The growing worldwide use of opioids for pain management is being met with mixed reactions at a gathering of experts on the subject at the Congress of the European Pain Federation in Florence, Italy.
While innovations in pain management were applauded, the lack of access to opioid pain medication in many parts of the world was of great concern.
“Opioid drugs are most effective as analgesics; they are now prescribed 7.5 times more often than they were in 1990, ” said European Pain Federation President Hans Georg Kress.
“Drugs based on these substances were long considered taboo due to their alleged addictive nature, but in recent years their usefulness in treating patients with severe chronic pain has clearly been recognized in medicine and in health policy.”
But according to Kress, those global statistics disguise what he called the true state of affairs. By no means is everybody in the world benefiting from the effectiveness of these drugs.
In a twenty year span (1990-2010) that saw an approximate 15-fold increase in the use of opioids across Europe, in third world countries such as Kazakhstan and Tajikistan, access to opioid pain medication – even to treat cancer pain — was virtually non-existent.
“There are obviously unmet medical needs, and healthcare policy makers can no longer be allowed to ignore them while millions of people are condemned to lives of agonizing pain. This is medically and ethically unacceptable,” said Kress.
But along with use comes abuse, followed by addiction and side effects.
In a Spanish study presented at the Congress, more than 40% of the patients investigated complained of side effects from opioids, such as nervousness, sexual dysfunction, insomnia and depression.
Another international study presented at the Congress suggested that many patients are given opioids even when there are no clinical benefits.
For those reasons, Kress stressed that opioids should only be prescribed in cases where patients do not have adverse reactions, where there are long-term benefits, and where other methods of treatment have failed.
The careful monitoring of patient consumption is another tool that should be encouraged. There’s rampant abuse in North America and Australia, said Kress, because the prescription of opioids is less strictly regulated than in Europe, where access is closely controlled by the use of special prescription forms or drug registers.
A recent Italian study found that a questionnaire designed to establish whether a patient is at risk of drug abuse before prescribing opioids was a reliable diagnostic tool, along with a thorough evaluation of a patient’s mental health.
A Norwegian study of more than 17,000 patients also showed that it is not always the appropriate patients that receive long-term opioid therapy. Over a five year period, one out of three patients doubled their opioid dosages.
Although a steep increase in dosage is a common phenomenon in long-term therapy, researchers found that high dosages were generally accompanied by heavy consumption of the addictive tranquillizer benzodiazepine. A separate Danish study also revealed a strong link between chronic pain, opioid and benzodiazepine use.
“As the European specialist organization, we are making the case for a sensible middle way between under prescription, over prescription, and the problems of drug abuse,” said Kress.
“There is no point in throwing the baby out with the bath water and allowing misuse in some parts of the world to result in worldwide restrictions. This would place insuperable barriers in the path of patients urgently in need of opioids to manage their pain.”
Among European countries, the use of opioids is highest in Denmark, Austria and Germany, where about 400 mg of opioids were consumed per capita. Poland, Lithuania and Latvia have the lowest opioid use, averaging about 30 mg per capita.
Chronic pain patients in many parts of the world have poor access to pain treatment. A survey released in 2011, called the “Global State of Pain Treatment: Access to Palliative Care as a Human Right,” found that pain relieving drugs and palliative care are so poorly available in some parts of the world that tens of millions of people – including 6.5 million terminal cancer and HIV patients – suffer needlessly.