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Benefits from opioids outweigh risks, study says
(WebMD) -- American doctors have long been reluctant to prescribe the most powerful of pain killers, opioids, fearing they'll turn patients into addicts or draw scrutiny from federal drug agents. After all, from opioids we get the heroin used on the streets as well as the morphine used in hospitals.
A new study, however, suggests those fears are unfounded. Researchers from the University of Wisconsin Medical School have found that while doctors are prescribing opioid pain killers more often these days, emergency rooms are not seeing significantly more cases of related drug abuse.
"It's important to make everyone aware of these findings," said June Dahl, Ph.D., professor of pharmacology and co-author of the study published in this week's issue of the Journal of the American Medical Association. "This paper addresses one of those myths: If you have a lot of prescribing of controlled substances, we're going to create all these addicts. There isn't any evidence for that."
The researchers analyzed national databases that tracked opioid prescriptions and drug abuse reported in hospital emergency rooms, from 1990 to 1996. During that time, they found that doctors prescribed 59 percent more morphine, 23 percent more oxycodone, 19 percent more hydromorphone and a whopping 1,168 percent more fentanyl -- all opioids used to treat pain from cancer, trauma and surgery. Use of another medication in the same class, meripidine, decreased by 35 percent.
At the same time, the number of people seeking help in emergency rooms for morphine abuse rose by just 3 percent. Reports of patients abusing the other four drugs actually decreased in the range of 15 to 59 percent.
Dahl said the findings indicate doctors may finally be doing a better job of treating pain. Studies of cancer and surgery patients have shown that half say they suffered severe pain unnecessarily, Dahl said.
"It's ingrained in the psyche of physicians to not use large amounts of opioids," agrees Barry Cole, M.D., the former president of the American Academy of Pain Management. Not only do doctors fear addiction, but also the wrath of federal drug agents. Prescriptions of opioids are strictly regulated by the federal Drug Enforcement Agency (DEA). To prescribe these medications, physicians must register with the agency and obtain a "DEA number" -- a license number that doctors note on every prescription for a controlled substance.
Such prescriptions are then tracked, and state officials can investigate doctors who prescribe abnormally large amounts of the drugs. Such investigations, however, are rare. Cole said state reviewers have the capacity to review only about 2 percent of all prescriptions.
Specialists in pain have long called for more liberal use of opioids, arguing that for many patients the benefits are great and the risks are small. Steven Feinberg, M.D., a former president of the American Academy of Pain Medicine, uses a careful scale when prescribing opioids for his patients in Palo Alto, California. He weighs the side effects: nausea, constipation, dizziness, falling and difficulty breathing. Then he weighs the benefits: Is his patient in such debilitating pain that without opioids the patient may not function normally, walk, lift objects or work? Opioids are worth the risk, he said, when the medications can help patients get back on their feet.
"Everything's a balance in life," he said. "It's like (deciding to perform) surgery, realizing you're putting someone's life on the line. A good pain doctor balances side effects against the benefits for more function and less pain."
© 2000 Healtheon/WebMD. All rights reserved.
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