Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


epidemicEpidemic: Risky prescribing practices have resulted in an epidemic of opioid misuse, abuse, and harm.  Poor and outdated teaching, research and prescribing methods contribute greatly to this.

“There’s been over 200,000 deaths from prescription opioids, hundreds of thousands of overdose admissions, and millions are addicted or dependent on prescription opioids.  …while some patients don’t meet the classic definition of opioid use disorder, as many as 30% of patients actually have opioid use disorder or are severely dependent,” [Gary Franklin, vice president of Physicians for Responsible Opioid Prescribing, said during a Webinar sponsored by the Centers for Disease Control and Prevention’s Clinician Outreach and Communication Activity (COCA).]

There are not enough data to justify the almost epidemic use of opioids in the treatment of chronic pain, but there are sufficient data to demonstrate the epidemic risk factors for self-harm.  The most common sources of opioid abuse and dependence is from the inappropriate treatment of fibromyalgia, headache and chronic low back pain.

Research indicates (Spine. 2008;33:199-204), that 14% of workers who sustained a low back injury were disabled at 1 year and that receiving opioids for at least 7 days at a cumulative dose of 150 mg morphine equivalent dose (MED) doubled the risk of being on disability 1 year later.

After adjusting for baseline reported pain, function, and injury severity…there is a dramatic increase in death when opioids are administered at a dose of 100 mg MED ―”but the risk of overdose is also two- to fivefold higher when that same opioid MED runs between 50 and 99 mg MED…(we need) to be paying a lot more attention to lower doses of opioids and never go over 100 mg MED.”

A combination of an opioid and either a benzodiazepine (such as Valium) or another sedative-hypnotic (Eg. Ambien) or muscle relaxants, can dramatically adds to the risk for opioid harm, even at lower doses of opioids.

There are also many nonpharmacologic alternatives to long-term opioid use that are strongly supported by evidence. Graded exercise is well established as a good treatment modality for chronic pain, as are cognitive-behavioral therapy (CBT), mindfulness-based stress reduction techniques, and various forms of meditation and yoga.”


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