Opioid Treatment 10-year Longevity Survey Final Report

Opioid Treatment 10-year Longevity Survey Final Report

Patients in this study were found to be functioning quite well after 10 or more years on generally stable opioid dosages—with the vast majority able to care for themselves and even drive.

https://www.practicalpainmanagement.com/amp/152

About eighteen months ago, I approached the publisher of Practical Pain Management to assist in a survey of long-term, opioid-treated pain patients. Rightly, as any good publisher, he asked why should I go to the time and expense to do a longevity survey? I then presented him my laundry list of reasons for doing the survey. Some explanations of my reasons for doing this survey are given here. Quite frankly this survey was needed, since we simply have little data on opioid long-term treatment.1,2 Also, opioid treatment is constantly under attack, so it seems logical to see if the popularity of this treatment is justified.

Reasons for the Survey

First, recall that we have just finished the “Decade of Pain.” Ushering in this decade were many laws, regulations, and guidelines—promulgated in many states—that encouraged physicians to prescribe opioids without fear of legal reprisal. Did anyone get help this decade? Did this political and humanitarian effort pay off?

Secondly, my own experience in practice was the predominant factor. I started my pain practice in 1975 while serving as a Public Health Physician in East Los Angeles County. Cancer and post-polio patients needed ‘narcotics’ (the common name prior to the more correct usage ‘opioids’) treatment for their severe chronic pain. I’ve now followed some chronic pain patients still taking opioids after 25 to 30 years.1 Also, I was a government consultant in the 1970s on Howard Hughes who managed to survive 30 years with intractable pain after a 1946 plane crash. His average opioid dosage over that time period was about 200 mg of morphine equivalence. But are my patients unusual or simply responsive to an overzealous clinician? Do opioid-treated patients in the hands of other physicians do just as well over a long period?

A little over a year ago there was another reason to do a longevity survey. At that time there was a vitriolic, anti-opioid propaganda campaign being waged. Some prominent academic institutions, pharmaceutical companies, professional organizations, and journals, almost in unison, essentially claimed that opioids shouldn’t be prescribed due to hyperalgesia or other as-yet unnamed complications. Some parties stated that opioids, if prescribed at all, should have a dosage restricted to some arbitrary number such as 200mg of morphine equivalence a day. Some claims fundamentally suggested that pain should only be treated with non-opioids, because opioids actually “cause pain.” Amazingly, some detoxification centers actually advertised for “clients” on the basis that the person’s pain would be cured if the patient spent $10K or $20K to detoxify from opioids. Needless to say, the anti-opioid campaign was hardly backed by bonafide medical management pain practitioners or scientific studies. So what was needed was a simple survey to see if there are long-term opioid-treated patients who are still doing well.

What the Survey Can’t Determine

This survey was not intended or designed to answer some ancillary questions. Not answered is which opioids are superior or could patients have done as well without opioids? Also, it wasn’t intended to determine optimal dosage or complications. The intent was clear and simple: Do some opioid-treated patients improve pain control, function better, and enhance their quality of life over a 10-year period?

Survey Methods

In early 2009, an advertisement was placed in this publication to identify any physician who had a cohort of chronic pain patients they had treated with opioids for 10 or more years and were willing to share outcome data. Three physicians, one each from Kentucky, Louisiana, and California, reported a total of 76 patients who have been treated with opioids for 10 or more years. These, together with the 24 patients treated by this author,1 provide a cohort of 100 patients who have been treated with opioids for 10 or more years and serve as subjects for this survey. Physicians completed a survey questionnaire for each patient that inquired about demographic status, cause of pain, opioids currently used, basic physical functions, activities of daily living, and stability of opioid dosage.

Results and Findings

Patients in this study appeared typical of most chronic pain patients in that they are primarily middle age or older and have degenerative diseases of the spine, joints, or peripheral nerves (see Tables 1 and 2). Most have maintained on one opioid, although some patients required two or three. The majority have been on stable dosages for many years (see Table 3). Despite the longevity of treatment, most function quite well. The vast majority of patients report good function in that they can dress, read, attend social functions, drive, and ambulate without assistance (see Table 4). Almost half (45%) reported they had been on a stable opioid dosage for at least 3 years.

Table 1. Demographics of 10-Year Opioid Patients
Age (Yrs) Range 30-83
Males 61 (61%)
Females 39 (39%)
Length of time in opioid treatment 10 – 35 yrs
Stable opioid dosage without significant escalation 3mos – 31 yrs
Table 2. Causes of Chronic Pain in This Population (N=100)
Spine disease 51
Arthritis 16
Peripheral neuropathy 14
Headache 10
Knee diseases 5
Abdominal adhesions 5
Hip diseases 4
Shoulder/arm diseases 4
Fibromyalgia 4
113*
*Adds up to more than 100 as some patients had more than 1 diagnosis.
Table 3. Opioids Currently Used by These 100 Patients
No. of Opioids Currently Used N(%)
1 62
2 26
3 12
Opioids Currently Used
Hydrocodone 56
Oxycodone 25
Fentanyl 15
Morphine 13
Methadone 8
Propoxyphene 8
Hydromorphone 5
Other 6
Table 4. Activities and Functions in These 10-Year+ Opioid Patients (N=100)
N(%)
Dress without assistance 82
Attend church/social events 89
Read newspapers, books, magazines 97
Gainful employment 25
Care for family 61
Ambulate unassisted 85
Ambulate with cane 5
Drive a car 74

Discussion

Recent epidemiologic studies indicate that about 10 million Americans now take opioid drugs for chronic pain control. This relatively recent and dramatic occurrence has had little outcome study.1,2 The author recently reported 24 Southern California chronic pain patients who were treated with opioids over 10 years and who had positive social, physical, and functional results.1 Outcomes from other patients treated by other physicians in other geographic areas were needed to confirm or deny the positive outcomes found with one physician in one geographic area. As stated above, this survey was not intended and doesn’t imply that there are patients who may have done as well or better if treated differently. Also this survey does not include patients who did not respond to opioids or stopped them due to complications.

This survey doesn’t lay claim to any sophisticated epidemiogic methodology or randomization. All this survey intended to do was meet one fundamental goal: “Are there chronic pain patients in the United States who have taken opioids over 10 years and report less pain, better function and have a better quality of life?” This survey satisfies this simple goal.

Conclusion

Patients reported here are functioning quite well after 10 or more years in opioid treatment. The vast majority can care for themselves and even drive. Opioid dosages have generally remained stable for long periods without significant escalation. Given the findings here, there is no obvious reason to discourage opioid use or encourage pain patients to cease opioids.

References

  • 1. Tennant F. A 10-year evaluation of chronic pain patients treated with opioids. Heroin Addict Relat Clin Probl. 2009. 11: 31-34.
  • 2. Portenoy RK, Farrar JT, Bakonjam M, et al. Long term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pharm. 2007. 23: 287-299.

3 Responses

  1. Knowledge is key, …and our enemies don’t have it.

  2. I am so delighted this survey was done. My loved one has adhesive arachnoidits, degenerative disc disease, chronic kidney disease and more for over 20 yrs. Before having pain meds he was not able to hold on to a job due to pain and other symptoms. He had tried alternative treatments and some caused his disease to progress and made him worse. He has been able to work because his pain is controlled and as result his progression has slowed. He is physically fit and has a very physical job. He has been on pain meds for over 20yrs and been on same high dose for 10yrs no increases. When his insurance company tried to force him to taper he was either house bound or bed bound for 2 months. During this time his pain was out of control and he developed new symptoms that we had never seen before. I believe during this time his disease progressed. We fought the insurance and won. He is now on his original stable dose of 10yrs. After all that we live in constant fear that for any reason his meds will be taken away along with his ability to work, function, and live life. Everything has changed since weaponization of CDC guidelines. To not have any power over what is put in and on your body is no life at all. Thank u again for doing this survey. I will continue to pray for all pain patients and their right to have power in their treatment. Another hard thing is that doctor patient relationship has been devistated and it will never get better until pain patients are protected by law over what is put in and on their bodies.

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