To the Editor: In response to the Editorial by Drs McLellan and Turner,1 the main problem with long-term use of opioids for chronic pain is the inability to ensure that the prescribed medications are actually being taken by the patient. Opioids have a huge street value, which may present patients with an overwhelming temptation to sell or trade their pills. My patients report that hydrocodone with acetaminophen sells on the street for $1 per milligram and that long-acting opioids without additives sell for more and present a greater risk for intravenous use. A single oxycodone 80-mg tablet may have a street value of $130. With dosing 3 times a day, this equates to $12 000 every month. While this may not be a starting dose, it is often reached over time. In addition to long-acting opioids, patients with chronic pain may get a second prescription for immediate release opioids to treat breakthrough pain.
Merrick M. Prescription Opioids and Overdose Deaths. JAMA. 2009;301(17):1766–1769. doi:10.1001/jama.2009.580
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