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Teachable Moment
Less Is More
January 2017

Ultra–High-Dose Opioids With Low Efficacy and Significant Harm—Time to Make a ChangeA Teachable Moment

Author Affiliations
  • 1Yale University School of Medicine, New Haven, Connecticut
  • 2VA Connecticut Healthcare System, West Haven
JAMA Intern Med. 2017;177(1):17-18. doi:10.1001/jamainternmed.2016.7344

A woman in her 50s presented for medically managed withdrawal from ultra–high-dose opioid therapy for chronic back pain. Her pain began following a back injury in 1983 that resulted in multiple herniated discs. Targeted injections of chymopapain to dissolve her displaced discs instead left her with arachnoiditis. Over the next decade, she underwent multiple lumbar spine surgical procedures and at one point returned to work, but an accidental fall aggravated her injury, rendering her indefinitely unable to work. Her pain was then managed with methadone but, concerned about oversedating effects, she underwent inpatient detoxification. Attempts at pain control using nonopioid medication failed to provide adequate relief, so she was prescribed oxycodone, 15 mg, 4 times a day, or 90 mg of morphine equivalent daily dose (MEDD).

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