In Reply Dr Chwistek and Dr Portenoy criticize our characterization of opioid analgesics as risky, which is a surprising position. Opioid dependence and potentially fatal respiratory depression are serious and well-known risks, the latter now responsible for more than 16 000 deaths per year in the United States.1
We agree there can be benefits as well as risks of these drugs. Certainly there are situations, including pain at the end of life and severe acute pain unlikely to respond to other treatments, in which potential benefits of opioids are so great that they justify certain risks. However, there is not good evidence for long-term efficacy when opioids are used for common chronic conditions such as osteoarthritis and chronic low back pain.2
Dowell D, Kunins HV, Farley TA. Risks Associated With Opioid Use—Reply. JAMA. 2013;310(16):1738–1739. doi:10.1001/jama.2013.277320
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