We've known for a while. However, when you tie compensation to patient satisfaction scores, guess what happens. Luckily I work for a department that acknowledged the risks early and created formalized guidelines for narcotic prescriptions. Even having written policy handouts still doesn't prevent me from having to call security at least once a shift to escort out agitated patients who believe they are owed narcotics.

In the context of this study, what does "for a year" mean in regards to using opioids? Is it a continuous, had a prescription fill every month for 12 months? Is it just had another fill a year later? I feel I'm not really understanding exactly what outcomes the study measured.

I'd never taken opiods (generic Vicodin) before severely fracturing my arm. It took a week for surgery to be scheduled so I took them for about three weeks before weaning myself off of them and then stopping. Had nasty withdrawal symptoms for several days - can only imagine how difficult it must be for people who take them for any real length of time.

In the context of this study, what does "for a year" mean in regards to using opioids? Is it a continuous, had a prescription fill every month for 12 months? Is it just had another fill a year later? I feel I'm not really understanding exactly what outcomes the study measured.

For a year = continued use for a year starting from the initial prescription with a gap no greater than 30 days.

In the context of this study, what does "for a year" mean in regards to using opioids? Is it a continuous, had a prescription fill every month for 12 months? Is it just had another fill a year later? I feel I'm not really understanding exactly what outcomes the study measured.

For a year = continued use for a year starting from the initial prescription with a gap no greater than 30 days.

Thanks! Seems in line with my initial impression before my cynicism had me questioning it.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

This assumes that most if not all of these patients on long term opiates don't actually need them. This is simply not the case, life-long pain due to permanent damage is quite real. A lot of it comes from the simple fact that the back-bone evolved for quadrupeds and modified for bipedal walking in a horrible hacked way that would horrify any structural engineer, tack on the obesity epidemic and you have the perfect storm for spinal cord damage

In the context of this study, what does "for a year" mean in regards to using opioids? Is it a continuous, had a prescription fill every month for 12 months? Is it just had another fill a year later? I feel I'm not really understanding exactly what outcomes the study measured.

For a year = continued use for a year starting from the initial prescription with a gap no greater than 30 days.

The paper also notes that this study doesn't include prescriptions paid out of pocket or any opioids obtained illegally so the reported rates are likely underrepresentation.

On the whole, the results are not terribly surprising. Patients with more serious issues are likely to be prescribed a longer initial course of pain management and continue using them for a longer duration. Also note that the observation period was 2006 through 2015, so a good chunk of the study was before people really started to realize how problematic long term opioid use is and certainly before the new (2016) CDC guidelines.

I think that there is a genetic component involved in the addiction. I am a cancer patient and had been on OxyContin and oxycodone for +4 years. Once I realized that the opioids were making me an aggressive asshole, I went a reduction schedule and stopping completely within 60 days. I had zero withdrawal symptoms. Now I manage with over the counter pain drugs.

Or, people in severe need of pain relief has the same need over a long time?

Sure, but this is still useful information for doctors even in that context. If as a doctor you know your patient will need at least 10 days of it, you can now be aware of the likelihood that the patient will need the same drugs for much longer. Since there is a 0% chance of a patient using these for a full year and not getting addicted, a doctor should be aware of the potential consequences when starting treatment.

That doesn't mean indefinite opioid prescriptions are universally bad though. My grandmother was unwell for a very long time and suffering from extreme pain. She and her doctors were fully aware that she was addicted to the medication, but she wasn't going to ever recover anyway so this was the best they could do.

I have never been in the kind of pain that requires this kind of medication so I know that I'm not qualified to make a cost-benefit analysis here, but I find it hard to believe that these drugs are really the best we can do for people in chronic severe pain.

I'd like to see the diagnoses for greater than 10 day prescriptions. Did those people have a potentially chronic condition and that lead to long-term use?

I have neuropathy from chemotherapy, and I was in terrible pain for 12 years due to being under-medicated. I would have fallen into the long-term user category. But the solution for me wasn't opioid reduction, but switching to extended release morphine. The unintended consequence of all these crackdowns is people with moderate to severe chronic pain being undermedicated, while doing nothing to stop addiction.

Doctors have a role in not prescribing opioids willy-nilly, but to claim that opioids shouldn't be used in chronic conditions is absurd.

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

The problem is all opioid use is the same when in there are very different valid use cases beyond the guidelines. Also, drug abuse and deaths from drug abuse have been occurring forever. What changes is the current drugs being abused. So a crackdown opioids will in reality shift much of the problem to other dangerous drugs. Then we will have a "new epidemic" of X.

I find the headline and general use of the word "opiod" a little too generic (no pun intended). The article only makes a few specific mentions of different types of opiod, does the study make the same distinctions? I'm sure the addiction rates for Vicodin are different from OxyContin are different from fentanyl (edit: oops, not the same as fenfen).

I'm sure this will spur massive new public policy reports on reducing opiod consumption and new research on marijuana effects on those with chronic pain. /s, just the last sentence

Also this article address chronic vs acute pain in that they are moving away from even using these drugs to treat chronic pain (that's pain that lasts a long time), this article is in regards to short term, acute pain.

I find the headline and general use of the word "opiod" a little too generic (no pun intended). The article only makes a few specific mentions of different types of opiod, does the study make the same distinctions? I'm sure the addiction rates for Vicodin are different from OxyContin are different from fentanyl (fenfen).

I'm sure this will spur massive new public policy reports on reducing opiod consumption and new research on marijuana effects on those with chronic pain. /s, just the last sentence

The paper is linked in the article and does compare different medications and classes of medications. Also, fentanyl is not "fenfen." "Fen-phen" is a combination anti-obesity drug that has nothing to do with opioids.

Or, people in severe need of pain relief has the same need over a long time?

If only. It is an ever growing need when opiates are involved, which is the problem.

Not necessarily.

I have been prescribed a variety of painkillers for many years now, and whilst it took a number of years to achieve an effective combination, the prescription mix that I now take (which includes both co-codamol and tramadol) has not changed for more than a decade.

I hear the withdrawal from tramadol is pretty nasty as well, these also come in a long acting so I'm wondering why it's singled out as it is?

Correct. It does vary with the individual, but I can tell you it was bad. The only thing I've experienced worse was withdrawing from 3mg of Ativan daily (for a year). That took over two weeks of living hell to get over. I had no "lesser drugs" or herbs to blunt the withdrawals. Just weeks of continuous hot and cold sweats, panic attacks, and literally zero sleep at night. I couldn't even sit down for more than a couple of minutes at a time before having to get up and pace.

Also this article address chronic vs acute pain in that they are moving away from even using these drugs to treat chronic pain (that's pain that lasts a long time), this article is in regards to short term, acute pain.

Beyond excluding cancer patients and those with a history of substance use disorder, this study makes no well defined distinction between the acute vs. chronic pain/diagnosis.

Broke my arm in two places a long time ago, 25 years ago. They gave me a prescription for Percocet as if it was aspirin. Took one pill and after the effects wore off threw the rest away and started taking tylenol instead.

My mom was given Oxycodone from her Dr. for arthritis pain and by the time she passed away in 2001, she had been addicted for some time.

If everyone would have their CYP2D6 gene tested prescribers would know if a patient would metabolize a drug quickly, normally, or poorly. Knowing that would help in prescribing the appropriate treatments.

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

I've been taking daily opioids for over a decade and I wonder the same thing. I've never felt any high from opioids at a prescribed dose, but euphoria is common at higher doses.

The biggest problem with opioids is the physical dependence. Even missing one dose can leave you feeling lethargic, nauseated, or malaise. Withdrawal symptoms are terrible. In addition, opioid tolerance builds up after time. Addicts require increasing dosages to get high. The makes the withdrawal symptoms worse and the viscious cycle spins out of control.

And since we put people in jail instead of treating them, you get the problem we're currently experiencing.

I don't understand what this even means. As someone who right now is sitting behind this keyboard recovering from spine surgery to remove constant pain, sometimes you NEED pain killers.

If someone only gets a supply for 5 days, maybe they had a splinter and they only needed a supply for 5 days. If they got a supply for a whole month, maybe it was a big freaking deal and not just a splinter, but a real pain that may not be going away FOR LIFE until surgery is performed. Anyone can logically look at that and realize they will need multiple months. They aren't getting refills for jollies. They are getting refills, from an initial uncommon 30 day supply, again indicating it was more than just a splinter, because the pain is still there.

My background is I had a herniated disc into the spinal cord and nerve root to my right arm. All feeling and movement was replaced with numbness and nails driven through every inch of my arm from my finger tips to my neck. You can't sleep. You can't raise you head. You suffer. Pain meds made it bearable. I had this for 6 months until surgery last week which thankfully removed all the pain. I actually went the last 2 months on no pain meds. Mainly because I didn't enjoy at all going through the stigma and judgement attached to "I need another refill" from someone who has never experienced real pain before and has decided that I am a junkie. Oh how I wished I could have just left the pain with them and went home normal while they lived in my hell. So I just kept my last 30 day supply as an emergency and dealt with it, knowing I had surgery coming.

There is no limit to the sympathy I feel for people with chronic pain that there is no fix for. If they want pain meds, let them buy them. If they want to die on pain meds, I understand. Keep them away from those who don't need them.

As for this article, I don't see where the length of a prescription means anything other than a correlation to the severity of the injury and stigma against the patient.

My grandmother was unwell for a very long time and suffering from extreme pain. She and her doctors were fully aware that she was addicted to the medication, but she wasn't going to ever recover anyway so this was the best they could do.

My mother went through the same thing before she died. She had an inoperable problem with her spine, replaced hip, replaced knee, kidney disease, fatty liver disease, severe arthritis, diabetes, etc. She was continuously in a lot of pain. The last year she was alive, she was on extended release morphine and oxy. I am glad that she was able to get some comfort (although it did not eliminate her pain), but being on high doses of those drugs means I actually lost my mother before she died. She wasn't the same person anymore.

In the context of this study, what does "for a year" mean in regards to using opioids? Is it a continuous, had a prescription fill every month for 12 months? Is it just had another fill a year later? I feel I'm not really understanding exactly what outcomes the study measured.

And does it properly account for those who have switched to heroin black-market pills?

Or, people in severe need of pain relief has the same need over a long time?

The new CDC recommendations mentioned in the article (to extremely over simplify) are to not prescribe opioids for chronic pain except in cases of cancer, palliative care, or end of life care. People in severe need of pain relief over a long period of time should not be utilizing this type of medication.

The problem being that the 'other treatments' that the CDC likes to push are just as poorly studied as opiates. While they have some efficacy, to say that they can simply replace opiates on a broad scale is more than a little disingenuous.

For example, Pregabalin (Lyrica) was one of the touted medications to get people off of opiates. Except that the DEA has placed it on the controlled substances list. Oops.

Unfortunately, as is typical, policy is being made more to push headlines and get something done, anything at all. Studies like this are interesting but typically get much more traction than are really warranted and, more importantly, tend not to get amplified or repeated. Let me put out one bit of anecdotal evidence that argues against the study. Opiate prescriptions for joint replacements tend to last longer than a week. Usually two or three weeks, sometimes longer. There are a hell of a lot of patients with joint replacements and I don't see anything resembling a 20% chronic opiate use rate in these folks. Likely this reflects the patient's age (joint replacement patients tend to be older) which has an effect on addiction potential, but the point is that reality is going to be quite a bit more complex than the CDC is expressing at this point.

This particular study is set up for all sorts of biases and really should be used as a stepping stone to other research, not as a guide to policy as of yet. But repeating or expanding the study will take years and twitter blurbs take seconds.

Never tried opioids/hard drugs, can someone tell me what kind of effect it gives you that is so addictive? (Just curious)

For some folks—and I'm one of them, unfortunately—opiates very quickly bring on a feeling of wonderful, poignant, intense euphoria. It's a feeling like being warm, except instead of physical warmth it's an emotional warmth. It's like being softly enfolded in a blanket of feeling like everything is going to work out wonderfully, even if you're actually feeling pretty cruddy about life.

And there's a physical component to it, not just emotional—a humming undercurrent of goodness that attaches itself to and flows through every part of your body. Everything just feels good. You're comfortable no matter what you're doing. If you're actually injured and taking the pills for that injury, the pain is dulled and put into a little box, and you can ignore the box and not look at it if you want. If you're taking the pills and you're not injured, the effect is magnified because you don't have pain to overcome.

Everything is...super interesting, and super exciting. The video game you might be playing is literally the most entrancing, uplifting, fun, vibrant, enjoyable game you've ever played—and while you're playing it, you don't want to ever be doing anything else. The twitter feed you're reading is more fascinating than the best novel you've ever read. The twitch stream you're watching is the most profound, most important thing you've ever seen.

An opiate high makes you feel hopeful, because it makes everything not just interesting, but good. If you've got nothing to look forward to on a Tuesday afternoon except coming home after work/school to a dirty empty house and eating a frozen dinner and playing video games until you fall asleep, an opiate high makes that afternoon into something profound, fun, enjoyable, purposeful, and meaningful. It flows in between the gaps and cracks in what would otherwise be soul-crushing boring routine and fills them in with light and joy and sparkling star-stuff and makes you feel awesome about whatever you're doing.

And, at least for me, after 5 or 6 hours of bliss, the high slowly fades into a beautiful heavy-limbed drowsiness and I can then sleep soundly for 8-10 hours and wake up feeling incredibly refreshed, with a slight echo of the previous day's high.

I am not joking when I say that if I had access to an unlimited supply of opiates, I'd take them every day. Absolutely, 100%. Because they're fucking awesome.

I hear the withdrawal from tramadol is pretty nasty as well, these also come in a long acting so I'm wondering why it's singled out as it is?

Correct. It does vary with the individual, but I can tell you it was bad. The only thing I've experienced worse was withdrawing from 3mg of Ativan daily (for a year). That took over two weeks of living hell to get over. I had no "lesser drugs" or herbs to blunt the withdrawals. Just weeks of continuous hot and cold sweats, panic attacks, and literally zero sleep at night. I couldn't even sit down for more than a couple of minutes at a time before having to get up and pace.

It can vary with time too.

I had no problem when the tablets ran out after an operation I had as a kid.

Now, though, when the pharmacy have not had the tablets and I have had to go "cold turkey", then yes, I have experienced similar symptoms (and more) to those you describe.

That said, I have deliberately weaned myself off the opioids temporarily (just to prove to myself that I could), and to do so over a few days was possible with minimal discomfort.

My grandmother was unwell for a very long time and suffering from extreme pain. She and her doctors were fully aware that she was addicted to the medication, but she wasn't going to ever recover anyway so this was the best they could do.

My mother went through the same thing before she died. She had an inoperable problem with her spine, replaced hip, replaced knee, kidney disease, fatty liver disease, severe arthritis, diabetes, etc. She was continuously in a lot of pain. The last year she was alive, she was on extended release morphine and oxy. I am glad that she was able to get some comfort (although it did not eliminate her pain), but being on high doses of those drugs means I actually lost my mother before she died. She wasn't the same person anymore.

I think you should be blaming the disease on losing your mother, not the drug. If she had no pain relief, you might have lost her more. Opiates are hardly a panacea - but they do have some utility.