Public Health Concerns You May Want To Understand
Chronic or palliative care is also not always a good option. Opioids and NSAIDs can be contraindicated due to comorbidities, and both may have only short-term and minimal benefits. A large, utilization review, conducted in Denmark, of 2,000 patients who used opioids long-term for chronic pain, found that opioid therapy failed to fulfill any of the treatment goals: pain relief, improved quality of life, or improved functional capacity. (1) Long-term opioid therapy has very real and serious adverse effects, such as physical dependence, tolerance, opioid-induced pain hyperalgesia, addiction, diversion, and abuse; and side effects such as impairment of the immune, endocrine, and reproductive systems. (2-5) Increasing abuse and diversion of prescription opioids have become a serious problem. According to the Centers for Disease Control and Prevention (CDC), during 2014, 28,647 (61%) drug overdose deaths involved some type of opioid, including heroin. Prescription opioids killed 19,000. (6)
Regard NSAIDS, a study in the New England Journal of Medicine estimated that at least 103,000 patients are hospitalized per year in the United States for serious gastrointestinal complications due to NSAID use. (7) At an estimated cost of $15,000 to $20,000 per hospitalization, the annual direct costs of such complications exceed $2 billion. This study also estimated that 16,500 NSAID-related deaths occur every year in the United States. This figure is similar to the annual number of deaths from AIDS and considerably greater than the number of deaths from asthma, cervical cancer or Hodgkin’s disease. NSAIDs can be considered to be the 15th most common cause of death in the US.
- Eriksen J, SjogrenP, Bruera E., Ekholm O, Rasmussen NK. Criticial issues on opioids in chronic non-cancer pain: An Epidemiological study. Pain 2006; 125:172-9
- Sacerdote P, Manfredi B, Mantegazza P, Panerai AE. Antinociceptive and immunosuppressive effects opiate drugs: A structure-related activity study. BR J Pharmocol 1997; 121:834-40.
- Vallejo R, deLeon-Casasola O, Benyamin R. Opioid therapy and immunosuppression. A review. AM J Ther 2004; 11:354-65.
- Rajagopal A, Vassilopoulou-Sellin R, Palmer Jk, Kaur G, Bruera E. Symptomatic hypogonadism in male survivors of cancer with chronic exposure to morphine. Cancer 2004; 100:851-8.
- Mao J. Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain 2002; 100:213-7.
- Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths- United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2016 Jan 1; 64: 1378-82.
- Wolfe MM, Lichenstein DR, Singh G. Gastrointestinal toxcicity of non-steroidal anti-inflammatory drugs. N engl J Med. 1999 Jun 17; 340(240): 1888-99.