PHARMACIST STEVE

By reducing a pt’s opioids to manage their  chronic pain. Could reduce their life expectancy by upwards of 7+ yrs.

Most of those estimated 100 +/- million chronic pain pts are no longer able to be employed, they produce NOTHING, they pay nothing toward our Social Security or Medicare “trust funds”.

They probably get some monthly money from Medicare disability, maybe from state’s Medicaid. From the bureaucrat’s perspective, we have nearly 30% of our population that are considered “takers”.

In 2000 our national debt was ~ 5 TRILLION and today it is 37+ TRILLION. Keep in mind that the 5 trillion national debt was after abt 225 yrs as being a country and involved in our Civil War, WW-1, WW-2, Korean, Vietnam wars.

Since 1965 we have been fighting the war on poverty- spending some 1 trillion/yr and today some 20% of our population is on Medicaid and since 1970 we have been fighting the war on drugs – spending a some 120-140 billion on that.  40% of households pay NO FEDERAL INCOME TAXES.

At the federal level, our country did not start imposing income taxes until the 1940’s.

So I asked perplexity.ai how having reducing/eliminating a chronic pain pt’s opioid therapy could impact the pt’s life expectancy

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What would be expected in the change in the pt’s life expectancy under such circumstances of reduced/stopped opioid pain management and substantial increase in BP?

Abrupt reduction or discontinuation of opioid pain management in chronic pain patients, especially when accompanied by a substantial and treatment-resistant increase in blood pressure, dramatically increases the risk of early mortality and can severely decrease life expectancy.[1][2][3]

### Life Expectancy Effects

– **Acute Harm and Mortality Risk:** Studies consistently show that opioid tapering—even when gradual—can lead to increased emergency department visits, hospitalizations, and poor control of chronic conditions like hypertension and diabetes in vulnerable patients. When opioids are withdrawn suddenly, uncontrolled pain and severe sympathetic activation (raising BP) set in, and mortality risk spikes even higher.[3][1]
– **Resistant Hypertension:** If heightened blood pressure becomes resistant to usual medications due to uncontrolled pain or withdrawal-induced sympathetic overdrive, the result is a compounded risk for fatal cardiovascular events (stroke, heart attack, heart failure) and accelerated end-organ damage.[4][1]
– **Excess Mortality:** The risk of death during the period out of opioid agonist treatment is roughly double compared to the period during stable treatment for opioid dependence; these findings translate to chronic pain populations as well, given their overlap in risk profile.[2]
– **Psychosocial and Suicide Risk:** Unrelieved chronic pain and withdrawal both dramatically increase the risk for depression, suicidal ideation, and suicide.[5][3]

### Expected Reduction in Life Expectancy

– **Case-Based and Cohort Data:** Some analyses suggest life expectancy is reduced by several years for patients with uncontrolled pain and resistant hypertension, potentially 5–7 years or more less than peers with controlled pain and BP.[1][2]
– **Instant Risk Increase:** Mortality risk from acute sympathetic crises (severe hypertensive emergencies) rises immediately; risk of fatal cardiovascular events can spike in weeks to months if pain is left uncontrolled and BP remains refractory.[3][1]

### Summary Table

| Scenario | Expected Life Expectancy Change |
|————————————————|—————————————-|
| Stable opioid/pain control + managed BP | Baseline for age, condition |
| Abrupt/tapered opioid stop, uncontrolled pain | 2–7 years reduction if prolonged[1][2][3] |
| Pain-induced resistant hypertension | Increased immediate cardiovascular risk |
| Suicidal ideation/suicide | Markedly increased sudden death risk |

In summary, life expectancy under these circumstances can decrease dramatically due to the dual impact of uncontrolled pain and resistant hypertension—often by several years, and sometimes more if acute events or suicide occur. This underscores the vital importance of safe, effective pain control and careful opioid management, particularly for vulnerable older adults with comorbid cardiovascular conditions.[2][1][3]

[1](https://health.ucdavis.edu/news/headlines/tapering-may-have-negative-impacts-for-patients-taking-opioids-long-term/2023/02)
[2](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2780655)
[3](https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes)
[4](https://www.mayoclinic.org/diseases-conditions/back-pain/in-depth/chronic-pain-medication-decisions/art-20360371)
[5](https://journalofethics.ama-assn.org/article/nonconsensual-tapering-high-dose-opioid-therapy-justifiable/2020-08)
[6](https://www.sciencedirect.com/science/article/pii/S003335062400146X)
[7](https://www.ncbi.nlm.nih.gov/books/NBK458655/)
[8](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm)
[9](https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf)
[10](https://pmc.ncbi.nlm.nih.gov/articles/PMC4036624/)
[11](https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/OUD%20issue%20brief%20final%20508%20compliant%204-19-18.docx)
[12](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2734070)
[13](https://www.ncbi.nlm.nih.gov/books/NBK549202/)
[14](https://www.sciencedirect.com/science/article/pii/S0885392402004116)
[15](https://www.ncbi.nlm.nih.gov/books/NBK526012/)
[16](https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf)
[17](https://pmc.ncbi.nlm.nih.gov/articles/PMC7854020/)
[18](https://www.cms.gov/about-cms/story-page/cdcs-tapering-guidance.pdf)
[19](https://www.acofp.org/news-and-publications/journal/article-detail/vol-16-no-3-fall-2024/opioid-use-elderly)
[20](https://www.who.int/news-room/fact-sheets/detail/opioid-overdose

 

Filed under: General Problems