Patients are commonly prescribed painkillers as a quick fix for chronic back pain, but new research at Yale shows that these short-term prescriptions may lead to drug abuse and dependence in the long run.
In an article published Tuesday in the Annals of Internal Medicine, researchers at the School of Medicine indicate that use of narcotics — also defined medically as opioids — may not be effective for treating chronic back pain and that long-term use may lead to addictive behavior and substance abuse.
Yalies who use the drugs recreationally said that while painkillers are easily obtainable, their use is not widespread on campus.
The authors said people who take the medications often begin to exhibit addictive behaviors, such as compulsively seeking the drugs or misusing prescriptions. This high risk for potential abuse and dependence makes the prescription of opioids for chronic pain problems particularly risky, said professor Robert Kerns, who co-authored the article.
“People who take these medications become dependent and have withdrawal when they try to discontinue its use,” he said. “Those problems, combined with the lack of data supporting its effectiveness over the long run, really challenge the [wisdom] of their widespread use.”
The study looked at patients over the age of 18 with chronic back pain and no former signs of opioid addiction. Opioid abuse behavior was reported in 24 percent of the cases, Martell said.
A student who said he has used painkillers such as Vicodin for recreational purposes said it was easy to obtain them from doctors without encountering any suspicion that the drugs would be misused.
“Both times I’ve gotten [medical] procedures done … the doctor just prescribed [painkillers] to me without even asking whether I needed them or anything,” the student said. “The first time I was too young to realize you could have fun with them and just threw them away, then the second time I was older … [and] I tried to use them.”
Demand for painkillers on campus is so low that local drug dealers do not carry them, said another student who has used painkillers recreationally, and people who do abuse them refrain from talking about them.
A third recreational painkiller user said the drugs are usually obtained informally through friends who have access to them — be it children of doctors or those who have medical problems that require painkillers — and it is hard to pass up the opportunity to take them.
“It’s tempting to abuse [painkillers] even if you have them for legit reasons,” the student said. “If you’re not in pain everyday and you have mood-altering drugs … there’s no reason not to save a few for a good night.”
The report suggests that narcotics may be effective for acute or short-term back pain, but that research on long-term effectiveness is inadequate and inconclusive.
“We found no studies that support using opioids for the long term,” said School of Medicine professor Dr. Bridget Martell, who was the study’s lead author. “There’s no literature out there that says opioids are effective for more than four months.”
Other recent data similarly identifies abuse behavior with prescription drugs, specifically painkillers such as opioids or opioid derivatives. According to the National Drug Intelligence Center, in 2004 the percentage of people reporting nonmedical use of such drugs in the past year was second only to the percentage who used marijuana.
Kerns said patients should exercise caution when narcotics are prescribed for them.
According to another study on which he recently participated, Kerns said, there are many alternatives available, such as psychological intervention, which could relieve chronic back pain without incurring the risks associated with opioids.
“If someone has chronic pain, they should seek specialty care and be sure to look at the range of medications available before jumping to opioids,” Martell said.