Overdoses in Patients on Opioids: Risks Associated with Mental Health Conditions and Their Treatment

Excerpt

For more than 20 years, opioid therapy has expanded beyond cancer pain treatment to widespread use for various chronic pain conditions. While opioids have improved the quality of life for many patients disabled by chronic pain, their long-term use remains controversial for several reasons. First, the long-term efficacy of opioids is unclear. Opioids provide clinically significant relief for only a minority of patients1—many patients continue to experience severe, disabling pain despite opioid treatment. Second, opioids are associated with several problematic side effects that many patients report as intolerable. In addition, opioids may lead to adverse physiologic effects (e.g., hyperalgesia and hypogonadism) not necessarily reversed by stopping opioid therapy. Third, opioids have potential for misuse, which may occur more frequently than previously thought. Although physical dependence is an expected result of chronic opioid use, some patients develop an opioid use disorder. Fourth and most concerning, is that with the wider use of opioids, there has been a parallel increase in opioid-related overdose deaths. Between 1999 and 2009, the rate of prescription opioid overdose deaths in the U.S. rose fourfold,2 reflecting an epidemic of prescription opioid overdoses. …