DONE WITH THEM

The patients who need opioids the most don’t seem to become addicted

The reason for the US opioid epidemic in the US, most public health experts believe, has everything to do with the nature of the drugs themselves.

Doctors prescribe powerful painkillers like Vicodin, OxyContin, and morphine to patients who may have severe pain as a result of surgery or illness. But because of the way opioids alter the brain’s reward system, many patients end up becoming dependent or addicted to these drugs and risk overdosing on them. Often, then, patients who visit the doctor for pain may end up trading one problem for another.

New findings, though, suggest this oft-repeated explanation might not tell the full story. In research presented at the 2016 Clinical Congress of the American College of Surgeons in Washington DC, surgeons from Brigham and Women’s Hospital in Boston showed that only about 1% of patients who suffered severe trauma and were prescribed opioids were still taking them a year later. The majority of them had stopped taking them after three months.

“Our findings in patients who sustain traumatic injury contradict the popular narrative about the role that appropriate use of opioids may play in the rate of opioid abuse in this country,” Andrew Schoenfeld, an orthopedic surgeon presenting the data, said in a statement.

For their work, the team looked at trauma cases reported in a military database from 2007 through 2016 with roughly 15,000 individuals. They followed patients who had severe injuries (scoring a nine or higher on a scale of one to 15), and required some form of pain management for a year. Although about half were prescribed opioids after leaving the hospital, only about 9% continued taking them after six months; that figure dropped to 1.1% after a year.

Schoenfeld and his team looked for particular risk factors that may have caused those patients to keep taking the painkillers. They found evidence that patients who were both older—45 to 64 compared to 18 to 24—and poorer, based on military rank when they were discharged from serving (less-senior personnel tended to be less wealthy, Schoenfeld said), tended to take opioids for longer.

These results can’t definitively say that patients who are severely hurt are less likely to become dependent on opioids. The findings have also not yet been published in a paper, let alone a peer-reviewed journal, and the data don’t show whether or not patients in the study were taking their prescriptions responsibly. Schoenfeld recommends that doctors still treat patients in pain with opioid drugs where needed, but thinks these results show that older or less wealthy patients may benefit from meeting regularly with a social worker or care manager as they make their recovery.

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