Positive History of Addiction
The authors deserve thanks for their thorough description of the alarming trend in opiate prescriptions (1). Psychological aspects have a major role in chronic, non-cancer-related pain, and it is for this reason that the usual escalation in diagnostic evaluation and therapy that characterizes modern hi-tech medicine often does not yield any improvement but actually results in deterioration.
The probability that patients without any history of addiction develop an addiction disorder de novo when given opiate analgesia is extremely low. The fact that the literature keeps reporting relatively high prevalence rates of addiction problems in patients receiving opiate analgesia—the authors of a recent review article estimated that “opioid use disorders” occur in up to a third of patients (2)—this indicates that the drugs are often prescribed to patients with a medical history of addiction. It is not surprising that these patients tend to increase their doses, which will have serious side effects including death from overdose (3). American and Canadian guidelines analyzed the problem and recommend certain screening instruments (4).
The longer term effectiveness of opiate analgesics in chronic, non-cancer-related pain has not been confirmed; the optimistic assumption that these medications are harmless does not stand up to further scrutiny, which also applies for the risk of addiction, and the increase in prescriptions is not primarily of benefit to cancer patients. This sobering conclusion needs to be acknowledged.
Dr. med. Dirk K. Wolter
Specialeansvarlig overlæge Gerontopsykiatrisk enhed
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Schubert I, Ihle P, Sabatowski R: Increase in opiate prescription in Germany between 2000 and 2010—a study based on insurance data. Dtsch Arztebl Int 2013; 110(4): 45–51 VOLLTEXT|
|2.||Juurlink DN, Dhalla IA: Dependence and addiction during chronic opioid therapy. J Med Toxicol 2012; 8: 393–9 CrossRef MEDLINE|
|3.||Wolter DK: Suchtgefahr und andere Risiken von (Opiat-) Analgetika – unterschätzt oder übertrieben? Psychotherapie im Alter 2012; 9: 197–212.|
|4.||Kahan M, Wilson L, Mailis-Gagnon A, Srivastava A; National Opioid Use Guideline Group: Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations. Can Fam Physician 2011; 57: 1269–76, e419–28. MEDLINE|