Opium study raises questions about painkillers
Farmers harvest the opium sap from the poppy plant in Fayzabad, Badakhshan, Afghanistan.
April 17th, 2012
06:31 PM ET

Opium study raises questions about painkillers

About 20 million people are using the drug opium or one of its derivatives. A new study suggests new reasons for viewing this as problematic.

Research in the British Medical Journal finds strong connections between people using opium and conditions such as cancer, circulatory diseases and respiratory conditions.

"Long term recreational opioid use, even at relatively modest levels, causes important increases in death from multiple different causes," said study co-author Paul Brennan, head of the Section of Genetics at the International Agency for Research on Cancer in Lyon, France.

Why it matters

Although this study focused on opium for recreational purposes, the research also has significant implications for medicinal uses of opium-derived painkillers - such as morphine and codeine, Irfan Dhalla, assistant professor at St. Michael's Hospital in Toronto, wrote in an accompanying editorial.

Dhalla points out that a separate study in the United States on osteoarthritis patients found a nearly two-fold mortality increase among those who used opioids compared to those who took non-steroidal anti-inflammatory drugs. Other research supports the conclusion that there's a risk apart from the chance of accidental overdose.

These risks are still not entirely understood, and more research is needed to determine exactly what's going on here.

"For the management of chronic non-cancer pain, a better prescription may be caution," Dhalla writes.

The research 

The authors used information from more than 50,000 people in northeastern Iran, who enrolled in the study between January 2004 and June 2008. At the time they entered the study, participants' ages ranged from 40 to 75. Researchers recorded opium use and other factors, and followed most of these people until May 2011.

Researchers adjusted for variables such as poverty and cigarette smoking, which could have otherwise influenced the health outcomes of the participants. They still found an 86% increased likelihood of death from major causes among people who used opium.

The study's design - observing patient's outcomes but not randomly assigning them to use opium or not - cannot prove that opium causes the death risk.

But the authors were unable to find any alternative explanation. The effects were similar in men and women, in smokers and non-smokers, and in people who live in urban and rural communities. Taking opium orally and smoking it both carried similar risks.

Also, most users who participated in this study did not begin taking opium because of a pre-existing illness, Brennan said.

soundoff (26 Responses)
  1. portland tony

    What is the good of studying painkillers without some form of measurement of effectiveness. It is obvious to the common observer that if one were in great pain only a strong opiate based painkiller would alleviate the suffering. If one had a minor ache, a non-steroidial anti inflammatory would used to ease pain. One could use a little common sense here and say that generally, the worse the pain, the sicker the patient and the stronger opiate based drug would statistically show more mortality than the NSAIDs?

    April 17, 2012 at 22:26 | Report abuse | Reply
    • Reasongal

      Absolutely. They cannot generalize these mortality rates to the population that is treating chronic pain. For example, I have rheumatoid arthritis and take Lortab and Avinza (both morphine based). I am at risk for leukemia because of my RA and the biologic immunosuppresant I take; RA can attack the heart and other organs. Too many variables!

      April 18, 2012 at 11:30 | Report abuse |
  2. Mike

    What kind of junk medical study is this, recreational use compared to use in patients with real pain? Opioids have their use ages, and shouldn't be demonized by medical studies done in countries with questionable qualities of life or a study that involves both a "pain killer" and anti-inflammatory for a condition that responds to both of them. Maybe those that design these studies should spend a week at their desk with an ice pick in their back and decide how the study should be done. I would rather use a medication known since the Neolithic times, then something found by accident(HTS,...) by a company whose only goal is to make billions of dollars, with products we have no real idea what they will do to us.

    April 17, 2012 at 23:07 | Report abuse | Reply
    • Maya

      They aren't being "demonized." This isn't a moral judgment. The data indicates that long term use of opiates even in modest amounts (recreational or therapeutic, the body doesn't know the difference) can have detrimental effects in otherwise healthy people. So unless you think that having a chronic health condition would make a person LESS likely to suffer these effects than a person who is healthy, I don't see why you have a problem.

      April 18, 2012 at 20:58 | Report abuse |
  3. Elijah Cohen

    This is quite absurd. I don't know how the researchers could possibly "find no other explanation," unless they were avoiding it. The number of less-than-credible dynamics in this study is really impressive, and the publication of those findings without criticism of those weaknesses is disappointing, to say the least. How an Iranian medical study was able to survey 50,000 people for 3 years, some of whom presumably suffer from any range of illness, addiction, dependencies and afflictions, and on top of that, they fail to give any amount of hedence to their health condition or differentiate between codeine, opium, opiates, opioids(were synthetics included?) and heroin. I don't think this raises any questions at all for me except this: How do you say "correlation does not equal causation" In Arabic?

    April 17, 2012 at 23:18 | Report abuse | Reply
  4. Marlee

    Long term opioid abuse is bad? There's a news flash.

    April 18, 2012 at 08:54 | Report abuse | Reply
    • derkName

      Its actually not...almost at all. This is a misconception created by the war on drugs. Chronic abuse (like anything else used excessively) is unhealthy...but even extremely large doses of opioids are safe if the persons body has worked its way up. The dangers of opioids are for the most part fabricated and are for absolute certain not as dangerous as many OTC meds. The media and medical community have taken the risks that plague drug addicts, and made them everyones problem, simply because its a cash cow. The biggest problem with opioids, is that those obsessed with control are trying to standardize a very personal and individualized treatment... and in doing so they are CAUSING the problems they say are bow risks of.

      August 20, 2016 at 10:13 | Report abuse |
  5. jstout511

    I am a not a medical professional. I am a boomer who works with my mother's doctors, including pain management specialists, who have tried the SAFE and less expensive route while my mother suffered with severe, chronic pain from all three of the conditions, I'll mention, here.

    Unfortunately, health care insurers use such inconclusive studies as rationalization for removing such meds from their formularies and, therefore, won't cover the expense. I read nothing in this article about quality of life. Did Dhalla even consider this in the study? NSAIDs may be effective, prophylatically, as with a placebo, when the pain is phantom. However, for those seniors who have osteoporosis, arthritis or even a broken vertebra, NSAIDs do little, if anything, to achieve true pain relief. If the pain is psychological, reach for the NSAID. If it's physical and severe, go with an opioid.

    April 18, 2012 at 10:14 | Report abuse | Reply
  6. t-dawg

    I once loved using pain killers for pain management and relaxation. However, when I stopped using to them manage my back pain and starting managing the pain through exercise and nutrition, I have noticed some interesting results. I feel better. Occasionally, I still use pain medicines for recreational purposes and surprise, I usually end up with increased back pain and muscle spasms. I have seen others that are my age who are dealing with pain that have had the same experiences as myself. I have also witnessed those who are continuing to manage their pain with opiates with no relief. I may have been converted, surprise, it only took 15 years!

    April 18, 2012 at 12:16 | Report abuse | Reply
  7. AnotherAtheist

    These are the most rational comments i've ever read on a cnn blog!

    April 18, 2012 at 12:42 | Report abuse | Reply
  8. Sy2502

    I think it's pretty useless to use these studies to prevent people from abusing pain killers. We all know the devastating effects of smoking, or of bad nutrition, but people do it anyway. And since opioids a one of the most addictive substances around, how good is it to tell an addict that his vice is bad for him?
    What I do want to see is doctors getting a bit less prescription happy. I have a friend who's a full pain killer addict who still gets his prescriptions refilled 10 years after the operation for which they were prescribed. Another friend, equally hooked on pain killers, had them prescribed for common heartburn! What are doctors thinking???

    April 18, 2012 at 13:01 | Report abuse | Reply
  9. Melissa's Pain

    I see lots of questions here. Has anyone seen the entire study? Some of your questions could be answered. I have not seen it, but I would like to. I also suffer a lot of physical pain (several herniated/bulging discs from neck to low back) and can say that the Opiate based drugs do help me a lot; and so do the anti-inflammatory drugs and the steroids. The sleeping pill I take doesn't help much. The opiate medication does help. I love it...maybe a little too much. However, when I don't take it (fear of addiction) at times, I do feel the withdraw symptoms. The symptoms feel like all over pain, like I have the flu. I get sweaty, my stomach feels nauseus, my bones ache (not just the joint area or normal pain from my back), but places that don't normally hurt like my forearms, thigh bones. It's a very wierd experience of pain. I notice these symptoms only after I stop taking the opiate that and I took it for a few days. My point here is that maybe the opiate drug specifically does cause an adverse effect to the cells and structures of my body that I don't notice; because it does make me feel good. Perhaps over time and continued use, that adverse reaction could be causing irrepairable damage to these areas of my body. I'm suggesting that maybe the research is valid. Until we can see the entire report, we should be open minded and careful.

    April 18, 2012 at 13:23 | Report abuse | Reply
    • Markus M

      Pure ingested opium would not have caused your ailments. The impurities and concentrated, laboratory made opiates are bad for you. Pure INGESTED opium is not. In fact, looking at real studies, ingested opium has anti-inflammatory properties that beat ibuprofen and helps prevent sickness. by singling out a single opiate and making a single opiate chemical, such as the commonly used hydrocodone, they have ruined, mostly, the beneficial properties of opium. hope I was of help. Thanks for reading

      December 11, 2013 at 10:19 | Report abuse |
    • Markus M

      of course I mean your suspected ailments.

      December 11, 2013 at 10:23 | Report abuse |
  10. J.C.

    This study found that those who smoke opium in northeastern Iran are more likely to die than those who do not? Something to keep in mind if I'm ever in Iran (or feel like smoking opium).

    April 18, 2012 at 15:05 | Report abuse | Reply
  11. OldTechie

    As several others noted, this report is based on poor clinical desing and any conclusion is fallacious. Unless one randomly assigned people to either NSAIDs or opium/ opioids, one can make no conclusions. CNN should ask for a medical expert to review such reports before publicizing them.

    April 19, 2012 at 15:43 | Report abuse | Reply
  12. Max Brooks

    Legalize marijuana and far less people would bother filling their painkiller prescriptions for minor to moderate pain

    April 19, 2012 at 18:13 | Report abuse | Reply
  13. mattcurtisnyc

    Having read the study carefully, I think the first problem is how its findings are being portrayed by CNN in a completely alarmist and irresponsible fashion. The study has absolutely nothing to do with pharmaceutical opioid analgesics. It is also not actually a study of 50,000 people, but rather of the 2145 people who died. While I think the researchers did a very good job what they had, there are strong reasons to suspect the quality of the data and the measures of association were hardly of a slam-dunk magnitude.

    This is not the first time that CNN has been shoddy in reporting health science, so I guess I'm not surprised though it's always a bit depressing to see a major news source work at a level about 3 notches below Web MD.

    April 19, 2012 at 20:31 | Report abuse | Reply
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