Research eyes narcotics in older patients

Older patients given a prescription narcotic for low to moderate pain following surgery are at elevated risk of becoming long-term users, researchers reported Monday.

The analysis published in the Archives of Internal Medicine is the latest research attempting to ferret out how prescribing practices among doctors can lead to long-term narcotic pain pill use.

Those receiving a narcotic painkiller -- an opioid -- within seven days of surgery were nearly 44 percent more likely than those receiving no prescription to become users, said Dr. Asim Alam of the University of Toronto in Canada, who led the research.

"It surprises me that the number prone to long-term [opioid] use is so high," said Stephen Dewey, director of the Laboratory for Molecular and Behavioral Neuroimaging at the Feinstein Institute for Medical Research in Manhasset.

But Dewey and Dr. Thomas Jan, another Long Island expert familiar with the Canadian analysis of nearly 400,000 patients, say the research should have done more to develop a clearer illustration of how people become addicted.

"I think what we're learning here is an incremental step -- a baby step -- it's not advancing the field," Dewey said.

In the study, patients were divided into three groups and compared: those who received opioids; those who received nonsteroidal anti-inflammatory medications, such as ibuprofen and naproxen; and patients who received no medications.

The average age of patients in the study was 66. Patients had undergone cataract surgery, gallbladder removal, prostate tissue removal and varicose vein stripping. They were given either a codeine-based medication or oxycodone.

Alam and his team found patients given any kind of pain reliever were more likely to need a painkiller a year later.

Patients who were prescribed nonsteroidal anti-inflammatory drugs within seven days of surgery were 3.7 times more likely to become long-term users of those medications than unmedicated patients.

Women are more often prescribed the drugs than men and are often given higher doses, said authors of an accompanying commentary in the journal.

Dewey said the study should have looked at patients with the same type of surgery and the same kinds of medications.

Dewey, who studies how narcotic drugs alter key pathways in the brain, said patients should be weaned off narcotics to avoid physical dependence.

Jan, a Massapequa pain management specialist, said the study is yet another in a growing number that focus on the downside of medicating patients in pain.

These studies, he said, make it difficult for patients in genuine need. "I would be very cautious about hanging my hat on that study," Jan said.The authors of an accompanying commentary in the journal noted that much has yet to be learned about prescribing opioid medications.