Long-term Opioids for Chronic Low Back Pain, A Destructive Treatment 

The USA has less than 5% of the world’s population and consumes 85% of the world’s prescription opioids.  Prescription opioids have been the cause of 150,000 deaths in the past 15 years, triple the number of American deaths in the Vietnam war.  Death toll in the United States from prescription opioids currently exceeds 16,000 per year. 

The risks of long-term opioid therapy vastly outweigh proven benefits.  It is associated with iatrogenic harm.  It has been observed that a third of opioid deaths relate to the diversion of opioids, receiving them out of the medical system, and over 50% because of overprescribing and misuse of these medications. 

Most deaths occur as a result of respiratory arrest during sleep. 

There is considered to be a small subset of patients, not clearly proven, who may be appropriate candidates for long-term opioid therapy. 

The American Pain Society has published that chronic opioid therapy can be an effective therapy for carefully selected monitored patients with chronic non-cancer pain, and this is also noted in the Canadian Practice Guidelines.  However, there is an absence of evidence on the benefits and risks from long-term randomized controlled trials on opioid therapy for chronic non-cancer pain and there remains a huge death toll and suffering related to this treatment. 

The long-term benefits of chronic opioid therapy for pain and function remain uncertain.  Epidemiologic studies have suggested that long-term use does not result in improvement in function or quality of life, and in a fair number of patients results in worse pain, worse reported health, lower level of activity and unemployment, higher healthcare utilization, and poorer quality of life. 

The recently published adverse effects of long-term opioids include respiratory depression, which can lead to death, falls and fractures, chronic constipation and intestinal blockage, hypogonadism, impotence, infertility, osteoporosis, cognitive and neurophysiologic effects of sedation, sleep disruption, hyperalgesia, depression, anxiety, deactivation, apathy, addiction and therefore opioid misuse, and dry mouth, which may lead to tooth decay. 

Recognition is given to The Back Letter, Volume 29, Number 2, February 2014, pages 118, 119, 120, and 121, in addition to R. Fu, Annals of Internal Medicine, 2013, H. Krumholz DMJ 2013, C. Laine-Annals of Internal Medicine, 2013, M. Rogers-DMJ 2013, N. Simmonds-Annals of Internal Medicine, 2013, K. Siontis-DMJ 2013

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