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 abuse.
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 drugs.
- 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.