Opioids are strong pain killing drugs that mimic the body’s own chemicals. Examples of prescription opioids include heroin (which metabolises to morphine and was banned after 1925), morphine, oxycodone and hydrocodone. As pain killers for acute pain, opioids work. However, over longer periods they become less effective, have more adverse effects, and can lead to tolerance, dependence, addiction, increased pain, and death. Here are some facts about long-term opioid use.
- The use of opioids for chronic non-cancer pain is not well supported by clinical trials (Cochrane review, Clinical Journal of Pain review)
- Rates of opioid prescription are increasing (here and here)
- The increase in prescription rates has been partly attributed to aggressive marketing and under-reporting of harmful effects and rates of addiction by the manufacturer, leading to several lawsuits and fines in the USA (here)
- Opioids lose effectiveness over time (here)
- Chronic opioid use leads to increased side effects (nausea, headache, constipation and depression of the central nervous system), to increased tolerance and drug dependence, and it may also lead to ‘hyperalgesia’: an increased sensitivity to pain (here, here, here and here)
- Increasing prescription rates are associated with increased rates of opioid abuse and addiction (here)
- There were 2.4 million opioid abusers in the US in 2010, most from prescription opioids, and the number of new abusers increased 225% between 1992 and 2000 (here)
- Opioid prescription rates are higher amongst the poor and unemployed (here and here)
- Deaths (intentional and non-intentional) from prescription opioids are associated with social disadvantage (here)
- Deaths from opioids are increasing and are currently responsible for more deaths than either cocaine or heroin in the US (here) and in Australia (here)
- Prescription opioids were responsible for 14,459 overdose deaths in the US in 2007 compared to 4,041 in 1999 (here), and 475,000 emergency room visits in 2009 (here)
- Opioids are often given for chronic back pain, and they are commonly given (long-term) after spine fusion surgery. These studies (here and here) report rates of chronic opioid use of 70% - 80% after spine fusion surgery
- Opioids are the biggest cause of loss of life after spine fusion surgery (usually in young patients) (here) and are associated with worse functional outcomes after spine surgery (here)
The bottom line
1. Opioids may not be effective for chronic non-cancer pain, and their use in such patients is associated with side effects, tolerance, dependence, and addiction.
2. Despite this, prescription opioid use is increasing and with that, the rates of opioid abuse and opioid related death are also increasing.
3. Harms from prescription opioids are over-represented in the socially disadvantaged.