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Mar 12, 2012

Harm From Long-term Opioid Therapy : Comment on “Long-term Analgesic Use After Low-Risk Surgery”

Arch Intern Med. 2012;172(5):430. doi:10.1001/archinternmed.2011.1724

As part of our “Less Is More” series, the Archives has recently published several articles on the dangers of opioid use for chronic pain. In this issue of the Archives, we publish a commentary on how women may be more vulnerable to harm from long-term opioid therapy than men.1 Although all drugs have adverse effects, we are concerned about the use of opioids for chronic pain because of the lack of efficacy data for pain lasting longer than 16 weeks; the widespread use of opioids; the number of serious adverse effects, including death, attributable to opioid use; and the open question, addressed in a commentary in this issue of the Archives, as to what we are treating when we use opioids for chronic noncancer pain.2 We thought that this article was a good reminder that initiation of short-term opioid therapy may lead to their longer-term use. We should be certain with any drug we prescribe that the benefits justify the risk. In the case of this study, it is unclear why 7% of elderly persons who were not previously taking opioids should have required them for minor operations known to cause little pain or why 8% of those who received an opioid for acute pain associated with minor surgery were still taking opioids 1 year later. We believe that when it comes to opioid administration for minor surgery, among older persons, less is more.