Balance Sought to Help Curb Growing Opioid Abuse

By Foxhall, Kathryn | Drug Topics, May 7, 2007 | Go to article overview

Balance Sought to Help Curb Growing Opioid Abuse


Foxhall, Kathryn, Drug Topics


In recent years, medicine has encouraged a more liberal use of opioids for the control of pain. But as the drugs have indeed been used more liberally, the level of abuse and addiction has also increased.

At a recent conference hosted by the National Institutes of Health on the tension between the two problems, Nora Volkow, M.D., head of the National Institute on Drug Abuse (NIDA), cited statistics confirming that in 2006 Vicodin (hydrocodone bitartrate and acetaminophen, Abbott) was the second most frequently abused drug by teenagers. In addition, in 2005 Vicodin and equivalent opiate formulations had more new abusers than did marijuana. And between 1999 and 2004, the number of overdoses in persons 15 to 24 years old doubled, with most of the overdoses ascribed to opiate analgesics.

Volkow emphasized, however, that the issue is particularly difficult, because these medications "are extremely useful for the treatment of pain and can be life-saving for many patients. So the issue requires much more knowledge to start with, and, in my perspective, cooperation between two fields that for many years have not really talked to each other."

Indeed, she asserted, a dialogue might find that, in some cases, "treating pain properly may be preventive against addiction."

Much of the meeting focused on how much more information is needed in order to use opioids well and avoid another historic opinion swing against their use.

Nathaniel Katz, M.D., M.S., director of the program on opioid risk management at Tufts Health Care Institute, noted that opioids don't work for everyone. In fact, he said, "the response rate in most clinical trials of opioids is probably in the 30% to 40% range of patients getting meaningful response." With opioid therapy, he continued, "it is part of the obligation of the physician to implement some sort of success criteria. ... And if somebody is not benefiting from opioid therapy or can't comply with it, then get them off."

Steven D. Passik, Ph.D., associate attending psychologist at Memorial Sloan-Kettering Cancer Center in New York, said that in a 400-patient survey he and colleagues did, 45% of pain patients had some aberrant behavior. …

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Balance Sought to Help Curb Growing Opioid Abuse
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