A recent study on prescription painkillers has generated a little controversy.
Patients started on prescription painkillers who have substance-use disorders or who frequently contact their doctors’ offices are at greater risk of having their medication doses increase early in therapy, also increasing their risk of opioid-related overdose or death, UC Davis Health System researchers have found.
Published online in the journal Pain Medicine, the study is the first to examine factors associated with opioid dose escalation during the first year of use and may help physicians identify patients who should not continue taking medications such as hydrocodone, codeine or oxycodone.
“Most physicians recognize that they need to carefully monitor patients who are prescribed high doses of opioid pain medication, but patients nearly always start these medications at lower doses and increase to more dangerous levels over time,” said Stephen Henry, assistant professor of general medicine and lead author of the study. “We wanted to develop a more complete picture of the patients who should raise red flags early in the course of pain therapy, before their dose levels put them at high risk of overdose or death.”
The study drew the attention of Dr. Richard Radnovich, a Boise Idaho osteopath who has participated in numerous clinical trials for pharmaceutical and medical devices aimed at treating chronic pain.
“The study should have had an anti-pain med bias alert,” he wrote. “The actual study was on dose escalation in the first year of therapy. Dose escalation, or needing ever increasing doses of pain meds to achieve the same effect, is a concern of patient and doc alike.”
“You have to really read the entire study to learn that only 9% of the people required dose escalation in the first year, 91% remained at about the starting dose!”
Radnovich concluded that the headline should read: “Fears of Dose Escalation Unfounded”.
It’s estimated that over 90% of patients taking opioid pain medications were prescribed them to treat chronic pain, which afflicts over 100 million American adults.
UC Davis’ Henry said he hopes the study results can help primary care physicians, who write the vast majority of pain medicine prescriptions, identify patients whose opioid use needs to be re-evaluated and whose pain may be better treated with non-opioid medications.