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Review
. 2013 Dec;154 Suppl 1(0 1):S94-S100.
doi: 10.1016/j.pain.2013.09.009. Epub 2013 Sep 11.

Opioid therapy for chronic pain in the United States: promises and perils

Mark D Sullivan  1 , Catherine Q Howe
Affiliations
Review

Opioid therapy for chronic pain in the United States: promises and perils

Mark D Sullivan et al. Pain. 2013 Dec.

Abstract

Opioid therapy offers the promise of reducing the burden of chronic pain in not just individual patients, but among the broad population of patients with chronic pain. Randomized trials have demonstrated that opioid therapy for up to 12-16weeks is superior to placebo, but have not addressed longer-term use. In the United States, opioid sales have quadrupled during 2000-2010, with parallel increases in opioid accidental overdose deaths and substance abuse admissions. Clinical use of long-term opioid therapy is characterized by a pattern of adverse selection, where high-risk patients are prescribed high-risk opioid regimens. This adverse selection may link these trends in use, abuse, and overdose. Long-term opioid therapy appears to be associated with iatrogenic harm to the patients who receive the prescriptions and to the general population. The United States has, in effect, conducted an experiment of population-wide treatment of chronic pain with long-term opioid therapy. The population-wide benefits have been hard to demonstrate, but the harms are now well demonstrated.

Keywords: Iatrogenic harm; Long-term opioid therapy; Mental health disorders; Pharmacoepidemiology; Substance use disorders.

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Conflict of interest statement

Conflict of interest statement:

Mark Sullivan has received educational grants from Pfizer, Covidien, and Endo. Catherine Howe has no conflicts to disclose.

Figures

Figure 1
Figure 1
Opioid consumption in USA
Figure 2
Figure 2
prescription opioid sales, deaths and substance abuse admissions in US
See this image and copyright information in PMC

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