Prescriptions for opioid painkillers have tripled in the past two decades. In 2012, 259 million opioid prescriptions were written, enough for every American adult to have a bottle of pills. Today, despite having only 4.6 percent of the world’s population, the U.S. consumes 80 percent of the world’s painkillers, according to the American Society of Interventional Pain Physicians.

Troubling trends

Not surprisingly, opioid use disorders are also on the rise. The National Institute on Drug Abuse estimates 2.6 million Americans had an opioid addiction in 2012. And deaths from drug overdose, with many involving opioids, now outnumber those caused by car accidents.

These troubling trends began to emerge in the late 1990s, after the FDA approved OxyContin and allowed it to be promoted to family doctors for treatment of common aches and pains. State medical boards loosened standards governing opioid prescribing, and then, in 2000 the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) implemented new pain management standards. Soon, more physicians and organizations began advocating for increased use of opioids to address what at the time was perceived to be a widespread problem of undertreated pain.

When prescribed on a short-term basis to treat severe acute pain, opioids can be helpful. In fact, they are one of the best medicines we have. But when these highly addictive medications are taken around-the-clock for extended periods to treat common conditions, they may actually produce more harm than help. An increasing body of research suggests for many chronic pain patients, opioids may be neither safe nor effective. Over time, patients develop tolerance, leading them to require higher and higher doses, which ultimately can lead to quality-of-life issues and functional decline, not to mention addiction. In some cases, opioids can even make pain worse, a phenomenon called hyperalgesia.

Flexible standards

Prescription standards in the U.S. are so flexible now that patients sometimes get opioids even when they don’t complain of pain. A 2014 George Washington University, School of Medicine study found a 10 percent increase in opioid prescriptions written for people visiting the emergency room, yet only a 4 percent increase in people coming to the ER complaining about pain.

At the center of the problem is overprescribing. But we must avoid castigating caregivers. Doctors didn’t start overprescribing opioids out of malicious intent, but rather out of a desire to treat pain more compassionately.

The top reason people visit a physician is pain. We have a culture that now seeks opioid medication for pain relief. Physician visits are shorter, and pressure to make decisions and provide quick solutions add to the doctor’s dilemma. Health care providers and the general public need to be aware of the serious risk of overdose, dependence and addiction associated with opioid medications.