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Re-evaluating Opioid Use in Chronic Pain: Then and Now

Opioid drugs have been on the marketplace for decades. But it wasn't until the 1980s that the idea of using long acting opioid products for chronic pain became reality.Before that time, opiates were mostly used short term; long term use of these products was pretty much limited to terminal illnesses, including cancer.  At that time, I was a newly licensed pharmacist; we were taught that, if someone had a terminal illness, quality of life was more important. If a terminally ill person became addicted to pain medication, so be it.


Dr. Russell Portenoy was one of the early proponents using opioid medications for patients with chronic pain conditions.  In the late 1980s, he co-authored a paper about a study using these products in this way.  The study was based on a relatively small sample: only 38 patients were involved. The authors contended that the benefits of long term opiate therapy experienced by the study subjects could be of potential benefit to many people with chronic pain. In the 1990s he and his follower asserted that less than 1% of users would become addicted; overdoses would not be a common problem; and that it would be easy to discontinue usage if/when that was necessary.


Dr Portenoy's theory took hold, and the opioid use for chronic pain skyrocketed.  The predictions of Dr. Portenoy and his associates have not come true.  Here are some scary facts about the real picture:
  • More than 16,000 people die from opioid overdoses every year.
  • Before the year 2000, less than 1 person per 10,000 was admitted to an opioid addiction treatment program.  By the year 2010, 5.4 persons per 10,000 fell victim to that fate.
  • Before the year 2000, approximately 2 kilograms of opioids were sold per 10,000 persons. By the year 2010, that number more than tripled to 7.1 kilograms per 10,000 persons.
So where are we now?

Dr. Portenoy and other pain doctors, who so widely promoted this concept in the mid 80's now admit that they erred in that they overstated the benefits of these drugs without paying much attention to the risks.  In an interview with the Wall Street Journal (Dec 2012), Dr. Portenoy says, " We didn't know then what we know now."

You can say I'm old school...but maybe what I learned back in pharmacy school about opioids was right all along.

Sources: Wall Street Journal; Wikimedia



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