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Although opioids are extremely valuable painkillers, particularly for patients at the end of life, drugs like Oxycontin (oxycodone) and Vicodin (hydrocodone and acetaminophen) are unfortunately better known for being addictive. While new studies have sharpened the understanding of how opioids work, and clarified their harms, the general question of safety remains complicated. Differences in the age and health of patients, their history of substance misuse, the nature of the pain and patients' sensitivity to certain drugs mean that a miracle drug for one person may be harmful to another. (See the top 10 medical breakthroughs...
Some of the overdose cases involved known drug misuse or suicide attempts, while others were due to patient error, but the study could not identify exactly what went wrong in all of the cases. Was it the high-prescribed dose alone, or were there other risk factors like illness, escalation of pain or undiagnosed addiction? While Von Korff and Volkow agree that prescription dose is a major contributor to overdose risk, they say better studies are needed to determine the precise causes and consequences. "One would hope that for a treatment regimen that millions of people are using...
Paradoxically, the findings suggest that the use of opioids could even help prevent addiction by reducing the risk of a psychological condition that is known to lead to substance misuse. "PTSD is so devastating, and it increases the likelihood of addiction," says Volkow. "I think it's definitely worth investigating...
Saxe's research suggests a mechanism by which opioids may affect PTSD risk. Trauma researchers have long known that social support is critical for recovery from PTSD, and that the brain's natural opioids are involved in feelings of nurture and bonding. Saxe found that the pediatric patients in the hospital who had the most anxiety about being away from their families were also the most likely to develop PTSD, but in those treated with opioids for pain, the risk was reduced. "The pathway was opioid dose reducing separation anxiety, and reduced separation anxiety reducing PTSD," says Saxe. (See pictures...
...Regimens Needed Over the past few decades, researchers have made strides in understanding the treatment of certain kinds of pain. Relieving acute pain from trauma or surgery, for instance, reduces immediate suffering, but also speeds healing and reduces complications; the short-term use of opioids in the hospital is known to be safe and effective. (See Dr. Mehmet Oz's prescription for living long and living well...