Pros and Cons: Weighing the Benefits of Prescription Painkillers

For the past three decades we’ve been hearing a considerable amount regarding the dangers of prescription opioids. Whether one is a staunch advocate for their clinical use, a hardline objector to their widespread distribution or lies somewhere in the middle, it is impossible to ignore the damage these drugs have caused since their arrival into the American medical landscape. From 1999-2010, the number of opioid-related deaths in the United States has increased 400%[1]. In an addiction crisis that spans the globe, America accounts for 80% of all global prescription opioid abuse[2]. With the constant stream of damning testimony regarding the lethality of these pills, many, including the Editorial Board at the New York Times[3], have been taking a closer look at whether or not they’re really worth it.

A Look at the History

In 1997 two distinct panels of experts introduced new guidelines for chronic pain management [4], both of which encouraged the increased dispensation of prescription opioids. In 2001 the United States Congress declared the preceding ten years to be a “Decade of Pain Control and Research” meaning that they would instruct the scientific community to explore ways to effectively alleviate chronic pain [5]. Doctors were under more pressure to offer compassionate care for pain and saw opioids as the ideal solution. When examining the timeline of prescription painkiller addiction in this country, we can identify the development of these new guidelines as a critical moment in the epidemic’s genesis.

The Floodgates Were Opened

Shortly after the introduction of these guidelines and the government-led push toward more compassionate treatment for chronic pain sufferers, sales of prescription drugs skyrocketed. The Journal of the American Medical Association reported that between 1997 and 2007, sales of oxycodone increased 400%; sales of methadone increased 1300%; and sales of hydrocodone increased 900%. The climate had shifted toward an emphasis on symptom relief and the medical community became increasingly complicit in this new wave of prescription dispensation. The majority of the prescriptions abused during this period were prescribed by a doctor. 

Unforeseen Consequences

By the early 2000’s the United States was facing an unprecedented prescription drug epidemic, which year in and year out, was killing more people than heroin and cocaine combined. According to a 2011 White House report, prescriptions were rivaled only by marijuana in their popularity, with 7 million Americans over the age of 12 engaging in non-medical use in the past month[6]. This rise in use also gave birth to a small industry of pain management clinics that irresponsibly dispensed prescriptions for monetary compensation; many of these facilities have already been shut down and their operating doctors have been disciplined.

Prescription painkillers are still the number-one addiction threat facing the United States. However, as the government has begun to crack down on abuse and illegal dispensation, many former abusers are finding pills too difficult and expensive to obtain. This has driven many of them to transition to heroin, which shares largely the same effects and chemical makeup as prescription painkillers. The National Center for Health Statistics reports that heroin-poisoning deaths in America have increased 400% from 2000 to 2013. They also indicated a strong correlation between these deaths and the continued rise of opioids.

The Problem Continues

Although federal and state government have taken steps to reverse the course of this epidemic, recent national data indicates that little progress is being made. Last month the Centers for Disease Control and Prevention reported that the percentage of adults age 20 or over who are abusing prescription painkillers remains high and that between 2011-12, 7% of adults reported use within the past month. As officials and prevention advocates continue their efforts, 46 Americans overdose and die each day. Last year the CDC reported that physicians wrote nearly 260 million prescriptions, which is enough for every adult in the country. Further research will determine the efficacy of law enforcement’s latest prevention efforts.

Is It Worth It?

As the drawbacks of these drugs are made more and more evident, many have been wondering if their clinical benefits are outweighed by their fatally addictive properties. A recent review from the American College of Physicians’ Annals of Internal Medicine turned up insufficient evidence to determine the effectiveness of prescription opioids in treating long-term chronic pain[7]. Another study from the US Department of Health and Human Services’ Agency for Healthcare and Research Quality found that, while there was limited evidence regarding the opioids’ long-term effectiveness in chronic pain treatment, there was increased risk of harmful effects the longer opioid therapy continues[8]. The devastating impact of prescription opioid addiction has become impossible to ignore. Despite all of the temporary efforts we undertake – drug monitoring, databases, community involvement, etc. – we must ask ourselves two things: is the unprecedented fatality worth the pain-relief benefits and are there less dangerous means of treating long-term chronic pain?