Chronic opioid therapy

Chronic opioid therapy is a continuous form of chronic pain therapy that uses opioid drugs to ease a patient’s pain. Common prescription opioids include codeine, fentanyl, oxycodone, morphine, hydrocodone, and meperidine. Chronic opioid therapy is used for chronic pain related to terminal diseases such as cancer as well as non-cancer conditions such as fibromyalgia and back pain. Chronic opioid therapy involves consistent, sometimes daily, usage of opioid drugs to relieve pain. Alongside its pain-relieving effects, it has been known to improve mood and level of functioning in many patients. Doctors have been prescribing opioids to patients dealing with pain symptoms or pain-related diagnoses since the early twentieth century. Prescription opioids are tightly regulated by the federal government, and doctors can lose their licenses if they do not prescribe the drug properly. The rate of opioid therapy prescriptions greatly increased between the 2000s and 2010s. This period also saw a steady uptick in opioid overdose deaths, forcing many health professionals to weigh the advantages and disadvantages of prescribing chronic opioid therapy for pain.

Background

An opioid is a compound derived from the opium found in opium poppy plants. Opioids bind to opioid receptors in the body and act as a pain reliever. Opium is a brown, grainy powder obtained from the seedpod of the poppy flower. Opium has been used by people to relieve pain for many centuries. Opium was primarily grown and used in the Middle East before the nineteenth century. It was considered a luxury good in the United States and Europe for hundreds of years. The nineteenth century saw opium become more readily available to populations all over the world. Opium production rapidly increased during this period following the discovery of the powder’s morphine alkaloid in 1806. Morphine’s pain-relieving potential increased demand for opium in the United States and Europe, and soon opioid drugs were being produced at a pharmacological level, making it more available than ever before.

This era saw the casual usage of morphine by Victorian society. Morphine purportedly treated a range of health problems. Doctors and pharmacists provided patients with morphine tinctures that treated pain associated with diarrhea, colic, menstruation, and many other conditions. Doctors also prescribed morphine to wealthy Victorian women suffering from such symptoms as “boredom” and “travails.”

The rise in casual opioid usage, which later included heroin usage, became a problem by the twentieth century. Widespread abuse was leading to many overdose deaths. In the United States, the government eventually stepped in and placed regulations on the usage of opioids. By the mid-1900s, the government crackdown on opioid usage was so strict that doctors were allowed to prescribe them as treatment only under very specific conditions. By this time, casual usage of opioids was illegal. Legal use of opioids was restricted to medical prescription, and doctors risked losing their licenses if they prescribed opioids inappropriately.

A number of health professionals valued opioids for their pain-relieving properties and eventually lobbied the government and the health community to reestablish opioids as an acceptable and effective treatment for acute and chronic pain. Over the next several decades, opioids reentered to public sphere as an important source of pain management. By the twenty-first century, opioid prescriptions were being written at a rate of hundreds of millions per year. Opioid prescriptions per capita increased 7.3 percent between 2007 and 2012. Despite the drug’s effectiveness, opioid therapy remained a subject of debate, particularly the use of chronic opioid therapy for chronic non-cancer pain. Some professionals argued that chronic opioid therapy did more harm than good and could lead to misuse or addiction. Others believed chronic opioid therapy was necessary and beneficial to chronic pain sufferers and was safe as long as the treatment followed a standardized approach.

Overview

Chronic opioid therapy is often prescribed by doctors to relieve severe acute and chronic pain symptoms resulting from life-limiting illnesses such as cancer. Originally limited to cancer treatment, chronic opioid therapy became available for treating chronic nonterminal pain toward the end of the twentieth century. Doctors began prescribing opioids for conditions such as back pain, osteoarthritis, fibromyalgia, and migraine headaches. Since the 1990s, opioid subscriptions have increased substantially. Researchers have also observed a steep rise in opioid misuse and overdose in these years. Opioids possess addictive properties that create dependence in some patients. According to a 2015 study conducted by the Agency Medical Directors’ Group, 60 percent of patients who take opioids for three months are still taking them five years later. Such factors have forced the medical community to reevaluate the costs and benefits of chronic opioid therapy and develop guidelines for the safe prescription of opioid drugs.

Chronic non-cancer pain is a common condition among American citizens. Some studies suggest as many as one in four Americans experience chronic pain in some form. Chronic pain particularly affects individuals sixty-five and older. Chronic opioid therapy can be prescribed to patients experiencing chronic pain, but experts recommend opioids only be prescribed once all other treatment options have been exhausted. Physicians should conduct a thorough physical examination and review a patient’s medical history to check for previous drug abuse, misuse, or addiction incidents. Doctors should also consider whether a patient’s pain in severely affecting his or her quality of life and whether the benefits outweigh the harms.

Patient education is critical when prescribing chronic opioid therapy. Doctors should alert patients about all potential risks of chronic opioid therapy and discuss the patient’s goals and expectations in regard to opioid usage. Most medical professionals recommend a trial period when beginning chronic opioid therapy in order to assess the effects of the treatment. Opioid dosage is individually tailored to each patient’s specific needs, and doctors are encouraged to reassess a patient’s needs regularly. If a patient’s needs change in such a way that chronic opioid therapy is no longer needed, doctors are encouraged to ween the patient off the opioids gradually to reduce the chance of withdrawal symptoms.

Bibliography

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Chou, Roger, et al. “Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain.” Journal of Pain, vol. 10, no. 2, 2014, pp. 113–30.

“Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain.” American Pain Society, www.americanpainsociety.org/uploads/education/guidelines/chronic-opioid-therapy-cncp.pdf. Accessed 23 Oct. 2018.

“Interagency Guideline on Prescribing Opioids for Pain.” Agency Medical Directors’ Group, June 2015, www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf. Accessed 23 Oct. 2018.

Lembke, Anna, et al. “Weighing the Risks and Benefits of Chronic Opioid Therapy.” American Family Physician, vol. 93, no. 12, 2016, pp. 982–90.

“Long-Term Opioid Therapy Reconsidered.” Annals of Internal Medicine, vol. 155, no. 5, 2011, 325–28.

“Opioid Overdose.” Centers for Disease Control and Prevention, 19 Oct. 2018, www.cdc.gov/drugoverdose/index.html. Accessed 23 Oct. 2018.

“Overdose Death Rates.” National Institute on Drug Abuse, Aug. 2018, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed 23 Oct. 2018.

“Patients on Chronic Opioid Therapy for Chronic Non-Cancer Pain Safety Guideline.” Kaiser Foundation Health Plan of Washington, wa.kaiserpermanente.org/static/pdf/public/guidelines/opioid.pdf. Accessed 23 Oct. 2018.