Doctors across America have been prescribing high doses of opioid painkillers and not carefully monitoring those patients to make sure they are okay, according to a study published in the Annals of Internal Medicine and funded by the National Institutes of Health.

The study found that the higher the dose of opioids prescribed, the more likely it is that patients might suffer an overdose. Without saying so directly, the study clearly implies that physicians have been remiss in their duty to monitor how patients are doing on higher doses of opioid painkillers.

The authors concluded that “patients who receive higher doses require careful monitoring” by prescribing physicians. Doctors need to make sure their patients follow directions exactly as prescribed, and are not experiencing unwanted side effects.

Patients who were prescribed 100 mg a day or more were found to be at nine times greater risk of overdose than patients who were prescribed 20 mg or less. Patients prescribed 50 mg to 99 mg day were at four times the risk of those lower dose patients.

The large, retrospective study was the first major investigation of opioid overdose and death statistics involving legitimate prescriptions. Previous studies of opioid overdose have focused only on illegal diversion of prescription drugs.

To explore the risks of overdose compared to prescribed dosage levels, the researchers analyzed opioid prescribing patterns for chronic non-cancer pain in 6,275 subjects from January 1, 1996, through December 31, 2005.

Study participants were Medicare beneficiaries from two states who were starting opioid therapy for nonmalignant pain for the first time. The drugs used included codeine, hydrocodone, oxycodone, propoxyphene, and tramadol. None of the patients had a cancer diagnosis, and none were using hospice or nursing home care. The authors compared the average daily opioid dose over the prior 90 days with reported fatal and nonfatal overdoses. The analysis revealed 51 opioid-related overdoses, six of which were fatal.

Not only are higher prescribed daily doses more dangerous, the study found, they are often unnecessary because of the evidence that higher doses don’t lead to better pain control. This also sounds like something physicians should have known about and could have dealt with through better patient monitoring.

In recent years, patients with chronic, non-cancer pain are increasingly being treated with long-term opioid therapy, with such as oxycodone, hydrocodone, propoxyphene, tramadol, codeine and many others. Medical journals, the news media and numerous physicians have criticized over-prescribing of opioids, and have called for better patient monitoring. The dangers of opioid overdose, the lack of effective pain management with higher doses, and the likely possibility of “opioid-induced hyperalgesia” — pain actually caused by opioids — have been a well known concern for decades.

It’s time that doctors followed up more frequently and closely with patients. As for the patients themselves, chronic pain can often be helped through alternative therapies such as Chiropractic and Acupuncture that do not carry the risks of opioids.

Annals of Internal Medicine, Dec. 2010, http://www.annals.org/content/152/2/85.abstract

This entry was posted on Monday, July 18th, 2011 at 6:25 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.