Opioids

Study of Postsurgical Patients Shows Addiction to Pain Pills Is Rare

While the risk of "opioid misuse" increased with the duration of the prescription, the overall rate was low.

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A new BMJ study of patients who received opioid analgesics after surgery, touted as evidence of how risky such prescriptions are, actually shows how rarely people become addicted in the course of treatment for acute pain. Tracking 568,612 opioid-naive patients who took prescription pain medication following surgery, Boston surgeon Gabriel Brat and his colleagues found that 5,906, or 1 percent, showed signs of "opioid misuse" during the course of the study, which included data from 2008 through 2016.

The outcome measure that Brat et al. used, "opioid dependence, abuse, or overdose," is a broad category that includes patterns of use falling short of what most people would recognize as addiction. That means the actual addiction rate in this study was less than 1 percent, although it's not clear how much less. The researchers note that "overall rates of misuse were low" but do not play up that angle. Instead they emphasize that the risk of misuse increased with the duration of the prescription.

"Each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients," Brat et al. write. For instance, "the rate of misuse more than doubled among those with one refill…versus those with no refills." But if you take a low number and double it, the number is still pretty low. The researchers say the incidence of opioid misuse rose from 145 cases per 100,000 person-years (roughly 0.15 percent annually) for patients with no refills to 293 cases per 100,000 person-years (0.29 percent annually) for patients who had one refill. The corresponding addiction rates would be substantially lower.

"Our study is highly suggestive of the conclusion that getting a refill increases your chances of opioid addiction," Brat told MedPage Today. "For surgical patients, it may be that we should focus less on the dose of opioids immediately after discharge and more on the length of time a patient is exposed to opioids."

Maybe, although the causality behind the correlation identified in this study may not go in the direction Brat suggests. It seems plausible that patients who like the psychoactive effects of opioids would be more inclined to ask for refills, in which case patients who are predisposed to addiction would be overrepresented in the group that received them. In other words, getting a refill may be a result rather than a cause of a higher addiction risk.

Either way, the overall results of this study should be reassuring, rather than alarming, for anyone who worries about getting hooked on pain pills after surgery. You would not get that impression from the MedPage Today story. "Each postsurgical opioid refill was associated with a 44% increase in misuse among opioid-naïve patients," reporter Judy George says in the second paragraph. "Likewise, each additional week of prescriptions bumped the risk of opioid misuse up nearly 20%, and misuse rates escalated when patients received more than 9 weeks of drugs."

A dozen paragraphs later, we learn that "overall rates of misuse were low" and get some sense of what that means in terms of rates. George is so keen to play up the risk of addiction that she says "the risk was nonzero even [when] prescription durations were shorter than 2 weeks." Nonzero is what science reporters say they think negligible is not scary enough.

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  1. If even 1 person gets pleasure from their pain medication then it must be outlawed. One only needs God. All other sources of relief come from Satan.

  2. If even 1 person gets pleasure from their pain medication then it must be outlawed. One only needs God. All other sources of relief come from Satan.

  3. Holy opiodacalypse.

    If I have to hear one more smug, supercilious allopathic moron proclaim that we have an opiodal public health emergency, he or she or it will be going straight to the chip house.

    1. We do have an opioid epidemic. Re-scheduling of hydrocodone to schedule 2 (the same as cocaine and methamphetamine, just FYI) has massively diminished the amount, dose, and duration of prescriptions. Where people could fairly easily get diverted pain pills before, now they can only buy street drugs, and since fentanyl is more potent and easier to smuggle, most “heroin” contains some amount of fentanyl. As we all have read, this is the real problem with the epidemic.

      “If you get high, you deserve to die.” – The DEA

    2. Not only is it an emergency, but it’s the CORPORASHUNZ!!! If only all drugs were limited to distribution by your local DEA agent, all would be well.

  4. The corresponding addiction rates would be substantially lower.

    Huh? Either they are or they aren’t*. If they didn’t look, ‘substantially lower’ is abject speculation. Presumably, somewhere into your third or fourth or 25th refill, the mere act of refilling is a indicative of both misuse and addiction.

    *With the usual libertarian, “I’m not suggesting policy here.” rider.

    1. “Presumably, somewhere into your third or fourth or 25th refill, the mere act of refilling is a indicative of both misuse and addiction.”

      Presumably, that individual into his third or fourth or 25th refill, is in pain.

      1. Presumably, that individual into his third or fourth or 25th refill, is in pain.

        Quite possibly exceptional pain. That doesn’t change the fact that they’re dependent on opioids to (not) function and/or that their healthcare provider isn’t actively facilitating it. Again, not proscribing policy, but medicated into protracted numbness is quite reasonably outside the bounds of any concept of ‘regular human use’.

        My point was that the sentence, as best as can be reasonably interpreted, is pure speculation. I’m not saying we have millions of addicts out there on their 25th prescription (quite the opposite) just that the assumption that the rate inherently declines is certainly no more accurate.

        If you were in pain and had surgery and still suffered enough pain that you required a protracted opioid regime, it kinda should call into question what procedure you had done and/or what your healthcare professionals are doing.

        1. Very good points mad.casual.

          My point was that too many people simply assume that the sole reason for seeking refill #s 3,4, and 5, etc., is to get high.

          Your last paragraph simply makes too much sense.

  5. Serious question:

    If the rate of addiction/misuse from “legitimate” patients is low, then were are all these ODing addicts coming from.

    Are the families of the deceased playing the sympathy card: “Oh my poor, husband/niece/friend got hooked on pain killers and had to turn to heroin”, because it sounds so much better than: “Yeah my wife was a junkie.”

    1. Yes. It’s becoming a way to blame the world for the thing existing. Same thing as the temperance movement and alcohol.

    2. Recreational use combined with other medications and booze. People who tend to get hooked on an opioid tend to have other psychological problems, for which doctors are increasingly prescribing medications.

  6. I’m starting to think this whole ‘addiction’ thing is completely fake.

    1. “Addiction” is almost irrelevant. The body metabolizes opiods with little problem, though the effects can have bad consequences.

      The real PROBLEMS are the result of tolerance and withdrawal. Tolerance, because you need more of it to avoid withdrawal. And it is withdrawal that incapacitates junkies, periodically makes them unable to hold a job, and it’s the fear of withdrawal that drives them to commit crimes to obtain the ever-increasing quantities. Kickin’ is hell.

      I know it’s commonly thought that “craving” drives junkies to damage society, but it’s fear. There are lots of people who ‘chip’ heroin as a party drug, even use regularly for extended periods, but eventually tolerance eats away the budget and contact with dealers and their minions leads to…well, a non-tenable situation.

      William Burroughs said “It takes an iron will to be a junkie.” and I think I know what he meant. (Though it helps to be a rich faggot, I guess. Him, not me, bitches.) And most people can’t handle it without harming themselves and society.

      There are, however, degrees of pain which it is highly undesirable to suffer. People taking the criminalization approach are not dealing with that. Until they, or doctors, or big pharma, DO, we’ll have this problem.

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