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Treatment with opioids not superior to treatment with non-opioid medications — Study

A study pub­lished by the Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion finds that treat­ment with opi­oids was not supe­ri­or to treat­ment with non-opi­oid med­ica­tions in patients with chron­ic back pain, hip or knee osteoarthri­tis pain.

You can find the full study here: http://ow.ly/veOf30iO8ms

Comments

So how, exact­ly, would a small sam­pling of 5,000 people“s waste water pro­vide any mean­ing­ful data when the infor­ma­tion col­lect­ed would be so abstruse and ambigu­ous? A bet­ter approach might be to probe the caus­es and sources of opi­oid addic­tion. How about study­ing alter­na­tive means of pain alle­vi­a­tion, and mak­ing opi­oids hard­er to obtain by impos­ing rules or lim­its on doc­tor pre­scrip­tions and phar­ma­ceu­ti­cal com­pa­nies” adver­tis­ing to doc­tors and patients? Not to men­tion pro­vid­ing psy­cho­log­i­cal coun­sel­ing for addicts? By the time the waste water test­ing eval­u­a­tion is done, there will be many more addicts and over­dos­es added to the list before any reme­di­al action can be estab­lished. There are oth­er meth­ods for deal­ing with opi­oid addic­tion that would be faster more effective.

It needs to be not­ed that this tri­al only involved 240 patients treat­ed for chron­ic pain in US Depart­ment of Vet­er­an Affairs. It has been wide­ly and false­ly mis­rep­re­sent­ed as proof that opi­oids are no more effec­tive than non-opi­oid treat­ments for chron­ic pain, which is an entire­ly false state­ment. Mil­lions of chron­ic pain patients have been effec­tive­ly tak­ing opi­oids, even extreme­ly high-dose opi­oids for long-term pain con­trol for hun­dreds of years sim­ply because no oth­er pain-reliev­ing modal­i­ty even com­pares with their effi­ca­cy. To sug­gest so is sim­ply ludicrous.

Addi­tion­al­ly, the sup­ple­men­tary mate­r­i­al from this study reveals that the mean dose of opi­oid was 21 MMED, and only 12.6% of patients ran­dom­ized to the opi­oid group were tak­ing over 50
MMED (which are both rel­a­tive­ly min­i­mal dos­es). Con­se­quent­ly, in lieu of false­ly claim­ing that opi­oids are no more effec­tive than non-opi­oid treat­ments for chron­ic pain, the results of this small tri­al should be more accu­rate­ly con­strued as: 1) patients whose pain is insuf­fi­cient to actu­al­ly war­rant opi­oid treat­ment do not par­tic­u­lar­ly ben­e­fit from opi­oids., and/or 2) opi­oids are of no ben­e­fit to patients with mod­er­ate to severe chron­ic pain when opi­oid dosage is insufficient. 

More suc­cinct­ly, the “study” was obvi­ous­ly specif­i­cal­ly struc­tured in a man­ner that would best demon­strate the study’s pre­con­ceived bla­tant­ly false state­ment. Non-opi­oid pain med­ica­tions are NOT any­where near as effec­tive as opi­oid pain med­ica­tions when admin­is­tered prop­er­ly and in suf­fi­cient dosages. Addi­tion­al­ly, many non-opi­oid pain med­ica­tions are sig­nif­i­cant­ly more dan­ger­ous than opi­oid pain med­ica­tions. Approx­i­mate­ly the same num­ber of peo­ple die every year from liv­er dam­age caused by non-opi­oid pain med­ica­tions as do from legal­ly pre­scribed opi­oid med­ica­tions tak­en specif­i­cal­ly as prescribed.

It needs to be not­ed that this tri­al only involved 240 patients treat­ed for chron­ic pain in US Depart­ment of Vet­er­an Affairs. It has been wide­ly and false­ly mis­rep­re­sent­ed as proof that opi­oids are no more effec­tive than non-opi­oid treat­ments for chron­ic pain, which is an entire­ly false state­ment. Mil­lions of chron­ic pain patients have been effec­tive­ly tak­ing opi­oids, even extreme­ly high-dose opi­oids for long-term pain con­trol for hun­dreds of years sim­ply because no oth­er pain-reliev­ing modal­i­ty even com­pares with their effi­ca­cy. To even sug­gest that non-opi­oid treat­ments are com­pa­ra­ble opi­oid treat­ment is ludicrous.

Addi­tion­al­ly, the sup­ple­men­tary mate­r­i­al from this study reveals that the mean dose of opi­oid was 21 MMED, and only 12.6% of patients ran­dom­ized to the opi­oid group were tak­ing over 50
MMED (which are both rel­a­tive­ly min­i­mal dos­es). Con­se­quent­ly, in lieu of false­ly claim­ing that opi­oids are no more effec­tive than non-opi­oid treat­ments for chron­ic pain, the results of this small tri­al should be more accu­rate­ly con­strued as: 1) patients whose pain is insuf­fi­cient to actu­al­ly war­rant opi­oid treat­ment do not par­tic­u­lar­ly ben­e­fit from opi­oids., and/or 2) opi­oids are of no ben­e­fit to patients with mod­er­ate to severe chron­ic pain when opi­oid dosage is insufficient. 

More suc­cinct­ly, the “study” was obvi­ous­ly specif­i­cal­ly struc­tured in a man­ner that would best demon­strate the study’s pre­con­ceived bla­tant­ly false state­ment. Non-opi­oid pain med­ica­tions are NOT any­where near as effec­tive as opi­oid pain med­ica­tions when admin­is­tered prop­er­ly and in suf­fi­cient dosages. Addi­tion­al­ly, many non-opi­oid pain med­ica­tions are sig­nif­i­cant­ly more dan­ger­ous than opi­oid pain med­ica­tions. Approx­i­mate­ly the same num­ber of peo­ple die every year from liv­er dam­age caused by non-opi­oid pain med­ica­tions as do from legal­ly pre­scribed opi­oid med­ica­tions tak­en specif­i­cal­ly as prescribed.

Michael McAulay

Take a look at the lim­i­ta­tions sec­tion of the study. It specif­i­cal­ly states the results do not apply to long term opi­oid treat­ment patients.

There is an essen­tial rea­son for this. Stud­ies like this find it “chal­leng­ing” to get long term opi­oid patients to stay in the stud­ies because when giv­en a place­bo, they are in intense pain. So they drop out. This is a seri­ous issue in clin­i­cal tri­als regard­ing chron­ic pain and opi­oid therapy.

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