At a time of increasing concern among physicians, public health advocates, and the lay public about the adverse consequences of high-dose opioids for chronic non-cancer pain, new research on the topic has pain investigators talking. This time, the relationship between opioid dose and the risk of involvement with road trauma is under the microscope in a study that has caught the attention of a popular pain listserv run by Linda Watkins, University of Colorado at Boulder, US.
In a population-based study over eight years using data from the Ontario, Canada, public health care system, first author Tara Gomes and colleagues reported that drivers taking 20 mg or more of morphine or its equivalent each day had a 21-42 percent increased risk of road trauma compared to drivers taking lower doses. The new finding appeared online January 14 in JAMA Internal Medicine, along with an accompanying editorial.
A previous population-based study from Gomes and colleagues (Gomes et al., 2011), also using Ontario public health data, found that high doses of opioids (≥200 mg of morphine or equivalent daily) were associated with an almost threefold increased risk of opioid-related mortality compared to lower doses (<20 mg) (also see related editorial by Mark Sullivan (Sullivan, 2011). The new study adds to the ongoing worries about opioid use—particularly high doses of the medications—for persistent non-malignant pain.
In the light of such findings, blaming the opioid is an understandable reaction, but the story is not so simple. For instance, chronic pain itself, which necessitates opioids in the first place, could play an important role in the association between the medications and road trauma. And opioids, of course, also provide relief for many pain sufferers, for whom the barriers to obtaining those medications can severely reduce quality of life.
It is that complicated nature of the issue to which Karen Berkley, an emeritus professor and active researcher at Florida State University, drew the attention of Watkins’ listserv. The ensuing discussion was so interesting that we asked Berkley, and the listserv participants who contributed to that discussion, if we could post their comments on PRF. They agreed—for the benefit of the entire pain research community.
Below is an edited version of their comments, which we hope will generate much further conversation and debate on PRF. Join the discussion by posting a response on PRF today!
Opioid dose and risk of road trauma in Canada: A population-based study. Gomes T, Redelmeier DA, Juurlink DN, Dhalla IA, Camacho X, Mamdani MM JAMA Intern Med. 2013 Jan 14:1-6.
Katz MH JAMA Intern Med. 2013 Jan 14:1.