Painkillers prescribed chronically to many Americans on disability
Effectiveness of narcotic painkillers like OxyContin 'at best uncertain, and the risks are very real'
A growing number of Americans on work disability chronically use powerful prescription painkillers, according to a new study.
Researchers found that between 2007 and 2011, about 44 per cent of people receiving Social Security Disability Insurance benefits were prescribed narcotic painkillers each year. And the percentage using the drugs long-term rose from 21 per cent in 2007 to 23 per cent in 2011.
Experts said the trend is worrying because narcotic painkillers — which include OxyContin, Percocet and Vicodin — can be addictive, or abused by people with existing drug problems.
What's more, when it comes to typical workplace injuries, narcotic painkillers are not a good long-term solution, the study authors noted.
"The effectiveness is at best uncertain, and the risks are very real," said researcher Ellen Meara, of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
The findings, reported in the September issue of the journal Medical Care, aren't surprising, Meara noted. Nationwide, prescriptions for narcotic painkillers — also known as opioids — surged 300 percent after 1999, according to the U.S. Centers for Disease Control and Prevention (CDC).
On Thursday, the U.S. Drug Enforcement Administration said it was proceeding with tough new controls on painkillers containing hydrocodone, which has been tied to a surge in dangerous addictions across the United States.
"I think a lot of providers and patients may be overvaluing the immediate relief, and not taking the long view.- Dr. Eric Collins
The new restrictions would cover prescription narcotic drugs such as Vicodin, Lortab and their generic equivalents, putting them in the same regulatory class as painkillers such as Oxycontin, Percocet and codeine. Patients will now only have access to a three-month supply of the drug and will have to see a doctor to get any refills.
The new Medical Care study focused on Americans younger than 65 who qualified for Medicare benefits because of long-standing work disabilities. Most had a "musculoskeletal" condition, such as chronic back, neck or joint pain, which don't, in the long run, respond well to prescription painkillers.
"In the short term, people get some relief," said Dr. Eric Collins, physician-in-chief at Silver Hill Hospital in New Canaan, Conn., which specializes in psychiatric and addiction treatment.
"But there's no good evidence that long-term use is effective for non-cancer pain," Collins said.
Painkillers offer short-term relief
Despite that, Meara's team found an increase in chronic painkiller use — defined as six or more prescriptions. By 2011, nearly one-quarter of disabled workers were using a prescription painkiller long-term.
On the other hand, prescriptions overall dipped slightly. They peaked in 2010, when just under 45 percent of disabled workers got a painkiller prescription. A year later, that was down one percentage point.
"I do think there will be less prescribing now," Collins said, noting the national concern over what many call an "opioid epidemic."
According to the CDC, about 12 million Americans abused prescription painkillers in 2010 — meaning they used the drugs for nonmedical reasons. And in recent years, roughly 15,000 Americans have died annually from overdosing on the drugs. That's triple the rate in 1999.
Both federal and state governments have taken steps to control painkiller prescriptions. Some states now require doctors to check state-run prescription databases before prescribing a painkiller to help spot patients who are "doctor-shopping" to get multiple prescriptions of the same drug.
In this study, people who were chronically taking painkillers often had multiple providers. But Meara said it's not clear how many of them might have been doctor-shopping.
Multiple factors contribute to the widespread use of prescription painkillers, Collins said.
At one time, prescription painkillers were rarely used. But starting in the 1980s, there was growing concern that many people in chronic pain weren't adequately treated. Pain came to be considered the "fifth vital sign," Collins noted, and doctors began to increasingly turn to narcotic painkillers.
The drugs do bring quick relief — at least in the short term. "It takes a lot longer to talk to patients about physical therapy, exercise and diet changes to lose weight, which might help with musculoskeletal pain," Collins said.
Plus, he noted, for people who have long been sedentary, the idea of becoming active when they're in pain could seem daunting.
"I think a lot of providers and patients may be overvaluing the immediate relief, and not taking the long view," Collins said.
Besides the risk of addiction, there are more common side effects of the drugs, such as chronic constipation. Also, research suggests that long-term use of prescription painkillers can ultimately worsen chronic pain, Collins said.
The truth is, Meara said, treating chronic pain is difficult. Common problems such as low back pain have no one-size-fits-all therapy, but a number of non-drug options exist, such as exercise, over-the-counter pain medications, acupuncture and biofeedback.
"We need to be cautious about moving to these drugs too quickly," Meara said. "And I think we need to be concerned about whether we're taking care of these patients adequately. We need to do a better job."