Overprescription of opioids is bad medicine

Artist: Ashley Mackenzie Via: High Fructose
Artist: Ashley Mackenzie
Via: High Fructose

Keith Humphreys points out that the problem with the explosion of prescriptions for opioids isn’t just addiction and overdose. They are often just not good medicine.

Opioids typically have a miraculous effect on acute pain, but this does not necessarily translate to chronic pain relief, particularly as tolerance sets in over time. Even more disturbing, my colleague Dr. Jodie Trafton and I are among many researchers who have found that a portion of long-term opioid users became hyperalgesic, i.e., they experience more rather than less pain.

This is not the only line of scientific findings that flies in the face of the assumption that if opioids are used less often, more pain will be the inevitable result. In a study my colleagues and I conducted with surgery patients (first author Dr. Ian Carroll; publication here), the amount of time individuals stayed on opioids after surgery, surprisingly, bore no relationship to their level of pain. People stay on opioids for a range of reasons not necessarily linked to pain; in our study taking them for long periods was well-predicted by pre-existing depression, for example. Many people who are on these medications would be in better health and equal or less pain if they were weaned off them.

A further dangerous side-effect of long-term opioids is hormonal, as Meier explains:

These drugs have a very powerful impact on our production of sexual hormones — testosterone in men and estrogen in women. Lower hormone production is not just about growing hair or sexual performance; it’s about your entire energy level. These drugs are depleting people of energy. There are even data showing that the more powerful opioids, the long-acting OxyContin, methadone, fentanyl, which is sold as Duragesic, have an even more powerful effect on depressing hormone production than short-acting opioids.