Harvard Health Letter

New caution about opioids

The pendulum is swinging back to more caution and restrictions on long-term use of these powerful pain relievers.

For years, there was great reluctance to use opioid pain relievers like morphine to treat pain, unless it was for a very short period or the person had a terminal disease, usually cancer — and even then there were misgivings. Both doctors and patients worried about addiction and side effects, especially the consequences these drugs sometimes have on mood and thinking. Laws and regulations made it difficult for doctors to prescribe opioids, which in a legal context are called narcotics. The legalities reinforced fears and negative connotations.

But starting about 1990, the qualms about opioids began to fade as the medical thinking about pain changed. Doctors began to see chronic pain as a condition that needed to be actively treated, not just tolerated or toughed out. The shift in attitude occurred partly because of research documenting that, in addition to the suffering it causes, chronic pain leads to depression, sleep loss, and immobility. Meanwhile, several studies downplayed the risk of opioid addiction. Drug makers developed longer-acting versions of the drugs that didn't need to be taken so often. Adoption of the term opioids, instead of narcotics, helped make the drugs more acceptable. The opioid drugs became some of the most commonly prescribed drugs in the country.

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