Tuesday's study only adds to the concern that these drugs are not being properly managed and patients not properly monitored. The study, published in the Journal of the American Medical Association, looked at more than 150,000 veterans on opioid prescription painkillers and found a link between those who were given high doses and those who suffered accidental fatal overdoses.
"Until recently, many have taught that there is no unsafe maximal dose of opioids, as long as doses are increased gradually. However, there is growing evidence that this is often not a terribly effective approach, and the safety concerns are growing," says Deyo.
"In the past, patients and physicians thought that the solution to pain was to give ever increasing doses of opioid medications [and] the risk of higher doses has been viewed as 'only' sleepiness or sedation, and rarely respiratory problems," says Dr. Timothy Collins, assistant professor of Medicine/Neurology at Duke University.
This research suggests that adverse outcomes, especially accidental overdose, could be in part related to the high doses given to some patients, which should cause physicians to reconsider whether higher doses are really the answer to patients' pain complaints, he says.
For Rain, the escalating doses of painkillers and other meds were not the answer to her chronic pain. After 25 years on multiple medications, the breaking point came when her doctors, in hopes of finally managing her constant pain, suggested a morphine pump to deliver powerful painkillers directly and regularly into her spinal cord fluid.
"I was already on so many pills, so I'm not sure why this was where I drew the line, but I went cold turkey," she says. Eight years ago Rain checked herself into a drug rehab center where she would be supervised while she went through withdrawal. She also went through years of intensive physical therapy to treat the many musculo-skeletal problems she had developed from her injuries, contributing to her pain.
Today, she says she has no pain, and has started a nonprofit, Point of Return, in California in hopes of helping others kick their dependence on painkillers.
If opioids are not improving the pain at a reasonable dose, another treatment should be discussed, adds Collins.