During the past several years, there has been increasing focus on opioid analgesics. Opioid use disorder related to prescription opioid analgesics is considered to be at epidemic proportions in the US. Moreover, it has been widely asserted that the overprescription of these drugs has resulted in the growing use of heroin.
In fact, we know relatively little about the causes of this crisis—and even less about the patients who run into problems with prescription opioids that were originally prescribed for legitimate pain complaints. The following questions seek to separate what we actually know about opioid analgesics and their use and misuse from what we don’t.
1.True or false? A significant number of patients treated with prescription opioid analgesics for pain turn to heroin when their opioid analgesics are discontinued.
Discussion: Although there are frequent reports that any limits on the prescribing of opioid analgesics to patients with pain will result in their using heroin if these drugs are discontinued, virtually no research supports this. Even among people who use prescription opioids for nonmedical reasons, only a small minority also use heroin.1
Answer: B. False
2. True or false? The recent increase in heroin use in the US has resulted from increasing restrictions on the prescribing ofopioid analgesics.
Discussion: Research shows that the increasing use of heroin in the US began before the newer restrictions on the prescribing of opioid analgesics were instituted.1
Answer: B. False
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2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. MMWR. 2016;65:1-150.
3. Sullivan MD, Ballantyne JC. Must we reduce pain intensity to treat chronic pain? Pain. 2016;157:65-69.
4. Gilron I, Tu D, Holden RR, et al. Combination of morphine with nortriptyline for neuropathic pain. Pain. 2015;156:1440-1448.
5. Smith TJ, Saiki CB. Cancer pain management. Mayo Clin Proc. 2015;90:1428-1439.