Prescription opioids have caused a 16-year increase in opioid-overdose deaths in the United States. From the years 2000-2016 more than 600,000 people died from a drug overdose. In 2016 alone, opioids killed more than 42,000 people. Of all opioid-overdose deaths, 40% involve prescription opioids (Centers for Disease Control and Prevention, 2018).
The amount of overall pain Americans have reported has not changed, but the amount of prescription opioids sold to hospitals, pharmacies and doctors’ offices has quadrupled from the years 1999-2010 (Centers for Disease Control and Prevention, 2018). One risk factor for opioid abuse is taking high daily dosages of prescription opioid pain relievers. Because of this, patients receiving long-term opioid therapy in a primary care setting are at risk of becoming addicted to opioids.
Despite the opioid epidemic, opioids remain the first choice among doctors in the treatment of severe to acute pain in the emergency department (Chang et al, 2017).
A clinical trial conducted by Dr. Phillip Chang, Chief Medical Officer at University of Kentucky Healthcare, found that patients in the emergency department with acute extremity pain, showed no significant or clinical differences in pain reduction at two hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics (Chang et al, 2017). In other words, a combination of opioids and acetaminophen has roughly the same pain-reducing affect on patients as a combination of ibuprofen and acetaminophen.
A randomized, double-blind clinical trial was conducted at an emergency department in New York from July 2015 to August 2016 (Chang et. al, 2017). The study included 416 patients aged 21 to 64 years with moderate to severe acute extremity pain. Patients received a single dose of an oral combination analgesic: ibuprofen and acetaminophen, hydrocodone and acetaminophen or codeine and acetaminophen (Kronemeyer, 2018). Participants received 400mg of ibuprofen and 1000mg of acetaminophen, 5mg of oxycodone and 325 mg of acetaminophen, 5mg of hydrocodone and 300mg of acetaminophen or 30mg of codeine and 300mg of acetaminophen (Chang et al., 2017). Pain intensity was analyzed using an 11-point numerical rating scale with zero indicating no pain and ten indicating the worst possible pain. Pain decreased in all treatment groups. The mean pain score was 8.7 the pain score decreased by 4.3 in the ibuprofen and acetaminophen group, 4.4 in the oxycodone and acetaminophen group, 3.5 in the hydrocodone and acetaminophen group and 3.9 in the codeine and acetaminophen group (Chang et al., 2017).
The objective of the study was to compare the amount of pain reduction at two hours after ingestion of four oral combination analgesics. From the results the researchers concluded no statistically significant differences in pain reduction at two hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics (Chang et al., 2017). Although the study only focused on treatment in the emergency department the clinical trial revealed that nonopioid combination analgesic can relieve pain and thus can be prescribed instead of opioids. This information could potentially help reduce the overuse and misuse of opioids.
For more information on this topic read “No Difference Seen Between Opioids, OTC Pain Drugs for Extremity in ED.”
Centers for Disease Control and Prevention. (2018). Opioid overdose| Drug overdose| CDC Injury Center. Retrieved from https://www.cdc.gov/drugoverdose/
Chang, A.K., Bijur, P.E., Esses, D. (2017). Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. The Journal of the American Medical Association, 318(17): 1661-1667. Doi: 10.1001/jama.2017.16190
Kronemeyer, B. (2018). No Difference Seen Between Opioids, OTC Pain Drugs for Extremity Pain in Emergency Department. Retrieved from https://www.pain medicinenews.com/Clinical-Pain-Medicine/Article/12-17/No-Difference-Seen-Between-Opioids-OTC-Pain-Drugs-for-Extremity-Pain-In-Emergency-Department