Prescription Painkiller Misuse Creates Tolerance in Orthopedic Patients
New findings from an American research team indicate that opioid medication overprescribing and misuse have significantly altered the baseline considerations for effective care of orthopedic health issues in the U.S.
As a whole, Americans consume opioid medications much more often than any other national population group in the world. Unfortunately, the U.S. also has a relatively high degree of exposure to opioid-related addiction and overdose. In a study review published in May 2015 in The Journal of the American Academy of Orthopaedic Surgeons, researchers from two U.S. institutions examined the effect that opioid prescribing patterns and opioid misuse have had on the course of care for people affected by orthopedic (muscle- and skeleton-related) health problems.
Orthopedic health is a broad subject area that includes the daily function of your muscles, bones and joints. Specific orthopedic problems in any given individual may include wear-and-tear-related osteoarthritis, immune system-related rheumatoid arthritis, broken bones, herniated discs, osteoporosis, bursitis, gout, tendinitis, injury-related back pain and a narrowing of the spinal canal called spinal stenosis. Injuries and arthritis (joint inflammation) are the two most likely sources of orthopedic issues, the National Library of Medicine reports. Tens of millions of Americans have osteoarthritis or some other form of arthritis, and over 400,000 people have joint problems severe enough to merit a knee or hip replacement. Doctors can address orthopedic pain with non-opioid medications that include nonsteroidal anti-inflammatories (NSAIDs), acetaminophen and corticosteroids. However, some affected individuals have moderate or severe short- or long-term pain symptoms that may benefit best from prescription opioids.
Opioid Overprescription and Misuse
Fully four-fifths of the world’s output of opioid medications is consumed by Americans, despite the fact that the U.S. contains less than one-twentieth of the global population. Compared to the rest of the world, Americans are particularly avid consumers of hydrocodone, an opioid substance found in medications that include Lorcet, Lortab and Vicodin. For a number of reasons, American doctors started issuing an increasingly large number of opioid prescriptions in the 1990s. By the early 2010s, known consequences of this spike in opioid prescribing included a steep rise in the number of people who misuse an opioid medication, as well as a steep rise in the number of people who experience non-fatal and fatal opioid overdoses. In addition, rising levels of prescription opioid consumption have fueled a rise in heroin consumption and heroin-related overdose.
The federal Substance Abuse and Mental Health Services Administration estimates that approximately 1.7 percent of all Americans over the age of 11 improperly consume an opioid painkiller in the average 30-day timeframe. This rate of misuse, while seemingly small, is higher than the combined rate for the three other most commonly misused medications (sedative-hypnotic tranquilizers, prescription stimulants and sedative-hypnotic sedatives). Most misusers obtain prescription opioids from friends or family members. However, significant numbers of misusers also get their medications from a doctor with legal prescribing authority.
Impact on Orthopedic Healthcare
In the study review published in The Journal of the American Academy of Orthopaedic Surgeons, researchers from the Lexington Clinic Orthopedics – Sports Medicine Center and Vanderbilt University used the work of previous research groups to explore the impact of physician prescribing patterns and medication misuse on the typical considerations in effect when using prescription opioids to help people with orthopedic health issues. As part of their review, the researchers looked at the most common sources of the opioid medications properly or improperly consumed in the U.S. They concluded that primary care doctors write more than a quarter of all opioid prescriptions, followed in descending order by doctors known as internists and orthopedic surgeons.
The researchers identified two specific outcomes that relate directly to the ability to help people dealing with serious orthopedic pain. First, a relatively high percentage of patients now exhibit tolerance to the doses of prescription opioids normally considered for therapeutic use. In addition, orthopedic patients as a whole are experiencing a reduced level of benefit from spinal surgeries, joint replacement surgeries and treatments used to address repetitive motion-related issues and other orthopedic problems acquired in the workplace.
The review’s authors point to a need for detailed assessments designed to pinpoint those individuals most likely to misuse an opioid medication and develop risks for abuse/addiction or overdose. They also note a need on the part of doctors to fully explain the likely outcomes of orthopedic procedures and prepare their patients for treatment with lower-risk non-opioid medications.