A recent study published in the Journal of Opioid Management indicates that pain patient abuse of opioids is largely overstated.
The investigation by Carl Roland of Pfizer, Inc. covered a large database of over 70 million patients collected from 2005 to 2010. Those who were prescribed opioids were found to abuse the medicine at a rate of only 0.195%.
That means less than 2 out of every 1,000 pain patients abused opioids.
While the rate of opioid abuse more than doubled from 2005 to 2010 (from 0.067% to 0.145%), it is still far, far lower rate than the ”epidemic” claimed by some, particularly the Physicians for Responsible Opioid Prescribing (PROP), which is opposed to the current prescribing patterns of opioid medicines.
I will not repeat the same mistakes that PROP and other critics of opioids for pain patients make. To wit: I will not make broad claims based on this evidence. It is just one study that needs to be repeated by others to ensure the reliability and repeatability of the findings.
However, I think I can fairly state that this study is highly suggestive. And because of the enormous size of the sample and the study’s design it’s at least as credible as those studies used to claim hysterically high numbers of pain patients abusing, diverting and becoming addicted to prescription opioids.
As with any new area of research, the initial forays into the subject are preliminary. Scientific knowledge is a slow deliberate, incremental process with often contrary results calling for further investigation.
However, as we have watched in the debate about the medical use of opioids, some activists are entirely too quick to use preliminary results as “evidence” to press for policy and legal changes to the use of these medicines. This can lead to grave, sometimes deadly consequences.
In many ways, that is simply human nature. We are very quick to seize on any results that seem to confirm our own ideas and prejudices. But research should be the antidote to the psychological proclivity to reach quick judgments.
Therefore, it is deeply troubling to me and others when those well trained in research methods pounce on preliminary results as final confirmation of their opinions.
That this happens among the general public isn’t alarming, but professionals who can affect public understanding should know better. The consequent rush to judgment is disappointing at best, and at worst can mislead authorities into wrongheaded, dangerous policy and law.
This type of mistake seems to be especially prevalent when it comes to drugs. It is especially pernicious at the junction of pain, medicine, regulations and law enforcement.
For example, I am committed to knowledge based medical practice wherein my doctor and I decide on the best course of my treatment for me without government regulators and law enforcement agencies interfering in that treatment.
Yes, new drugs need to be vetted for safety, efficacy and embedded in best practices. But I want organizations like PROP and the DEA to stay the hell out of my doctor’s consultation room and stop interfering with treatment that works for me and millions of others.
We all know that opioids can become very dangerous when misused. But it has always scalded my intellect to have others tell me how dangerous these medicines are and how my use of them should be tightly regulated.
It seems as if each time I go to pick up my medicine, I am faced with yet another interfering regulation pronounced by the state, insurance companies or the large pharmacy where I do business. And pain patients are expected to cooperate no matter how intrusive, stupid or inconvenient these demands are.
It’s a fact of life that policy and law enforcement decisions will be fought in the political arena, often using dueling research results. And it is in that area that the average consumer is often lost in the arcane language of statistics.
What is to be done?
We as pain patients need to become educated consumers of research. The basic ingredients of research are fairly easy to comprehend; but it is often the details, like the composition of sampling groups, operational definitions, and confidence intervals, that overwhelm the uninitiated.
The first place to look for the consumer is to the “conclusion” or “discussion” section of the report. Another resource is to ask our physicians to look into a particular study and explain it.
Research results should never be taken as the final word, as most results are provisional and subject to the discovery of new knowledge. There is rarely an “a-ha” moment. Our decisions should be made by the weight of the evidence and on the advice we trust.
Remember, research results are often used in political contests. Each citation should be approached with care, thoughtfulness and a bit of skepticism. That applies to the research report I mentioned at the start of this column – which was funded and conducted by Pfizer, one of the world’s largest drug makers.
My bias is obvious. I think that the results of this report land closer to reality than many others.
As all results are provisional, I would hope that interest groups like PROP and regulatory agencies like the FDA and DEA would exercise more care and caution.
They should think long and deliberately before interfering with life-saving treatment.
Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here.
National Pain Report welcomes other opinions.
The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.