Narcotic Pain Killers Don't Raise Risk of Drug Abuse
April 4, 2000 (Ithaca, N.Y.) -- Physicians may hesitate to prescribe, and
patients may hesitate to take, strong painkillers such as morphine -- even when
pain is severe and chronic. Fear that use of these drugs will lead to drug
abuse is part of the problem, but a new study, reported in the April 5
Journal of the American Medical Association, says that increased use of
morphine for pain control during the past decade did not cause increased drug
David E. Joranson, MSSW, and colleagues at the University of Wisconsin
Medical School in Madison found that medical prescriptions for opioids, or
morphine-like drugs derived from the opium poppy plant, increased from 1990 to
1996. However, cases involving abuse of these drugs dropped from just over 5%
of all drug abuse cases to 3.8% during that same time.
This study was conducted using the government's Drug Abuse Warning Network
(DAWN) database, which tracks drug abuse-related health problems seen in
hospital emergency rooms.
"The barriers to use of opioid analgesics in pain management include the
fear that they will be abused," Joranson tells WebMD. "We asked what
effect, if any, the increased emphasis on use of opioids for pain management
has had on the abuse of these drugs. Our major finding was that the medical use
of opioid analgesics has increased, but there has been no corresponding
increase in abuse of opioids."
"The major implication of our study is that there is no support for the
fear that opioid abuse would increase if the appropriate medical use of opioids
increases," Joranson says. "From international as well as national
perspectives, the goal of pain management is to improve the relief of pain,
including through the use of controlled substances, while limiting abuse of
these drugs. Our study suggests this goal can be realized. However, it is
important to remember that there are many types of pain, and not all should be
treated with opioids."
Russell K. Portenoy, MD, who reviewed the study for WebMD, says that the
study provides "an important contribution to the process of destigmatizing
medical use of the opioid drugs, not only for physicians but also for the
regulatory and law-enforcement communities." Portenoy is chairman of the
department of pain medicine and palliative care at Beth Israel Medical Center
in New York City and is past-president of the American Pain Society.
"For the past decade, pain specialists have been saying that opioids are
underused in treatment of cancer pain, and we also feel they are [necessary]
for management of certain types of severe, chronic, nonmalignant pain. This
report should contribute to the evolution of how physicians look at the
risk-benefit ratio of the opioid analgesics," Portenoy says.
- Physicians and patients may be wary about using morphine and morphine-like
drugs as pain killers, fearing that their use could lead to abuse of the
- New research shows, however, that there has been an increase in
prescriptions of morphine and other opioids but a decrease in drug abuse cases
involving these drugs.
- One expert expresses hope that this study will encourage the medical use of
opioids, as many pain specialists believe they are not always used in cases
where they would be a good choice.