A recent article  revealed that 2/3 of patients who received opioids (drugs like morphine) for 90 days following surgery were still taking them one year later. It doesn’t make sense that there still is pain from the surgery one year later. Did these patients become dependent or addicted to the drugs?  Did they really need the medication for pain in the first place?

It was suggested that patients who undergo minimally painful surgeries should perhaps never receive opioids for pain. This thinking is consistent with the current discussion in the USA about the dangers of overuse and abuse of opioids. Annual emergency room visits and unintentional deaths from opioids have dramatically increased in the past five years. Widespread, persistent use of opioids is increasing without a clear understanding of the benefits or of all the associated risks. Making it harder to get the medication and limiting its availability is one way to reduce the unwanted effects.

Many physicians have been alarmed over the misuse of opioids and will not prescribe them at all or will often provide less than adequate doses to effectively treat their patient’s pain. I recently saw a young man who, despite severe back pain that would require surgery, was denied opioid because he had a high score on a test that measured risk for its misuse. Since I understood the risk, I was able to successfully provide opioids while staying in close contact with the patient and his mother before and after surgery.

Indiscriminate provision of opioids is potentially harmful but so are overly restrictive attitudes and rules governing its availability. Each patient deserves to be evaluated as an individual so that compassionate and rational pain care can be provided.

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