nathan Palmer, Isaac Kohane, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study”, BMJ 2018;360:j5790 – http://www.bmj.com/content/360/bmj.j5790.long

Brat et al investigated medical insurance records of more than 586,000 patients prescribed opioids for the first time after surgery.  

Less than 1% continued renewing their prescriptions longer than 13 weeks; 0.6% were later diagnosed with Opioid Use Disorder during follow-up periods averaging 2.6 years between 2008 and 2016.  

It is likely that many recorded diagnoses of Opioid Abuse Disorder in these patients were incorrect.

Many doctors who diagnose patients with abuse are general practitioners who lack deep training in addiction and have little experience evaluating the behaviors that actually define addiction.

Likewise, some physicians confuse patient reports of continuing pain – caused by failed surgery – for potential opioid abuse.

2. Eric C. Sun, Beth D. Darnall, Laurence C. Baker, Sean Mackey, “Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period”, JAMA Internal Medicine 2016;176(9):1286-1293. – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2532789

Sun et al tracked long-term opioid prescriptions in non-surgical patients and compared prescription rates to 642,000 patients who received one of eleven common types of surgery.

Opioid prescriptions were defined as “chronic” when 10 or more scripts were written in one year or a prescription was renewed continuously for more than 120 days.

The rate for chronic prescriptions of opioid analgesics among millions of non-surgical patients was estimated at 0.136 percent.

For 4 of the 11 surgical procedures studied, the same rate of prescriptions occurred after surgery as before.

For the 7 remaining procedures, long term opioid prescriptions rose to 0.174% for caesarean delivery, and 0.69% for total knee replacement – a procedure known to cause lingering pain in many who undergo it.

It is thus likely that many on-going prescriptions after knee replacement reflected chronic post-surgical pain, rather than issues of opioid misuse.

To put the case in simpler words:

actual risk of post-surgical opioid dependence or protracted prescribing is so small that efforts to “solve” the opioid crisis by restricting patient access will horribly harm far more people than they help.

Moreover, the natural variability of individual opioid metabolism is so large that it is impossible to specify any useful one-size-fits-all limit on the number or strength of pills that may be needed to control post-surgical pain.

Dr, Lawhern collects all kinds of articles and data supporting our need for opioid pain relievers which rebut the common nonsensical narrative of innocent patients getting “hooked” on opioids, getting addicted, and overdosing.

You can find a great deal of useful information on his advocacy site:

http://www.face-facts.org/Lawhern

Richard A “Red” Lawhern PhD
Twitter: @Lawhern1
Facebook: https://www.facebook.com/red.lawhern
Publications: http://www.face-facts.org/Lawhern
Personal Website: http://www.lawhern.org

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