Drug poisoning deaths are currently at their highest ever recorded level in the United States, the National Drug Threat Assessment reported in November 2016. “Every year since 2009, drug poisoning deaths have outnumbered deaths by firearms, motor vehicle crashes, suicide, and homicide.”
The epidemic is largely driven by the extensive use of opioid pain relievers for acute and chronic pain conditions. More than 30 percent of Americans have some form of acute or chronic pain. According to the US Department of Health and Human Services, on an average day, more than 650,000 opioid prescriptions are dispensed and 3,900 people initiate the non-medical use of prescription opioids.
In an article in the New England Journal of Medicine, Nora Volkow and Thomas McLellan point out that “opioid analgesics are widely diverted and improperly used” and that “the major source of diverted opioids is physician prescriptions.” While illegal diversion of opioids is an important problem, the drugs can also pose dangers for legitimate pain patients.
A 2016 Columbia University study was the first to indicate a direct link between pain and opioid addiction risk. The research by the Columbia University Medical Center revealed that people with moderate or more severe pain had a 41 percent higher risk of developing prescription opioid use disorders than those without, independent of other demographic and clinical factors.
The researchers analyzed data from a national survey of alcohol and substance use in more than 34,000 adults in two waves, three years apart. At each point, they examined pain, prescription opioid use disorders, and other variables such as age, gender, anxiety or mood disorders, and family history of drug, alcohol, and behavioral problems.
Participants who reported pain and those with prescription opioid use disorders were also more likely than others to report recent substance use, mood or anxiety disorders, or have a family history of alcohol use disorder.
“These findings indicate that adults who report moderate or more severe pain are at increased risk of becoming addicted to prescription opioids,” said Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center and senior author of the report. “In light of the national opioid abuse epidemic, these new results underscore the importance of developing effective, multimodal approaches to managing common painful medical conditions.”
Among other things, pain patients need to be more carefully screened for addiction risk factors such as a genetic predisposition or an existing mental health condition. Severe pain is stressful and causes anxiety. Chronic pain can cause permanent stress, which in turn can lead to depression. Some pain patients will eventually exceed the prescribed dosage of their pain medication or misuse other substances.
“In evaluating patients who present with pain, physicians should also be attentive to addiction risk factors such as age, sex, and personal or family history of drug abuse,” Columbia University’s Dr. Olfson added. “If opioids are prescribed, it is important for clinicians to monitor their patients carefully for warning signs of opioid addiction.”