> America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths
The US uses far more opioids than any other country. Does the US have far more pain than any other country?
> and more suffering for patients.
No.
You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain.
People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.
> You seem to think that opioids are an effective treatment for long term pain
Because it can be. In many cases of severe persistent pain, they are the only effective treatment. There are many situations where literally nothing else works save for anesthetic infusions.
> and is now addicted to opioids
Those patients and doctors are making the determination that addiction is better than the alternative. Why is anyones business if that is what they decide? Frankly being addicted to a prescription painkiller is not any different from addiction to ADHD medication, a benzodiazepine (which are far worse in terms of addiction, withdrawal, and consequence), or an anti-depressant.
> People with long term pain need rapid access to a specialist pain management clinic.
Sure. But do you expect a patient to come back every 6 hours for another lidocaine injection? What do you think they do in pain management clinics? If you think the side effects of an opiate are bad wait until you see people on heavy gabapentin or benzodiazepenes as 'alternatives', who, btw are getting practically no relief from their pain at all but are heavily medicated.
> Given the limited duration of clinical trials, data on efficacy of long term opioid use are available only from case series and open-label extensions of controlled trials. These latter have been systematically reviewed. Open-label extension data suggest that a small proportion of patients may derive continuing benefit from opioids in the long term but the relevance to clinical practice is uncertain as patients with co-morbidities that may predispose to problematic opioid use are generally excluded from clinical trials and evaluation of long term use does not, in these studies, identify potential benefits from placebo effect, benefits of additional therapies or spontaneous resolution of symptoms.
> Analysis of open label data does not enable firm conclusions regarding improvement in function or quality of life with long term opioid treatment. Data from prospective cohort studies suggest that opioids retard return to work after injury and may prolong functional recovery or worsen physical functioning. A Danish cross-sectional study has suggested that when comparing opioid users with non-opioid users, opioid use appears to be associated with poorer self-related quality of life and employment status, increased healthcare use, and worse pain. These studies do not demonstrate causality in relation to opioids and poor function in a number of domains but indicate that the hoped for end points of pain reduction and improvement in function are not being met with long term opioid treatment.
Particularly:
> Important Practice Points
> Patients who do not achieve useful pain relief from opioids within 2-4 weeks are unlikely to gain benefit in the long term.
> Patients who may benefit from opioids in the long term will demonstrate a favourable response within 2-4 weeks.
> Short-term efficacy does not guarantee long-term efficacy.
> Data regarding improvement in quality of life with long-term opioid use are inconclusive.
> There is no good evidence of dose-response with opioids, beyond doses used in clinical trials, usually up to 120mg/day morphine equivalent. There is no evidence for efficacy of high dose opioids in long-term pain.
That "no evidence" bit should worry you. Why doesn't it?
> Those patients and doctors are making the determination that addiction is better than the alternative
Because, as the RCA keep saying: opioids are not treating the pain, and are causing harm to the patient. Patients keep taking the meds not because those meds work, but because they are addicted to those meds.
Your comments are best summarized as "I have no experience on this matter but I can spend a few seconds on google and then copy and paste" which may work well for writing a shell script but fortunately it's not how medicine or health care works.
You make it sound like I only just googled these. Even if that's true (and it's not, and that's trivially easy to check) so what? I'm posting government level advice backed by meta analysis.
Your the one posting your opinion. Frankly, I don't care about your personal experience. Look at eg knee arthroscopy for an example of how useless personal experience of both patients and doctors in health care.
https://www.vox.com/policy-and-politics/2017/6/28/15881246/d...
> America has about 4 percent of the world’s population — but about 27 percent of the world’s drug overdose deaths
The US uses far more opioids than any other country. Does the US have far more pain than any other country?
> and more suffering for patients.
No.
You seem to think that opioids are an effective treatment for long term pain. They usually are not. The patient either stops taking them because of side effects, and is still in pain. Or the patient develops a tolerance, and needs to take more and more, and is now addicted to opioids and taking dangerously large amounts of opioids and, importantly, is still in pain.
People with long term pain need rapid access to a specialist pain management clinic. Opioids might be a choice of treatment, but they will be carefully prescribed, not dished out.