Magazine article Clinical Psychiatry News

Opioid Overuse. (Guest Editorial)

Magazine article Clinical Psychiatry News

Opioid Overuse. (Guest Editorial)

Article excerpt

Recently, at the annual meeting of American Academy of Pain Medicine, I heard speaer after speaer advocating more liberal use of opioids in the treatment of all types of pain without distinguishing among acute pain, chronic pain, headache, neuropathic pain, or cancer pain. In my opinion, an uncontrolled trend is underway toward the more liberal use of opioids without discriminating patient from patient or illness from illness.

Five years ago my colleagues and I increasingly began seeing patients with intractable headache who were using immense amounts of opioids. Although I have advocated for a liberalization of opioid use, I am sounding this caution because advocacy has surpassed the development and dissemination of sound principles of use. We must develop guidelines and standards of care before we open floodgates that hurt people, forcing a return to more Neanderthal thining about treating pain.

Who should be given these drugs for long-term use, and who should give them? If we say there is a place for opioids in treating refractory headache, how do we define refractory?

I am seriously concerned that opioids are used as a first-line treatment or as early treatment in patients who have not had the benefit of expert or advanced pain care. It is my view that only rarely should opioids be administered by primary care doctors before referral to pain specialists or tertiary care centers.

Perhaps opioids should be used only as first-line treatment for headache in elderly patients who can't take other treatments but who might obtain relief from small-dose opioid therapy without significant consequences to major organ systems.

There should be different criteria for the use of sustained opioids in younger patients than in older ones. Currently, our inpatient program has six teenagers under the age of 17 with intractable headache that impairs them from going to school. Five of the six are on huge doses of daily opioids. I thin that's a problem.

We don't know what we will be doing to young people if we put them on opioids for 5 or 10 or 20 years. I've seen 70-year-old women and men who have been on opioids for 25 or 30 years. …

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