CINCINNATI—University of Cincinnati (UC) researchers are asking the medical community to consider its own role in the rise in prescription opioid abuse, calling for more research on iatrogenic addiction (addiction resulting from medical treatment) and changes in the way medical providers are educated about pain management.
In a commentary published online ahead of print Sept. 11, 2014, in the American Journal of Public Health, the researchers say that the current epidemic of drug overdose deaths requires the medical community to look beyond traditional programs aimed at combatting drug misuse and diversion.
Instead, the authors say, more attention should be paid to how pain is treated for patients who are using prescription opioid medications as prescribed. Opioids are medications that work in a way similar to morphine and heroin.
In 2010, approximately 46 Americans died each day in the U.S. as a result of an overdose involving prescription opioids. This increase in overdose deaths, the authors write, parallels the increase in sales of prescription opioids.
"Clearly, there is a need to reduce the number of pain pills available to those who are abusing them and there are many efforts underway to do that,” says lead author Gillian Beauchamp, MD. "Our question is how do people become addicted in the first place, and how often does the spiral into addiction begin even though the patient is taking pain medication just as their doctor told them to?”
Over the past several decades, Beauchamp says, medical providers have been taught to treat pain and not worry about addiction. But, she says, given the current opioid epidemic, it now seems likely that doctors’ legitimate attempts to treat pain have actually helped to cause addiction in at least some cases.
"As physicians, we routinely warn patients about the risks of sedation from these medications, but rarely discuss the risk of addiction,” says senior author Michael Lyons, MD. "That should change right away, but the situation is difficult because we don’t know precisely how big the risk is.”
Lyons and team argue that research is urgently needed so that providers are able to judge when the risks of addiction are justified by the need to treat pain, and communicate these risks to patients.
"To do this, we need to better understand the potential risk of opioid addiction when treating pain, and which patients have the greatest risk of becoming addicted,” Lyons says.
UC researchers working in the emergency department at University of Cincinnati Medical Center are now conducting a study among patients with opioid addiction to determine what led them to become addicted.
"Physicians should once again become mindful that prescription opioids may lead to addiction in susceptible patients, even when prescribed and used appropriately,” the authors write. "This recognition necessarily requires that the mission to treat pain must be balanced to at least some degree by a mission to prevent opioid abuse and addiction.”
Beauchamp, previously a chief resident at UC, is now a fellow of clinical toxicology at Oregon Health and Science University. Lyons and coauthor Shawn Ryan, MD, are faculty within the UC Department of Emergency Medicine. Winstanley is an assistant professor in UC’s James L. Winkle College of Pharmacy and holds a joint appointment in the UC Department of Psychiatry and Behavioral Neuroscience.