Study Finds Opioids Might Not be Better than Non-Opioid Medication in Many Cases

Opioids may not treat long-term, chronic pain more effectively than non-opioid medication, according to a new study from the University of Minnesota. The study, published in the Journal of the American Medical Association earlier this month, suggests doctors may want to limit opioid prescriptions when treating patients with chronic pain from conditions like hip or knee arthritis.

“A lot of prescribers have been waiting for a study like this,” said Laura Palombi, an assistant professor in the University of Minnesota’s College of Pharmacy who studies the opioid epidemic. “We’ve seen the harms of opioids, and we know people do benefit from them and not everyone gets addicted to them, but it’s nice to see how they actually compare.”

Researchers recruited patients from Veterans Affairs clinics for the study, and treated some with opioid medications — including oxycodone or morphine — and others with non-opioid medications, like acetaminophen. The findings come in amid the worsening opioid crisis that has public health employees nationwide scrambling for solutions. Emergency room visits for suspected opioid overdoses increased 30 percent between July 2016 and September 2017, according to a report on data from 45 states published by the Centers for Disease Control this month.

Lead author Erin E. Krebs, University Medical School associate professor, said that during her education in the early 2000s, experts said opioids weren’t effective, but that later physicians strongly recommended prescribing them. “I was a student at the time and it was interesting to see the advice change in a short period of time,” Krebs said. “That made me interested in looking into this.”

Some researchers say this switch wasn’t prompted by any new studies or scientific developments, which has left them wondering why experts changed the narrative around opioids. Robert Levy, assistant professor of family medicine and community health, said he thinks the influence of drug companies in medical schools played a role. “Every doctor says they are impartial, and of course the drug companies never said what to do, but the education was shaped by drug companies,” he said.

These companies have also guided prescription practices, said Susan Craddock, University professor and director of the Center for Bioethics. “They send representatives to physicians to talk up the advantages of the new drug just going on the market,” Craddock said. “It is quite easy to talk about advantages of a drug without talking about disadvantages, or without comparing opioids to, say, ibuprofen.”

Levy said the study will be a helpful tool for physicians discussing chronic pain treatment with patients. However, the findings alone won’t solve the crisis, since Americans are very accepting of opioid use and they’re easy for doctors to prescribe, he said. According to data collected by the International Narcotics Control Board, Americans consumed about 30 percent of opioids produced globally in 2015, despite making up less than 5 percent of the population. The researchers said opioids should still play a role in pain treatment, but the drugs’ uses should be limited to end of life care and cancer treatment.

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  • Very interesting. Sometimes I think people want opioids for pain relief because they've been led to believe that they are a "miracle" drug of sorts. I think people also believe that RX pain relievers must be necessary, because doctors prescribe them so readily. Who knows? Maybe a lot of the effectiveness of RX drugs on pain is psychological. In any case, I'm a firm believer in trying non-prescription meds first. It's a much safer approach!
  • A persons tolerance and body’s metabolizing of drugs also is a factor. My brother woke up after his cancer surgery significantly earlier than expected (they wheeled him into recovery room n he got up and was walking n talking immediately whereas they said he would be resting for 1-2 hours... my dad needs to warn any new dentist he sees that they will need to refreeze the same spot every 5 minutes otherwise it wears off (they didn’t believe him until they started drilling n he asked for them to add more freezing as he mentioned pre- work.

    Then there’s me, even before I tried any opiates (or drugs or alcohol even), I was getting dental work done and they couldn’t freeze my nerve, I could feel it all, so he tried 6x every 5 minutes and it still never worked. I was a child n couldn’t imagine going through that again so the following year I went to a children’s dental office which I was to be asleep during the procedure. I had some children’s Tylenol, then CO2 then an IV. Well I woke up with the IV in my arm, so i shouldn’t have woken up for another couple hours, like my brother lol

    So due to this (and possibly I messed up my ability to use standard meds. I usually have to take 5-600 mg n it barely does anything. Naproxen & T3s (Tylenol with codeine & caffeine) often makes ppl sick and woozy, I take two n it barely dulls the pain.
    It’s so unfortunate that ppl who need opiate assistance for pain often can’t get it and even worse the number of deaths :( and some doctors are just terrified to give them out anymore even if it’s needed. But I think it’s important to keep the scripts low with no refill and all systems should link up so doctors can see if this patient in front of them asking for refill of their delaudids didn’t just get them from another doctor and is abusing them.
    Would have been nice if my little brother could have had something stronger than a NSAID for his 6 inch incision on his groin! At least things seem to be recognized and steps are being taken. I’m not opposed to doctors being more cautious with scripts especially since this opioid crisis basically was huge up here first and everyone is burying loved ones, it’s a societal problem now (those judgemental people can’t look down on OD victims as much now since it easily could be their friend or child who was found unresponsive).
    So many issues still but it’s a start
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