Men more likely to die from high-dose opioid use for chronic pain

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http://www.ctvnews.ca/health/men-more-l ... -1.2526374

That's why I always say not to use these drugs long term

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Daniel Clauw, MD, professor at the University of Michigan in Ann Arbor, pain specialist:

Let me first acknowledge that as a pain researcher, I'm on one far end of the continuum with respect to opioids, and I think opioids should hardly ever be used to treat chronic pain. I really worry — and I give lectures about this — that those of us in the pain field haven't been as strongly anti-opioid as we should be.

If you look, there have only been a couple of studies that have randomized someone with chronic pain to opioids vs non-opioids and followed them for a year, including the Krebs study 4 or 5 years ago, and then a very recent study did the same thing.

What people failed to note in both of those studies is that the group of people that received the opioids didn't just not do better than the non-opioid people, they did worse. In both of those trials, when people got to a year out, the opioid-treated patients had statistically worse pain scores than the non–opioid-treated patients; these were two long, prospective trials where people were randomized to either opioid or non-opioid therapy.

I have always worried that in any group of chronic pain patients, if you look at those on opioids, they always look worse in every way. People say that's been confounded by indication and that we put the people with worse pain on opioids. I don't think that's true. I think that opioids actually make pain worse for a subset of patients with chronic pain. Because of that, we really should be using these as a last line if people are refractory to everything else. There just is not the evidence base.

The other thing that I don't think people are aware of is how high the all-cause mortality is. When someone is on an opioid, it's 70% higher or double in every year. It's not because of overdose deaths, but it's due to higher rates of myocardial infarctions, motor traffic accidents, suicides, and many other things that people die of at very high rates when they're taking an opioid.

I'm sorry about the rant, but I really do think we should be putting opioids where they were 25 years ago: You use them only when nothing else has worked.