More opiates used to treat severe pain By Merritt McKinney

NEW YORK, Apr 04 (Reuters Health) -- Opiate drugs are being used more often to treat severe, chronic pain -- but this rise has not led to wider abuse of the drugs, according to a report in the April 5th issue of The Journal of the American Medical Association.

Experts urge effective treatment of severe pain, such as pain caused by trauma, surgery, or cancer -- and the opiate class of drugs is mportant in relieving such pain. But some have feared that prescribing these drugs more often might lead to more cases of drug abuse. New data sugests that these fears are unfounded. In fact, the proportion of all cases of drug abuse that involved opioid analgesics actually DECLINED from 1990 to 1996, researchers report.

In an interview with Reuters Health, lead researcher David E. Joranson, of the University of Wisconsin Medical School in Madison, explained that the results of the study do not support this fear.

``I wasn't surprised, but we were very pleased,'' he said. ''You're struck by how exaggerated the fears of opioids are.''

Joranson and his colleagues based the conclusions on data from the Drug Abuse Warning Network (DAWN), which collects information on cases of drug abuse reported by hospital emergency departments around the country. They tracked the use of five types of opioid analgesics: morphine, fentanyl, oxycodone, hydromorphone and meperidine.

From 1990 to 1996, the medical use of morphine increased by approximately 59%, fentanyl by 1,168%, oxycodone by 23% and hydromorphone by 19%. The medical use of meperidine declined by about 35%.

Despite the increase in use of most of these drugs, reports of abuse declined by approximately 39% for meperidine, 29% for oxycodone, 59% for fentanyl, and 15% for hydromorphone. Morphine was the only one of the drugs that was abused more in 1996, but the increase was only 3%.

And the proportion of all drug-abuse cases that involved opioid analgesics declined during the 1990s. They were involved in 3.8% of all drug-abuse cases reported through DAWN in 1996, compared with 5.1% in 1990.

But in his comments to Reuters Health, Joranson also noted that many people who could benefit from the pain-killing drugs are still not receiving them. ``We suspect that patient access to opioid analgesics is so bad in some places that pain patients are checking themselves into methadone programs only to get pain management,'' he said. He and his colleagues are planning a study to investigate the situation.

Joranson stated that the potential for abuse of these drugs is real, but that patients should not be denied the drugs because of this risk. When cases of abuse are detected, he said it is important to identify and deal with the source of the abused drugs and not deprive needy patients of adequate pain management.

SOURCE: The Journal of the American Medical Association 2000;283:1710-1714.