Emerson, your post aligns with the main narrative pushed by the media, so I understand why you'd believe it, but the reporting on the issue has been abysmal.
Some people in here are talking about this like "well maybe, but not for chronic pain."
Straight up reality from a prescriber: the use of narcotics for non-cancer chronic pain is absolutely, 100% unsupported by evidence.
This statement is a bit hard to parse. First, cancer is not the only condition that can put people in terrible pain. Far from it. Secondly, opioids absolutely do work for the pain of those conditions, and they can be taken safely, and the vast majority do.
The practice is bad medicine and is why we're in the situation we are.
Opioid prescriptions are not the main problem, in fact they only a very small part, only about 4.5%. The vast majority of opioid related deaths are the result of either people mixing opioids with other drugs, which you can't do safely in a lot of cases, or as a result of using illegal street versions which contain fentanyl which is a hundred times stronger than other opioids and 50 times stronger than heroin, or even carfentanyl which if I recall correctly is ten times stronger than that. Since the illegal versions aren't measured as strictly as the prescription ones, they're dangerous and easy to overdose on.
http://reason.com/archives/2016/05/18/opioid-epidemic-myths
Despite the decline in use, opioid-related deaths reported by the U.S. Centers for Disease Control and Prevention (CDC) continued to rise through 2014, when there were 29,467, a record number. An overwhelming majority of such deaths—more than nine out of 10, according to data from New York City—involve mixtures of opioids with other drugs rather than straightforward overdoses.
Opioid prescriptions are not actually dangerous to take long-term:
Opioid-related deaths are rare even for patients who take narcotics every day for years. The CDC cites "a recent study of patients aged 15–64 years receiving opioids for chronic noncancer pain" who were followed for up to 13 years. The researchers found that "one in 550 patients died from opioid-related overdose," which is a risk of less than 0.2 percent.
The vast majority taking opioid prescriptions are not abusing them:
A recent study by Castlight Health estimated that 4.5 percent of people who have received opioid prescriptions qualify as "abusers," and its definition, based on the amount prescribed and the number of prescribers, probably captures some legitimate patients as well.
Their use for other forms of chronic pain only became widespread in the 90s when the drug manufacturers were pushing them on everyone and claiming they weren't addictive.
The drug companies absolutely should not have tried to act like they had no risk of addiction at all, but now we're swinging back in the opposite direction and overreacting. They are not always addicting.
In the long term they make people's pain and people's function worse. Opioid-induced hyperalgesia and central sensitization are a real thing. At bare minimum in the long term you get increasing dependence, increasing dose tolerance and decreasing effectiveness eventually leading to just as much pain as the patient started with despite taking enough narcotics to kill a large animal.
Its probably making your problem worse though. Opiods treat the surface level pain but don't treat any of the psychological factors, so you end up being in worse pain than you would be if you never took them in the first place. It's not an imperfect solution, it's just a different problem.
It's not as real as it seems because of incorrect methodology. I suggest you read the criticism section on wikipedia about opioid-induced hyperalgesia. With proper methodology, it's not really a problem at all.
In examining the published studies on opioid-induced hyperalgesia (OIH), Reznikov et al criticize the methodologies employed on both humans and animals as being far-removed from the typical regimen and dosages of pain patients in the real world.[18] They also note that some OIH studies were performed on drug addicts in methadone rehabilitation programs, and that such results are very difficult to generalize and apply to medical patients in chronic pain. In contrast, a study of 224 chronic pain patients receiving 'commonly-used' doses of oral opioids, in more typical clinical scenarios, found that the opioid-treated patients actually experienced no difference in pain sensitivity when compared to patients on non-opioid treatments. The authors conclude that opioid-induced hyperalgesia may not be an issue of any significance for normal, medically-treated chronic pain patients at all.[18]
Even opioid tolerance isn't as much of a problem as people fear because you can simply rotate them.
Opioid-induced hyperalgesia has also been criticized as overdiagnosed among chronic pain patients, due to poor differential practice in distinguishing it from the much more common phenomenon of opioid tolerance.[19] The misdiagnosis of common opioid tolerance (OT) as opioid-induced hyperalgesia (OIH) can be problematic as the clinical actions suggested by each condition can be contrary to each other. Patients misdiagnosed with OIH may have their opioid dose mistakenly decreased (in the attempt to counter OIH) at times when it is actually appropriate for their dose to be increased or rotated (as a counter to opioid tolerance).[19]
The suggestion that chronic pain patients who are diagnosed as experiencing opioid-induced hyperalgesia ought to be completely withdrawn from opioid therapy has also been met with criticism. This is not only because of the uncertainties surrounding the diagnosis of OIH in the first place,[18] but because of the viability of rotating the patient between different opioid analgesics over time. Opioid rotation is considered a valid alternative to the reduction or cessation of opioid therapy,[20] and multiple studies demonstrate the rotation of opioids to be a safe and effective protocol.[21][22][23]
I personally have a family member who's been taking prescription opioids safely for years for a condition with no cure. She didn't get addicted. Doesn't even get high. Opioids absolutely can work, and safely, but because of the hysteria the media is whipping up about them, important details which reveal the real sources of the problem are ignored.
We're basically freaking out about a slowly dripping pipe (the small number of problem doctors) when there's a gushing pipe on the other side of the room (street drugs, lack of knowledge about the stuff you can't mix them with and the reasons why people are turning to drugs in the first place, like hopelessness).
The terrible reporting is causing people to overreact and recently caused an across-the-board reduction of pain meds. My family member only gets a fifth of what she got before for no good reason at all, as they already put patients through regular checks to make sure they aren't abusing them. It's like they decided to reduce the speed limit to 10 mph everywhere because some people speed and cause crashes. They're also not as easy to get as people think from almost all doctors, as they're generally paranoid about prescribing them and some pharmacies won't even fill prescriptions for them anymore.
The overreaction is causing real suffering to a ton of people who can't get adequate pain relief. People are killing themselves because they just can't take it anymore, which is obviously worse than the other risks, which are again far smaller than commonly believed. We need to get the word out that they absolutely can be taken safely. One opioid was even reformulated to make it resistant to abuse, so what's the point of clamping down on that too? It's also making the problem worse as pain patients who can't get relief turn to the illegal stuff like heroin.
In 2015, opioid deaths were above 33,000. Yet no one talks about the approximately 16,500 people who died in 2015 from NSAIDs, or the
400,000 who died from cigarettes in the US, and millions more around the world.
The opioid epidemic is absolutely a problem, but it's not prescriptions. We need to look at the true sources and address them, though I know that the systemic societal issues driving people to opioids in the first place are going to be very difficult to fix and keeping out the illegal drugs is impossible, but decriminalizing personal use to make it easier for people to get treatment for their addictions would be a great start.
TLDR: Prescription opioids are not the problem, illegal ones and the reasons people are turning to them to the first place are, and the overreaction is causing a lot of pain patients to suffer needlessly.
