At the center of the nation’s opioid crisis is a simple fact: Large numbers of Americans experience serious pain, and the vast majority of those who have used strong painkillers for a long period say they work.
That’s one key takeaway from a new Washington Post-Kaiser Family Foundation national poll of long-term opioid users, people who have taken the drugs for at least two months during the past two years.
The Centers for Disease Control and Prevention has discouraged doctors from prescribing opioid painkillers for chronic pain treatment after a sharp rise in overdose deaths related to opiates ranging from prescription painkillers to heroin and synthetic drugs such as fentanyl. CDC Director Tom Frieden recently told The Post that “prescription opiates are as addictive as heroin,” and the agency's guidelines have noted that there is limited evidence that the drugs are effective in treating long-term pain. The Post-Kaiser survey finds that about 1 in 20 Americans have taken the drugs to treat pain for at least two months over the past two years, representing a significant barrier to curbing the country’s reliance on the drugs.
The survey of adults who have used opioids for at least two months in the past two years found more than 4 in 10 saying that their health is “only fair” or “poor” (42 percent), more than double the share of all Americans who rated their health as negatively in a November Kaiser Family Foundation poll (18 percent). And 7 in 10 long-term opioid users say a disability, handicap or chronic disease keeps them from participating fully in work, school, housework or other activities.
Roughly 4 in 10 long-term opioid users say chronic pain was the reason they first started taking the drugs, while about one-quarter each cited pain after surgery or following an accident or injury.
But opioid users say the painkillers make a significant difference — 92 percent say that prescription painkillers reduce their pain at least somewhat well, including over half (53 percent) say they do so “very well.” In a separate question, 57 percent say their quality of life is better than if they had not taken the medications.
When long-term opioid users are asked about the medication’s impact on five broad aspect of their lives, they rate two positively on balance, two as mixed and one negative. Opioid users report the most positive impact on their physical health, with 42 percent saying painkillers have had a positive impact on their health, another 20 percent saying it has been negative and 37 reporting no impact. Regarding their ability to do their job, just under a quarter (23 percent) say painkillers have had a positive impact, while 14 percent say they’ve had a negative impact and another 48 percent said they’ve had no impact.
Long-term opioid users split on how the drugs have affected mental health and personal relationships. About 1 in 5 say painkillers have had a positive impact on their mental health and another 1 in 5 say they have had a negative impact on their mental health, while almost 6 in 10 say they’ve had no impact. Similarly, 68 percent say opioids have had no impact on their personal relationships, while 15 percent report a positive effect and 16 percent say it has been negative.
The only measure in which long-term opioid users report more of a negative impact than a positive one was in finances: Just 8 percent say painkillers had a positive impact on their finances compared with a larger 17 percent who said they were negative. A 74-percent majority, though, said painkillers had no impact on their finances.
Two areas where long-term opioid users report significant problems are dependence and adverse side effects. Roughly one-third (34 percent) of long-term opioid users say they became addicted to or physically dependent on the drugs (separately, 31 percent say they are dependent, 23 percent say they are addicted). Physical side effects are common, with 55 percent saying the drugs have caused constipation and another 50 percent reporting indigestion, dry mouth or nausea.
The poll finds that people who live in the same household as a long-term opioid user report a more negative picture across the board — 54 percent say the person they live with is or was addicted to or dependent on painkillers. Household members are also significantly more concerned about side-effects than are opioid users themselves. A 67 percent majority say they’re at least somewhat concerned about side-effects of the painkillers, compared with 49 percent of those who use them. Household members are also more likely than opioid users themselves to say the painkillers have had negative impacts on the user's physical health (39 percent vs. 20 percent of users) and the user's mental health (39 percent vs. 19 percent).
But regardless of the adverse effects, the Post-Kaiser survey results show clearly why opioid users feel the medication is necessary, and why they are worried about the impact of a crackdown on abuse of the drugs.
Two-thirds of long-term users say they are very or somewhat concerned that efforts to decrease abuse of prescription painkillers could make it more difficult to obtain them. Nearly 6 in 10 say that as it is, prescription painkillers are difficult to obtain for medical purposes.
Allaying those concerns represents a big task for those seeking to combat the worst effects of opioids and one that’s not likely to go away soon.
This Washington Post-Kaiser Family Foundation poll was conducted by telephone Oct. 3-Nov. 9 among a random national sample of 622 adults age 18 and older who say they have taken strong prescription painkillers for a period of two months or more at some time in the past two years other than to treat pain from cancer or terminal illness and 187 household members of someone meeting the previous requirements. The results from the sample of personal users have a margin of sampling error of plus or minus five percentage points and the sample of household members has an error margin of plus or minus nine percentage points.
Scott Clement contributed to this report.