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A meta study of 38 studies from 7 years ago on patients using opioids for chronic pain found that 21-29% of the patients misuse the drugs and 8-12% of the patie

A meta study of 38 studies from 7 years ago on patients using opioids for chronic pain found that 21-29% of the patients misuse the drugs and 8-12% of the patients are addicted to them. That doesn't seem "extremely small" like you said, though maybe it's better now. I think there are reasons why opioids are no longer recommended for the treatment of most patients with chronic pain that you aren't fairly acknowledging. https://journals.lww.com/pain/Abstract/2015/04000/Rates_of_opioid_misuse,_abuse,_and_addiction_in.3.aspx https://journals.lww.com/pain/Abstract/2015/04000/Rates_of_o...

atdrummond 5y ago
https://www.nejm.org/doi/full/10.1056/NEJMra1507771 https://www.nejm.org/doi/full/10.1056/NEJMra1507771 Volkow is a mainstream researcher, using data from the peak of the crisis, and cites the rate at just under 8%. It is not at all unreasonable to assume that with proper prescribing (unlike what happened in the 90s and 2000s) that chronic pain patients can have opioid misuse and addiction numbers near or matching that of palliative care patients, where addiction rates are closer to 1% than 10%.
NineStarPoint 5y ago
I’ll agree I wouldn’t describe that as extremely small. The misuse stat is pretty bad. The addiction though…essentially for every 10 people who are treated for chronic pain, 1 of them gets addicted? With 9/10 of those people getting to live a more pleasant life…Chronic pain is awful, and the good done by alleviating it might be worth that cost.
- behringer 5y ago
  And let's not forget the 1/10 very likely would be in extreme pain bordering on torture instead of addiction. It's lose lose for them.
  - google234123 5y ago
    I’m not sure how you figure that this hypothesis is “very likely” true. It’s actually very likely not. The papers don’t mention this at all.
- atdrummond 5y ago
  Just to be clear - the cohort in his paper is not all opioid users. It is the subset most likely to become addicts, for the following reasons: 1. The meta-analysis occurred during the period of time that pill mills and other unscrupulous prescribing was rampant. See that there was no note regarding patients' (legal) polydrug use or by morphine equivalent dosing, nor was there any modification to the analysis of the data to see how this period in the legal drug market impacted patient outcomes. 2. This analysis selects for chronic pain patients, which tends to mean the long term users of opioids while excluding the acute patients who, particularly among the in-patient subset, pretty much never become addicts during their course of use - which is what we'd expect if these compounds were as addictive as claimed. 3. These cohort selections often do not include some or all palliative care patients. I won't accuse them of doing this to sensationalize their numbers but it does have a significant impact on results, as again palliative care patients very rarely cease their use and carry forward afterwards an opioid misuse disorder. 4. They do not control for or look at the specific impact of the main problematic legal opioid - Purdue Pharma's original OxyContin formula. Because this drug did not have the pharmacodynamic profile claimed by the firm and represented in the safety studies, it was considerably more likely to cause opioid use disorder, as patients would be much more likely to take extra doses to cover the shortfall in the dosing window. This would lead to patients who otherwise would exist on a steady dose asking for increasing doses - or, worse, turning to the street to acquire diverted doses.

atdrummond 5y ago

https://www.nejm.org/doi/full/10.1056/NEJMra1507771 https://www.nejm.org/doi/full/10.1056/NEJMra1507771 Volkow is a mainstream researcher, using data from the peak of the crisis, and cites the rate at just under 8%. It is not at all unreasonable to assume that with proper prescribing (unlike what happened in the 90s and 2000s) that chronic pain patients can have opioid misuse and addiction numbers near or matching that of palliative care patients, where addiction rates are closer to 1% than 10%.

NineStarPoint 5y ago

I’ll agree I wouldn’t describe that as extremely small. The misuse stat is pretty bad. The addiction though…essentially for every 10 people who are treated for chronic pain, 1 of them gets addicted? With 9/10 of those people getting to live a more pleasant life…Chronic pain is awful, and the good done by alleviating it might be worth that cost.

behringer 5y ago
And let's not forget the 1/10 very likely would be in extreme pain bordering on torture instead of addiction. It's lose lose for them.
- google234123 5y ago
  I’m not sure how you figure that this hypothesis is “very likely” true. It’s actually very likely not. The papers don’t mention this at all.
atdrummond 5y ago
Just to be clear - the cohort in his paper is not all opioid users. It is the subset most likely to become addicts, for the following reasons: 1. The meta-analysis occurred during the period of time that pill mills and other unscrupulous prescribing was rampant. See that there was no note regarding patients' (legal) polydrug use or by morphine equivalent dosing, nor was there any modification to the analysis of the data to see how this period in the legal drug market impacted patient outcomes. 2. This analysis selects for chronic pain patients, which tends to mean the long term users of opioids while excluding the acute patients who, particularly among the in-patient subset, pretty much never become addicts during their course of use - which is what we'd expect if these compounds were as addictive as claimed. 3. These cohort selections often do not include some or all palliative care patients. I won't accuse them of doing this to sensationalize their numbers but it does have a significant impact on results, as again palliative care patients very rarely cease their use and carry forward afterwards an opioid misuse disorder. 4. They do not control for or look at the specific impact of the main problematic legal opioid - Purdue Pharma's original OxyContin formula. Because this drug did not have the pharmacodynamic profile claimed by the firm and represented in the safety studies, it was considerably more likely to cause opioid use disorder, as patients would be much more likely to take extra doses to cover the shortfall in the dosing window. This would lead to patients who otherwise would exist on a steady dose asking for increasing doses - or, worse, turning to the street to acquire diverted doses.