Opioids: What Patients -- and Doctors -- Think
WebMD Health News
Dec. 30, 2015 -- After using prescription pain medicines known as opioids, more than one-third of respondents in a WebMD survey say they keep those medicines for future use.
About the same percentage, though, believe it's rare for those medications to fall into the wrong hands, despite what's been called a national epidemic of opioid dependence.
Both WebMD and its sister site, Medscape, conducted the surveys online -- WebMD of 1,887 consumers and Medscape of 1,513 health care professionals. The questions explored issues including opioid prescribing practices, use and disposal of these meds, and beliefs and awareness surrounding misuse and addiction.
Opioids are a class of powerful pain-relieving drugs. They include codeine, fentanyl, hydrocodone, morphine, and oxycodone, among others. They have similar effects to those of heroin -- euphoria and pain relief -- when they are misused.
The total number of opioid pain relievers prescribed in the United States has soared in the past 25 years, to more than 200 million. Meanwhile, the National Institute on Drug Abuse says opioid overdose deaths have more than tripled in the past 13 years. The CDC said earlier this month that these deaths, including from both prescription drugs and heroin, hit record levels in 2014, increasing 14% in just 1 year.
While consumers showed awareness of opioid risks, they seemed to believe addiction isn't something that would happen to them or their families. Nearly half say they have concerns about other patients becoming addicted, but only 21% are concerned for themselves or their loved ones.
- 35% say they have taken an opioid in the past 3 years.
- 92% of those say they have also explored alternatives to relieve pain.
- Over-the-counter medication tops the list of those alternatives (80%), followed by topical prescriptions (32%), or alternatives such as acupuncture (25%).
- But only 26% say those other options were effective.
That may be why 41% of patients say they save their unused opioids for future use, with nearly the same percentage -- 42% -- thinking it's rare for those to fall into someone else's hands, such as children's or teens'.
"I was struck by the number of unused opioids that patients are keeping," says WebMD medical editor Arefa Cassoobhoy, MD, MPH.
"Are people afraid of getting addicted and using less than they might need? Or, when doctors decide to give an opioid, are they giving more pills than they need to? I think research in these areas would help us understand how to educate patients and their doctors to use opioids safely and effectively."
Most health care providers pass on their concerns to their patients. The majority (86%) say they raise the risk of addiction and abuse with their patients, while 91% say they discuss how and when to take the medications, and 93% say they cover side effects.
Cassoobhoy says she is pleased to see that doctors and patients are discussing such issues. "That's an important conversation that needs to happen."
But those discussions don't always cover the full range of risks -- 45%, or nearly half of prescribers, say they do not discuss how to safely store or properly dispose of these medications. But 36% of health care providers say they believe opioids frequently fall into the wrong hands.
Health care professionals had other concerns, too.
99% of the 1,513 professionals say they're concerned about opioid misuse.
- 88% of them say they do prescribe such medications, but more than two-thirds report they now write fewer prescriptions for them.
- More than a third believe the backlash against opioids may be driving patients to drugs such as heroin or morphine.
Health care professionals were more likely to say that addiction, abuse, and misuse of the drugs frequently happens.
- More than half of health care providers say they think sharing opioid medications happens frequently, compared to 42% of consumers.
- 54% of providers say addiction frequently happens, compared to 46% of consumers.
About half of health care professionals say opioids are frequently taken other than as prescribed, compared to 46% of consumers. (Only 2% of consumers, though, say they share their medication.)
That should set off alarm bells, says pain specialist Peter Abaci, MD, of Bay Area Pain & Wellness Center in Los Gatos, CA.
"If nearly half of patients think there are addiction problems, that raises eyebrows," Abaci says. "And if you're a provider and you think over half of your patients are going to have addiction problems from the medications you're prescribing, why would you prescribe them? Those numbers may not be the true rates at which addiction occurs, but that's the perception."
"It's chronic pain that needs more of a different approach, a more comprehensive and less medication-intensive approach," he says.
According to the CDC, little evidence supports opioids' effectiveness for treating chronic pain, while such treatment is linked with both abuse and overdose. Abaci hopes that any regulations or changes in practice address such concerns about chronic pain treatment, but leave providers free to prescribe for conditions for which they have proved helpful.
"We don't want to see people with acute pain or cancer pain suffer," he says.
Abaci favors a comprehensive, multi-disciplinary approach to pain management that addresses the physical, psychological, and social aspects of chronic pain. But, he says, the health insurance industry and Medicare do not reimburse doctors for such care.
"People with chronic pain do better and see the best results when they get comprehensive care," Abaci says. "But how can you expect doctors to do better if you don't give them a system in which to offer that type of care? That's why you see such heavy dependence on the medication route of treatment."
SOURCES: Peter Abaci, MD, pain specialist, Bay Area Pain and Wellness Center, Los Gatos, CA. Arefa Cassoobhoy, MD, medical editor, WebMD. Press release, National Safety Council. CDC: "Prescribing Data." WebMD Consumer Opioid Survey, November 18 to December 8, 2015. Margin of error +/-2.25% at 95% confidence level. Medscape Opioid Survey, November 18 to December 8, 2015. Margin of error +/-2.25% at 95% confidence level.
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