Word: opioid
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According to a review presented in February at the American Academy of Pain Medicine's annual meeting, methadone accounted for 5% of opioid prescriptions in the U.S. between 1999 and 2009 but was involved in 30% of opioid overdose deaths, as reported in malpractice cases, medical literature and federal and state databases. Some of these deaths occurred in heroin users being treated with methadone for addiction, but the overwhelming number of cases were in people who were prescribed the drug for chronic pain. (See the most common hospital mishaps...
...happen to think that methadone is an extraordinarily valuable drug," says longtime opioid researcher Gavril Pasternak, head of molecular pharmacology at Memorial Sloan-Kettering Cancer Center in New York City. "It works in many patients who don't respond to other agents, but it is more dangerous in the sense that it's more difficult to prescribe appropriately. We have to do better in terms of educating physicians...
...while the risk of opioid addiction in the elderly is low, there are other cautions. A study published in January by Von Korff and colleagues linked high-dose opioid use to a doubling of the risk of broken bones in the elderly. "One-third of these were hip and pelvic fractures," Von Korff says. "These can really be debilitating." The authors speculate that the patients may have been prone to falls caused by dizziness or sedation, side effects of drug treatment that tend to occur early in a new drug regimen or when dosage changes...
Potential to Treat Psychological Pain One of the most intriguing new findings regarding opioid use came out of a study including 696 Navy and Marine troops who were injured in combat in Iraq between 2004 and 2006. Published in the New England Journal of Medicine in January, the study found that soldiers who were given morphine during resuscitation and treatment for physical trauma were half as likely to develop posttraumatic stress disorder (PTSD) as those who did not get the drug. (See the top 10 medical breakthroughs...
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...