An American’s odds of dying from an opioid overdose are now greater than his or her odds of dying in a car accident — and far greater than dying from a gun-related injury. That’s according to a 2019 report from the National Safety Council (NSC), a nonprofit that tracks rates of injury and death due to different causes. Opioid overdose is now the most common cause of accidental death in the U.S., according to the council.
While doctors today are prescribing opioid painkillers less often than they did in 2012, which is the year opioid prescriptions peaked, approximately 59 opioid prescriptions are written for every 100 Americans, according to the most recent CDC data. At the same time, opioid-related deaths are more common than ever before — fueled largely by the rise of fentanyl, which is a synthetic opioid that is up to 100-times more potent than morphine, and is often bought and used illicitly.
While the current epidemic of opioid overuse and abuse is on everyone’s radar, experts say it’s still common for doctors to prescribe opioids in situations when these drugs aren’t necessary. “I think the medical community has made progress, but there are still parts of the country where doctors — and particularly surgeons and dentists — are not up to date, and over-prescribing is still a problem,” says Dr. Michael Englesbe, a professor of surgery at the University of Michigan and co-director of the Michigan Opioid Prescribing and Engagement Network. He says many people still receive an opioid prescription from their doctor following routine outpatient surgery or dental procedures such as wisdom-tooth extractions, even though non-opioid drugs are just as effective at controlling pain.
Others reiterate this point. “There is no evidence that opioids are uniquely effective beyond standard pain medications like ibuprofen,” says Dr. Michael Barnett, an assistant professor of health policy and management at Harvard’s T.H. Chan School of Public Health. “Most people have a hard time believing this, but opioids are not super powerful or more effective than [non-opioid painkillers] — they just come with more cognitive side effects, like euphoria.”
Barnett’s research on opioid prescription patterns and the risks of long-term opioid use has appeared in the New England Journal of Medicine. He says prescription opioids still have a place in pain management and medical care, but that place should not be as a first-line treatment. “There are people who try ibuprofen or other non-opioid painkillers and those don’t work,” he says. “Those are situations where a physician may try an opioid, but it is not a given that opioids will work any better.” There are also people who can’t use non-opioid painkillers due to allergies or pre-existing conditions; for these folks, opioids may also be appropriate.
Barnett is currently serving as an expert witness in ongoing lawsuits involving opioid manufacturers, and so he chooses his words carefully. “Any exposure to an opioid medication increases the likelihood that you will be on that for a long period of time or develop an opioid addiction in the future,” he says. “The magnitude of risk varies from study to study, but people should be wary of them.”
“Most people have a hard time believing this, but opioids are not super powerful or more effective than [non-opioid painkillers] — they just come with more cognitive side-effects, like euphoria.”
What should you do if your doctor prescribes you an opioid? “I think it’s very reasonable for patients to ask why they need to be on that drug,” he says. That’s especially true if a patient hasn’t yet tried acetaminophen, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), or if pain is a chronic issue. “Opioids can still be used for chronic pain” — especially in end-of-life or palliative-care contexts — “but there’s very little data that chronic opioid use helps people in the long-run,” he says.
Along with asking a doctor why an opioid is necessary, people should also ask whether they’re being given the lowest-strength dose that could be effective. “One thing for patients to realize is that when they’re being written an opioid prescription, their physician is just making a best guess — there are no hard-and-fast rules for prescribing these drugs,” Barnett says. “Doctors are notorious for prescribing way more opioids than people need,” both in terms of dose and in terms of the number of pills. “Even if you do need opioids, you should generally only be on them for a few days,” he adds.
It’s also important to take opioids only as needed. These drugs aren’t like antibiotics, and people don’t need to finish what they’re prescribed or to take them at a certain frequency. “You should take as few as you need,” Englesbe says.
Finally, it’s critical that people get rid of any unused pills. A lot of opioid deaths start when friends or family members find and abuse leftovers, he explains. Throwing away or flushing opioids is an environmental hazard, and so he recommends returning them to a pharmacy. “Walgreens has been taking these back for a while now, and more and more pharmacies are starting to do that,” he says.
Long story short, the use of opioids is highly questionable unless a person is in unendurable pain and has exhausted other options. Especially for young people or those with a history of substance abuse or addiction, Englesbe says the risks of opioids outweigh the rewards.
When his own daughter broke her arm playing soccer, he says he made sure she was not prescribed these drugs. “My kids will never get them — I would rather have them smoke cigarettes,” he says. “You just never know how a person’s going to react to them.”