Prescription Painkillers: Fact or Myth

Consumer Reports recently published an article in the Washington Post detailing some facts and myths surrounding opioid painkillers like Percocet, Vicodin and Oxycodone. One of the biggest myths is that overdose occurs only in addicts.  The fact is that 60% of opioid overdoses involved patients using legally prescribed drugs from a single prescriber. Another myth is that opioid painkillers are not addictive if used to treat pain.  The fact is that between 5 and 25% of patients will become addicted with long term use. It is important for prescribers and patients to weigh the risks and benefits of using opioid painkillers, especially when treating chronic pain.

America is in pain—and being killed by its painkillers.

It starts with drugs such as OxyContin, Percocet and Vicodin—prescription narcotics that can make days bearable if you are recovering from surgery or suffering from cancer. But they can be as addictive as heroin and are rife with deadly side effects.

Use of these and other opioids has skyrocketed in recent years. Prescriptions have climbed 300 percent in the past decade, and Vicodin and other drugs containing the narcotic hydrocodone are now the most commonly prescribed medications in the United States.

With that increased use have come increased deaths: 46 people per day, or almost 17,000 people per year, die from overdoses of the drugs. That’s up more than 400 percent from 1999. And for every death, more than 30 people go to an emergency room because of opioid complications.

With numbers like that, some argue that the Food and Drug Administration would do all it could to reverse the trend. But against the recommendation of its own panel of expert advisers, the agency last December approved Zohydro ER, a long-acting version of hydrocodone.

“We think the benefits of the drug outweigh its risks,” says Douglas Throckmorton, who oversees regulation of drugs for the FDA. He says that Zohydro ER offers an option to some people in pain and that the FDA has taken steps to make all opioids safer by, for example, requiring stronger warnings on drug labels. The FDA says it will also keep a close eye on how Zohydro ER is used in the marketplace.

But attorneys general from 28 states have asked the FDA to reconsider its decision because the drug offers no clear advantages over others already on the market and its potency makes it a target for misuse and abuse. And more than a dozen Republican and Democratic members of Congress have signed a bill that would ban Zohydro ER.

Deadly misconceptions

One of the biggest misconceptions people have about opioids is that the risks apply to other people, not themselves. But the typical victim of overdose might not be whom you think. About 60 percent of overdoses occur in people prescribed the drugs by a single physician, not in those who “doctor-shopped” or who got the drugs on the black market. And a third of those were taking a low dose.

Used properly, opioids can ease severe short-term pain from, say, surgery or a broken bone. But people run into trouble when they inadvertently misuse the drugs—combining them with alcohol or other drugs (such as sleeping pills), taking them in too high a dose or for too long, or using them while driving or in other situations when they need to be alert.

The general public and health-care providers harbor outdated and dangerous notions about opioids. Here are three of the biggest misconceptions and the facts you need to know to stay safe:

Misconception: Opioids work well for chronic pain. Chronic pain is defined as pain that lasts longer than three to six months and that is not associated with a terminal illness. An estimated 90 percent of people with chronic pain wind up being prescribed an opioid despite little evidence that the drugs help much or are safe in such situations.

People who take opioids for more than a few weeks often develop tolerance, so they require higher doses, which breeds dependence. And although higher doses can ease pain, they commonly cause nausea and constipation, disrupt your immune system and sex life, and leave you feeling too fuzzy-headed to participate in things such as physical activity that can speed your recovery. And in a cruel twist, the drugs can make some people more sensitive to pain.

The safer approach: For certain types of pain—including nerve pain, migraines and fibromyalgia—other prescription medications usually work better than opioids. For other types of chronic pain, ask your doctor about trying over-the-counter drugs such as acetaminophen, ibuprofen and naproxen before prescription drugs. Nondrug measures such as exercise, massage, behavioral therapy and acupuncture might also help.

Misconception: Opioids are not addictive when used to treat pain. Between 5 and 25 percent of people who use prescription pain pills long-term get addicted. Fewer women are dependent on prescription painkillers than men, but they may become dependent more quickly and are more likely to doctor-shop.

The safer approach: Chronic pain often waxes and wanes. If you and your doctor feel you need an opioid, reserve it for flare-ups.

Misconception: Extended-release versions are safer. Opioids such as hydromorphone (Exalgo), oxycodone (OxyContin and related generics),

morphine (Avinza, MS Contin and generics), and the newly approved Zohydro ER stay in the body longer and are usually stronger than short-acting opioids. They should be reserved for patients who need round-the-clock relief. But doctors sometimes prescribe them for convenience—patients need to take fewer pills—and because they believe that long-acting drugs are less likely to cause a drug high and lead to addiction. But there’s no evidence those drugs work better or are safer than short-acting ones.

The safer approach: It’s usually best to start with a short-acting opioid. Because long-acting drugs are more likely to be stolen, misused and abused, expect careful monitoring if your doctor prescribes one. “For example, your physician may insist that you return for regular visits or that he count your pills to ensure that you are taking them on the prescribed schedule.

Copyright 2014. Consumers Union of United States Inc.

http://www.washingtonpost.com/national/health-science/

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