It is now known that for existing opioid analgesics, today’s medical patient is rarely tomorrow’s non-medical abuser. [1] Risk of opioid use disorder among actively managed medical patients is so low as to be difficult to measure. Indeed, large scale studies of post-surgical patients prescribed opioids for the first time reveal an incidence of Opioid Use Disorder (OUD) diagnoses of
0.6% or less for follow-up periods averaging 2.5 years; [2] this number is likely a maximum, given that many diagnoses are recorded by General Practitioners who lack significant training in evaluating patient behaviors said to define OUD.
Incidence of protracted opioid prescribing for 13 weeks or longer in post-surgical patients is also known to be
less than 1%. Such prescribing may be more closely related to procedure failure than to properties of opioid analgesics per se. Procedures in which “chronic” prescribing is most often observed are also among those in which procedure failures and emergence of chronic pain are highest (e.g. total knee replacement). [3]
It is also known that there is no reliable statistical relationship between rates of opioid prescribing by physicians versus rates of opioid overdose-related mortality from all sources (legal prescriptions, individual or corporate diversion of prescriptions, and illegal street drugs). Moreover, there has never been a relationship during the past 20 years. Published prescribing and demographics of the CDC directly contradict any such relationship. People over age 55 are prescribed opioids for pain two to three times more often than youth and young adults under age 25; however, age-adjusted overdose related mortality in seniors is the lowest of any age group and has been largely stable for 20 years, while mortality in youth and young adults has skyrocketed to levels now six times higher than in seniors. [4], [5]
References:
[1] Singer JA, Sullum JZ, Shatman ME, Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder, Journal of Pain Research 2019:12 617–620.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369835/
[2] Brat GA, Agniel D, Beam A, et al. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ. 2018;360:j5790.
https://www.bmj.com/content/360/bmj.j5790
[3] Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016;176(9):1286-1293.
[4] Lawhern RA.”Over Prescribing Did Not Cause the Opioid Crisis.” Blog of Dr. Lynn Webster. Last updated April 5, 2019.
http://www.lynnwebstermd.com/over-prescribing/.
[5] Lawhern RA, Tucker JA. Analysis of US Opioid Mortality and ER Visit Data. Last updated April 2019. Available at:
http://face-facts.org/atip/analysis-of-us-opioid-mortality-and-er-visit-data-v15-april-2019/.
