Opioid Treatment Longevity Study: Interim Report
In September 2008, I published a report on some of my intractable pain patients who have been treated with opioid drugs for 10 or 20 or more years. My report in Practical Pain Management was partially presented and published in Europe due to the courtesy and request of EUROPAD which is a European organization dedicated to proper opioid use for addiction and pain. My report concluded that some patients I had personally followed over one to three decades had remained on a fairly stable dosage of opioids, claimed their pain had permanently reduced, and maintained normal activities of daily living and were even able to drive and pursue gainful employment.
Acknowledging that my report was based on my own patients and that I’m an anecdotal, biased, self-interested observer, the publisher of Practical Pain Management and I decided to solicit other physicians to see if there are any in the USA who currently have patients who have been on opioids for 10, 20, or more years.
I am gratified to report that we have identified a handful of physicians in the United States who have patients that have been treated with opioids for over 10, 20, or more years. When we called for physicians to come forward, we questioned whether we would find any, because we felt that regulations, bias, multiple economic barriers, and various encroachments on ambulatory pain practice would have eliminated the possibility that any such physicians and cadre of long-term, opioid patients could be identified. Fortunately, the United States has a few brave and dedicated physicians who have steadfastly provided opioid treatment for some patients for over 10, 20, or more years.
A preliminary review of data we have so far collected reveals a surprising number of 20 year plus patients. As with my personal cases, most patients report a functional life with few complications. Why is this survey being done? Simply to determine what to expect now that about 10 million patients take opioids for pain on a regular basis. Who is going to provide the care? What type of patient may need to take opioids for life? Above all, should patient and physician alike be developing a withdrawal program or is life-time treatment acceptable? Patient and physician should know that our preliminary survey clearly shows that at least some patients can function and maintain good health after taking opioids for 20 years.
We have received criticisms that this type of study isn’t a longitudinal, double blind, placebo-controlled, randomized, fixed dose study to determine if opioids are beneficial and what the dosage should be. Hark the recent drumbeat to cease or limit dosages of opioid medication because a patient may develop hyperalgesia or require long-term medical management in community-based internal medicine or family practice offices. We reject these criticisms simply because we don’t believe any institutional review board or human subjects protection committee would ethically allow a legitimate chronic pan patient to be randomized to a placebo or fixed dose regimen—given that we clearly now know that undertreated pain has its own serious life-shortening and debilitating complications including cardiovascular accidents, cerebral atrophy, adrenal exhaustion, malnutrition, physical immobility, and suicide.
In summary, studies and surveys of existing long-term patients reveals not only our best immediate shot at increasing knowledge about opioid care, but ethical problems with randomized, double blind, placebo, or fixed dose studies prohibit or greatly limit any other types of long-term studies. After all, is a severe pan patient really going to take a placebo for 10 to 20 years to give us some “definitive” answers? At this point we request and solicit additional physicians and patients for this study. If you, as a reader, have 10- to 20-year opioid-treated pain patient(s)— or know a physician who does—please contact Practical Pain Management or me.
Forest Tennant, MD, DrPH
Veract Intractable Pain Clinic
336 S. Glendora Ave.
West Covina, CA 91790