Gavin: Surveys Says: We Still Have a Long Way to Go on Opioids

Thursday, December 15, 2016 | 0

Last week, I referred all of you to a piece by Dr. Stephen Martin, wherein he offers a critique of the Centers for Disease Control and Prevention opioid guidelines as well as the overall public health approach to opioid misuse and abuse.

Michael Gavin

While I disagreed with most of his views, I thought the article represented the kind of informed dialogue in which we need to engage in order to move the public policy discussion forward (and I further suggested that our collective ability to engage in rational, data-driven debate will make us or mar us as a society).

In the article, Dr. Martin cites a range of studies that put the risk of addiction to opioids somewhere between 2% and 10%. He also suggests that the CDC's lack of focus on diversion, wherein lawful prescription drugs end up being 'diverted' from their intended purpose and routed into illegal drug trafficking, is a major issue.  

He writes: "... the threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in a longitudinal clinical relationship."

Both those positions appear to be refuted by survey data collected by the Washington Post and Kaiser Family Foundation, and published in the Post on Friday. 

The Post and KFF surveyed 622 long-term opioid users (defined as use for two months or longer) and 187 household members of long-term opioid users. The survey was taken over a roughly five-week period from Oct. 3 through Nov. 9, and the overall results have a margin of sampling error of /- 4 points. 

We learn, among many other interesting things, that:

• 34% of long-term opioid users say they are/were addicted or dependent on opioids.
• 54% of household members say the opioid user is/was addicted or dependent.
• Nearly all long-term users (95%) said they began taking the drugs to relieve pain from surgery, an injury or a chronic condition. 
• Just 3% said that they started as recreational users.

Further, the presumption of safety within a "longitudinal clinical relationship" is called into question by the fact that while the survey suggests a largely positive relationship between patients and doctors, only 33% of patients reported that their doctors discussed a plan for getting off of the medication at the onset of therapy.

That's a standard best practice, and two-thirds of doctors aren't doing it.  

Despite all of this data, the vast majority of survey respondents say these drugs have dramatically changed their lives for the better. While their household members appear to have a different view, this highlights the difficult public health position in which we find ourselves. Benefits and risks aren't as clear cut as we wish they could be.  

Finally, I'm struck by staying power of the "100 million Americans in chronic pain" statistic. The Post uses it here and it remains a pervasive data point for the justification of long-term opioid use. But to steal a phrase from Dr. Martin himself (who stole it from Mencken), this statistic is "neat, plausible and wrong."

If we're going to have a debate about chronic pain, we have to start with the facts.

Michael Gavin is president of Prium, a medical managed care provider for the workers' compensation industry. This column was reprinted with permission from the firm's Evidence Based blog.