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Are opioids appropriate for treating Chronic Pain?

• While research is still evolving, all current medical and government guidelines provide a role for opioids in treating chronic pain that cannot be managed by other means.

• Opioids are not typically recommended as a first or second line of treatment for chronic pain but, when prescribed appropriately, significantly improve the lives of some patients.

• 8 million people in the US take prescribed opioids to manage chronic pain.

Are Chronic Pain patients addicted to their medication?

• People often confuse dependence and addiction, but there is a critical difference between the two.

• Anyone who takes opioid medication may develop a physiological dependence on the drug, meaning they’ll experience side effects if they abruptly stop taking it.

• Addiction is marked by compulsive drug seeking and use despite adverse life consequences.

• By contract, pain patients who appropriately use opioids take medication on a set schedule in ways that improve their lives.

What is the risk of addiction?

• According to Nora Volkow, the Director of the National Institute on Drug Abuse, addiction occurs in only a small percentage of persons who are prescribed opioids — even among those with preexisting risks. Many factors affect a person’s risk for addiction, which medical professionals should screen for when prescribing.

• Well-documented studies show a risk of addiction ranging from less than 0.6% to 8%.

• Large national surveys show that most people who misuse prescription opioids did not receive them while under a doctor’s care; they stole, borrowed. or bought medication that had been prescribed to others. This is known as “diversion.”

What is the risk of accidental overdose?

• According to a long-term study of two million people, the risk of overdose among pain patients prescribed opioids was 0.022%.

• Most drug overdose deaths result from multiple legal and illegal drugs being taken at the same time. This is known as a “polypharmacy” drug overdose.

• Today, overdose deaths are driven primarily by illegally produced fentanyl and its potent analogs, heroin and stimulants.

Is opioid prescribing still increasing?

• No. According to CDC data, opioid prescriptions have dropped since 2010-2 and have continued to fall to levels last seen in the 1990s.

• During the years when prescribing dropped, drug overdoses escalated dramatically.

What problems do patients who use opioid medication face today?

• At least 40 states, three major retail pharmacies, and many payers have laws or policies with rigid limits on opioid prescribing. These policies draw on the CDC’s 2016 prescribing guideline, but the agency considers them a misapplication of the guideline.

• The CDC updated its prescribing guideline in 2022 to warn against such misapplications.

• Patients regularly taking opioid medication face impediments to care: 50% of primary care providers won’t see a new patient taking daily opioids and 81% are reluctant to.

• Too many patients today face a dangerous practice known as “forced” or abrupt tapering – a unilateral decision by providers to reduce dosage or stop medication altogether.

• While voluntary dose reduction helps some patients, forced or abrupt tapering can destabilize patients mentally and physically and even lead to suicide or drug overdose.

• Human Rights Watch found that providers were tapering patients due to outside pressures and against their best medical judgment, discontinuing medication in those they believed benefited from opioids.

• Forced or abrupt tapering creates the kinds of problems policymakers sought to avoid.

• Just changing the dose of a person who has been stable on opioids puts them at three times higher risk for overdose or other adverse effects according to one study.

• Another study showed that Medicaid patients on high doses were often tapered within 24 hours and 49% were hospitalized or had an emergency visit as a result.

• A recent study found that abrupt discontinuation of opioids is on the rise in all patients, and the FDA has warned about the dangers of this practice.

• Patients today, including those with cancer or sickle cell, experience difficulty filling legitimate prescriptions.