Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

I commend the authors on using real-world practices to demonstrate that opiod therapy for CNCP was associated with lower receipt of certain key preventive health interventions. It is certainly plausible that there is a cause and effect relationship.

But a decrease in preventive care is only the tip of the ice-berg. As most primary clinicians know from their own experience with patients on continuous opioids for CNCP, drug-seeking patients are one of the most disruptive and disturbing parts of primary care practice, a fact that our group has substantiated in a study using students as participant observers that has been submitted for publication. And while opiates are a crucial part of taking care of patients who have been acutely injured, are recovering from a surgical intervention, or have chronic pain due to cancer, they are a dismal failure in treating chronic pain for the vast majority of patients whose discomfort stems from other causes. Not only do patients often become addicted to these drugs, but the increasing number of deaths from unintended overdoses of prescription opiates is a public health emergency.

We are currently in the early stages of a project to improve the care of patients with opiate addictions in rural Washington State. The very fact that such a project is urgently necessary reflects the mayhem that has been caused by indiscriminate use of opiates. In many of our communities, the diversion of these medications is rife, and has led to addiction and death in children who obtain these medications. Given the fact that there are other proven and safe methods for treating patients with CNCP - NSAIDS, trycyclics, physical therapy, cognitive behavioral therapy - I would suggest that both patients and doctors would be better off if we reserved opioid therapy to a much more targeted subset of the population.

Competing interests:   None declared