Monday, March 20, 2017 10:00 pm
Seeds of disc-ord
I play Ultimate Frisbee. As I am now in my 40s, it is pretty easy to get injured. I have had my share, specifically with my ribs, ankle and wrist. Nothing major, no surgery, but every other year or so, I hurt myself enough that it is difficult to sleep for several days. More than once, I’ve been prescribed Vicodin to help with sleeping.
After several days, my wrist or ribs have healed enough that I stopped taking the drug and disposed of the unused pills at my local police station (in the lobby, 8 a.m. to 5 p.m. Monday through Friday). At the time, I didn’t think the exact length of the prescription mattered all that much. I probably took pills for three days, but it might have been five or six. At the time, I just cared about sleeping through the night.
Well, it turns out there is a real difference. The Centers for Disease Control and Prevention recently published a report on opioid prescriptions and their long-term use. The bottom line: A short prescription can quickly lead to long-term use. The long-term use has a lot of risks. Considering that we are in the middle of an epidemic, for many people there are probably better options.
The study looked at patients’ behavior after an initial prescription of an opioid (there are many, many types of varying strength). One of the key findings was that the length of the first prescription was related to whether the patient was continuing to use the drug one year later. A one-day prescription was a predictor of a roughly 6 percent chance of using the drug one year later. An eight-day prescription was 14. A 31-day prescription was a 30 percent chance.
The biggest increase was around five days. That is, there is a significant difference between a three-day and a seven-day prescription.
This matters. Historically, opioids have been used for short-term pain. Using them for long-term pain has been controversial. Recent studies have been somewhat mixed on how effective they are for long-term pain.
Some studies show that long-term opioid use can reduce patient-reported pain. However, patient-reported pain is a subtle business. It is not as reliably measured as other medical indicators such as blood pressure or cholesterol level.
Studies of patients’ progress on more concrete outcomes, like being able to do daily activities, have not been very definitive. That is, on average, patients using opioids for long-term pain relief don’t show a clear improvement in being able to do more daily activities.
There are other treatments for long-term pain. Careful studies show that, on average (i.e., for many but not all people), these other treatments may be just as effective at helping with daily activities. As a result of these studies, the CDC has been refining guidelines to encourage doctors to try these other treatments.
The recommendations won’t surprise you: physical therapy, exercise, cognitive behavioral therapy, and acetaminophen or ibuprofen. It seems like a mix of general, overall good health recommendations.
So the next time I end up on the wrong end of a collision trying to get a Frisbee, I will be a bit careful about exactly how long that prescription is for. I’ll also try to be open-minded about trying other methods of pain control.
Christer Watson, of Fort Wayne, is a professor of physics at Manchester University. Opinions expressed are his own. He wrote this for The Journal Gazette, where his columns appear the first and third Tuesday of each month.