Abuse and misuse of prescription opioid analgesics is a growing national concern that has increased exponentially over the past few decades. A position paper from the American Academy of Neurology (AAN) suggests that the risk of prescription painkillers, including death, overdose, and addiction, far outweigh the potential benefits of treating headaches, fibromyalgia, lower back pain, and other non-cancerous conditions.

"More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs," Dr. Gary M. Franklin, research professor in the Department of Environmental & Occupational Health Sciences in the University of Washington School of Public Health in Seattle and a Fellow with the AAN, said in a statement.

Franklin and his colleagues from the AAN referenced studies showing that 50 percent of patients who are prescribed painkillers, such as morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone, or a combination of the drugs with acetaminophen, for a period of three months are still taking them five years later. According to the Centers for Disease Control and Prevention, rates of drug overdose deaths in the United States have tripled in the past 20 years. Over 12 million people reported using prescription painkillers without a prescription or simply for the feeling they cause in 2010.

Although opioid analgesics, such as hydrocodone, oxycodone, and morphine, do, in fact, provide significant short-term pain relief, there is currently no research to prove they can sustain long-term pain relief and improve function without leading to overdose, dependence, or addiction. Prescription painkillers decrease the brain’s perception of pain by binding to its receptors. This feeling of euphoria tends to result in dependence and addiction over time. As people build up a tolerance, they will try to achieve that euphoric feeling and avoid withdrawal symptoms by taking larger doses.

"More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use," Franklin added. "There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions, and patients need to work together to stop this epidemic."

The AAN’s statement provided doctors with suggestions to help them prescribe opioids in a safer and more effective manner. They recommend creating an opioid treatment plan while screening for current/past drug abuse and depression. Patients should also be asked to undergo random urine drug screenings and track daily morphine equivalent dose via online dosing calculator. Doctors should consult pain management specialists should the dosage exceed 80 to 120 milligrams per day, especially when pain and function do not improve. All drugs prescribed to patients should be monitored through the state Prescription Drug Monitoring Programs.

Source: Franklin G, et al. Neurology. 2014.