Opioids are addictive…aren’t they? What does the science say…

Opioids are safe and effective for chronic pain and addiction is RARE.

Opioids are highly addictive, dangerous drugs, and when you take opioids long term, addiction is inevitable!

How many times have you heard this?  Or words to that effect?

How many times have you heard that opioids are irresistible, that once you try an opioid, you will forever be condemned to craving the euphoria that only opioids provide? 

How many times have you heard about the ‘accidental addict’ the person who had one oxycodone tablet, prescribed by their dentist for a toothache, and then they became an instant addict.  Not their fault! It’s the drugs!  They are so powerful!  No one can resist!

How many times have you heard the ‘hijacked brain’ theory, that addiction is a disease caused by exposure to opioids?

I’m betting a lot.

Its all over the media, all the time.

You’ve read the news articles, you’ve heard the warnings, you’ve even watched Dopesick!  You know this is true, right?

People like Anna Lembke push these ideas to flog her books.

Politicians repeat this garbage to create fear and gain votes and campaign donations.

Website editors publish the sensational headlines to get clicks.

The thing is none of it is true.

No, really. Its not true.

For years now, there has been a fear campaign against opioids.  It started in the US in response to their illicit drug crisis, falsely targeting prescription opioids as the cause of their ‘opioid epidemic’.  The core idea being that opioids are so addictive, so dangerous, that they should never be prescribed. 

This led to mass force tapers and people living with severe, daily pain, from painful, incurable, progressive diseases were abandoned and left to suffer.  Often left to die.  

America loves a good fear campaign and the war on opioids spread like wildfire to other western countries, like Canada, the UK, and Australia, where I call home.  And forced tapers started happening here too, especially after June 2020 when the rules around opioid prescribing were changed.

It happened to me.  For more than three years now, I have been enduring severe, daily pain because my opioid pain medications were reduced to a dose that only manages my pain for a few hours of the day. 

And there is absolutely no good reason for this.  Because this fear of addiction is not based on fact. Its not based on evidence. Its not based on medicine.

Its all a lie. 

The truth about prescription opioids for chronic pain is that addiction is very rare. 

The evidence is in. There are quite a few studies that show that opioids are safe and effective long term, but this recent Australian study is a game-changer.  It conclusively shows that opioids are safe to prescribe for pain, long term, and that addiction is RARE.

Here’s a link to the study:   Five-Year Trajectories of Prescription Opioid Use

The study was by researchers at the National Drug and Alcohol Research Centre at the University of NSW, led by Natasa Gisev, PhD.  They followed almost 3.5 million people who were prescribed an opioid for five years to determine what their opioid use patterns became.

They had five trajectories of long-term opioid use, which were identified as very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%).

They found that the vast majority of people, 92%, were in the very low use or low use category and their exposure to opioids was time limited.  They used opioids for a short period of time, and once their pain resolved, they stopped using opioids.  With no problems or signs of addiction.

For those who did go on to sustained use, the researchers concluded:

“The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.”

Meaning that those people who went onto ‘sustained use’ had painful diseases and continued using opioids, not because of addiction, but because they were treating severe, chronic pain.

So there you have it.  Opioids prescribed for pain do not lead to addiction in the vast majority of cases. 

Wait, you say. What about all the other studies that show opioids are extremely addictive?

Well, the researchers discussed that too. They examined previous studies and found that they excluded certain groups of people, such as those with cancer, or opioid use disorder, or used wildly varying definitions of ‘long term use’.  As a result, the estimates of the prevalence of addiction has varied hugely across different studies, from as low as 0.2% to as high as 57%.  Even the phrase ‘long-term use’ is ambiguous, as many of those people with ‘long-term use’ were actually treating pain, and were not addicted, but the studies don’t differentiate. They assume all ‘long-term use’ represents addiction.

No other studies followed the actual trajectory of use, and no other study comes close to being as large as this one (almost 3.5 MILLION people).  And the data was obtained from the actual prescribing records, from the Pharmaceutical Benefits Scheme (PBS). Therefore, the data is accurate.  Inpatient opioid scripts and private scripts (where the patient pays full cost) were not captured, but these represent a tiny subset of all opioid prescriptions.

I know that this study will be hard to believe for some people, who have strong, ingrained, beliefs about opioids and addiction.  But please. Read the study. These beliefs are not based on fact.

Also, critics will say “it’s only one study” and that’s fair.  But don’t worry, I have plenty more studies that show opioids are safe and effective.  And plenty of studies showing that opioids are extremely addictive that have been rebutted and widely discredited.  I’ll be writing about those too.

This is a high-quality study, over a long period of time (5 years) with a very large population.  It should not be ignored or dismissed.  And policy makers should take note because the study clearly calls into question the current policy in Australia of never initiating opioids for chronic non-cancer pain, leaving people to suffer needlessly.  Many doctors refuse to prescribe opioids at all, but this study should compel GPs to reassess that position. 

The researchers wrote (bolding is mine) :

“Overall, these findings suggest that most people who initiate an opioid prescription are likely to have low, time-limited exposure to opioids with little indication of ongoing use.

This possibility is an important consideration for policymakers and stakeholders considering population-level prescribing of high-risk drugs. Opioids are essential drugs for acute and cancer pain, and many people with CNCP benefit from opioids.

Continued focus and policy responses based on findings from a small group of people with increased risk of harms run the risk of limiting access to people who safely derive objective benefits from opioids.”

In short, the vast majority of people who take opioids for severe, chronic pain do so safely, never develop an addiction, and experience reduced pain, improved function and improved quality of life. 

Most reputable studies on opioid addiction put the addiction rate at less than 1% meaning there is NO good reason to deny people access to safe, effective opioid pain relief. 

Additionally, current Australian policies and guidelines on opioid prescribing need to be re-examined and re-evaluated, as they are based on low quality evidence, and myth and disinformation.

I’m very disappointed to see that this study received NO media coverage.  It was published in JAMA back in August and barely made a ripple.  NO media picked it up, no journalists interviewed the researchers and twitter did not light up.  Whereas garbage like the OPAL study, which was pure trash but appealed to everyone’s anti-opioid biases, was shared mindlessly and made worldwide headlines.

Because everyone drank the kool-aid. 

But now, there are studies that are showing everything you’ve been told about opioids is a wrong.  

People living with severe, daily pain are suffering unnecessarily. 

So please.  Read the study.  Please share it.  Be part of the enlightened few, not the ignorant majority. Be the change.

Most people will never need opiods. Those of us who do are a small minority.  But we matter.  Our lives should not be ended because of others’ ignorance and biases.  The truth about opioids has been suppressed and twisted and people living with painful, progressive diseases have suffered enough.   Please help.

I made a youtube video on this study, you can see it here.

For more about my advocacy work, go to Pain Patient Advocacy Australia