Both those positions appear to be refuted by survey data collected by the Washington Post and Kaiser Family Foundation and published in the Post on Friday.
The Post and KFF surveyed 622 long term opioid users (defined as use for 2 months or longer) and 187 household members of long term opioid users. The survey was taken over a roughly 5 week period from October 3 through November 9 and the overall results have a margin of sampling error of +/- 4 points.
We learn, among many other interesting things, that...
- 34% of long-term opioid users say they are/were addicted or dependent on opioids
- 54% of household members say the opioid user is/was addicted or dependent
- Nearly all long-term users (95 percent) said that they began taking the drugs to relieve pain from surgery, an injury or a chronic condition.
- Just 3 percent said that they started as recreational users.
Further, the presumption of safety within a "longitudinal clinical relationship" is called into question by the fact that while the survey suggests a largely positive relationship between patients and doctors, only 33% of patients reported that their doctors discussed a plan for getting off of the medication at the onset of therapy. That's a standard best practice... and two-thirds of doctors aren't doing it.
Despite all of this data, the vast majority of survey respondents say these drugs have dramatically changed their lives for the better. While their household members appear to have a different view, this highlights the difficult public health position in which we find ourselves. Benefits and risks aren't as clear cut as we wish they could be.
Finally, I'm struck by staying power of the "100 million Americans in chronic pain" statistic. The Post uses it here and it remains a pervasive data point for the justification of long term opioid use. But to steal a phrase from Dr. Martin himself (who stole it from Mencken), this statistic is "neat, plausible, and wrong." If we're going to have a debate about chronic pain, we have to start with the facts.
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