Opioids might not treat pain better than Tylenol, UMN study says

The study found that opioids weren’t any better at managing chronic pain than non-opioid medicines.

by Wesley Hortenbach

Opioids may not treat long-term, chronic pain more effectively than non-opioid medication, according to a new study from the University of Minnesota.

The study, published in the Journal of the American Medical Association earlier this month, suggests doctors may want to limit opioid prescriptions when treating patients with chronic pain from conditions like hip or knee arthritis.

“A lot of prescribers have been waiting for a study like this,” said Laura Palombi, an assistant professor in the University of Minnesota’s College of Pharmacy who studies the opioid epidemic. “We’ve seen the harms of opioids, and we know people do benefit from them and not everyone gets addicted to them, but it’s nice to see how they actually compare.”

Researchers recruited patients from Veterans Affairs clinics for the study, and treated some with opioid medications — including oxycodone or morphine — and others with non-opioid medications, like acetaminophen.

The findings come in amid the worsening opioid crisis that has public health employees nationwide scrambling for solutions. Emergency room visits for suspected opioid overdoses increased 30 percent between July 2016 and September 2017, according to a report on data from 45 states published by the Centers for Disease Control this month. 

Lead author Erin E. Krebs, University Medical School associate professor, said that during her education in the early 2000s, experts said opioids weren’t effective, but that later physicians strongly recommended prescribing them. 

“I was a student at the time and it was interesting to see the advice change in a short period of time,” Krebs said. “That made me interested in looking into this.”

Some researchers say this switch wasn’t prompted by any new studies or scientific developments, which has left them wondering why experts changed the narrative around opioids.

Robert Levy, assistant professor of family medicine and community health, said he thinks the influence of drug companies in medical schools played a role.

“Every doctor says they are impartial, and of course the drug companies never said what to do, but the education was shaped by drug companies,” he said.

These companies have also guided prescription practices, said Susan Craddock, University professor and director of the Center for Bioethics.

“They send representatives to physicians to talk up the advantages of the new drug just going on the market,” Craddock said. “It is quite easy to talk about advantages of a drug without talking about disadvantages, or without comparing opioids to, say, ibuprofen.”

Levy said the study will be a helpful tool for physicians discussing chronic pain treatment with patients. However, the findings alone won’t solve the crisis, since Americans are very accepting of opioid use and they’re easy for doctors to prescribe, he said.

According to data collected by the International Narcotics Control Board, Americans consumed about 30 percent of opioids produced globally in 2015, despite making up less than 5 percent of the population.

The researchers said opioids should still play a role in pain treatment, but the drugs’ uses should be limited to end of life care and cancer treatment.

Krebs will work on a similar, larger trial later this year involving patients who take high-dose opioids.