Low Back Pain – US Opioid Epidemic Fueled by Prescribing Practices

by / Wednesday, 30 March 2016 /

The United States is facing the worst “man-made epidemic” of opioid abuse in the history of modern medicine, and it is the direct result of poor research and outdated teaching practices, according to a leading pain expert.

“There’s been over 200,000 deaths from prescription opioids and many more hundreds of thousands of overdose admissions, and millions are addicted or dependent on prescription opioids, and while some patients don’t meet the classic definition of opioid use disorder, as many as 30% of patients who are sitting across from you in your office have opioid use disorder or are severely dependent,” Gary Franklin, MD, MPH, vice president of Physicians for Responsible Opioid Prescribing, said during a Webinar sponsored by the Centers for Disease Control and Prevention’s Clinician Outreach and Communication Activity (COCA).

“So this is an extremely serious epidemic, and while I know that taking care of these patients is not an easy thing to do, we need to reduce overdose deaths and admissions, and we have ways to reverse trends which we all need to embrace.”

The most important step toward reversing the epidemic of prescription opioid abuse is to stop prescribing opioids for the wrong indications.

Recent reports have consistently concluded that there are insufficient data on the long-term effectiveness of prescription opioids to support their use in the treatment of chronic pain, but there is clear evidence of a dose-dependent risk for serious harms.

The biggest triggers to the initiation and perpetuation of prescription opioid abuse comes from their use for the treatment of nonspecific musculoskeletal disorders, especially chronic low back pain, headaches, and disorders such as fibromyalgia.

Although there is no proven benefit for their use in these disorders, “people with these indications are on chronic opioids, and they have become disabled, and they are spilling over into social security and disability systems,” Dr Franklin said.

In recognition of this problem, the American Academy of Neurology and a number of states, including Washington, have produced guidelines that advise that in general, opioids should not be routinely used for the treatment of musculoskeletal conditions, headache, or fibromyalgia.

“Not only is there no evidence to support their use in these conditions, there is quite a bit of evidence against doing so, and these are probably the most routine patients we have who are on chronic opioids and who have become dependent and addicted to them in our country,” Dr Franklin said.

Indeed, in a 2008 study conducted by Dr Franklin and colleagues (Spine. 2008;33:199-204), results showed that 14% of workers who sustained a low back injury were disabled at 1 year and that receiving opioids for at least 7 days at a cumulative dose of 150 mg morphine equivalent dose (MED) doubled the risk of being on disability 1 year later, after adjusting for baseline reported pain, function, and injury severity.

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Elements as Published in: Medscape