For a number of the 76.5 million Americans who live with chronic pain, perhaps from back pain, arthritis, diabetes, fibromyalgia, or cancer, prescription opioids are integral tools to function in life. According to the Brattleboro Retreat, hydrocodone was the single most prescribed drug in the United States in 2010.
The nonprofit American Pain Foundation advocates for public awareness of what it describes as a “woefully undertreated” epidemic that drains $100 billion in productivity annually from the national economy.
The subject of a withering investigation in December by the nonprofit investigative news operation ProPublica, which revealed that the nonprofit “collected nearly 90 percent of its $5 million funding last year from the drug and medical-device industry - and closely mirrors its positions,” the APF contends that “[u]nless a patient has a past or current personal or family history of substance abuse, the likelihood of addiction is low when opioids are taken as prescribed and under the guidance of a physician.” (The APF rejects the implications of the report and asserts that its agenda is independent.)
Another group, Physicians for Responsible Opioid Prescribing (PROP), advocates “cautious, evidence-based” approaches to the drugs. The organization takes the stance that opioids are effective for short-term pain management but describes the medical research on the effectiveness of long-term use as “limited” and “of low quality.” PROP cites other side effects beyond addiction: respiratory depression, serious fractures from falls, hypogonadism and other endocrine disruption “ that can cause a spectrum of adverse effects,” and other serious or life-threatening issues.
PROP offers a constellation of recommendations for those prescribing opioid medication for chronic pain which can be summarized in two words: be careful.
The APF calls on a multi-pronged approach to opioids that looks at “the good, the bad, and the ugly,” supporting law enforcement and government efforts to curb their abuse and tighten their access while reducing the stigmas that keep them from being used to their best advantage by the patients who legitimately need them.
According to a 2006 National Survey on Drug Use and Health from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration's Office of Applied Studies, “71 percent of people abusing prescription pain relievers received them from a friend or family member without a prescription. Prescription pain relievers are usually stolen from medicine cabinets, purchased or shared in schools, or simply given away,” the APF writes.
For those who do become dependent on opioids, the stakes become very high.
“Our doctors see the results of illegitimate use,” said Jeffrey Kelliher, media relations coordinator for the Brattleboro Retreat.
Kelliher points to the December issue of the journal Healthcare Ledger, which took an in-depth look at the treatment of addiction to prescription opioids.
The article quoted Dr. Tod Miller of the Windham Center in Bellows Falls: “If one observes a group of problem drinkers who meet the criteria for alcohol addiction, almost 90 percent of them will manage to stop drinking, and many never need treatment.”
“The statistics are almost exactly reversed with opiate addiction,” he continued. “Even with treatment, only 10 percent to 20 percent of these patients ever get off opiates; most continue to use or die from their use.”
The article also quotes Dr. Geoffrey Kane, chief of addiction services for the Retreat.
“Practically, there is no distinction between prescription opioid addiction and heroin addiction,” he said. “At least for short-acting opioids, the pharmacology is the same, and the withdrawal is the same.”