High cost, dubious benefit

Re: “Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone.”¹ In medical school, I was given the textbook Managing Pain: The Canadian Healthcare Professional’s Guide. The book recommends prescribing oxycodone over morphine and endorses continuous release opioids because of a “lower abuse potential.” The production costs of the manual were paid for by the manufacturer of OxyContin (oxycodone).

Even though opioid misuse is a very complicated issue, some simple changes may be helpful. Eighty milligram oxycodone pills remain on public formulary in Ontario despite the fact that this dose is not supported by current pain management guidelines.² The Committee to Evaluate Drugs recently recommended that 5 mg controlled-release oxycodone pills not be added to the formulary in Ontario, noting the cost and that “oxycodone has not been demonstrated to be therapeutically superior to morphine or other opioid analgesics.” Similar reasoning might lead them to remove oxycodone from the public formulary altogether. The millions of dollars saved could be spent on safer pain management modalities.

The unpleasantness of denying patients opioids sometimes makes it difficult for me to remember that doing so is safe and often appropriate. Indeed, while there is virtually no evidence that long-term opioids are helpful in non-cancer pain, the study by Dhalla and colleagues shows that writing these prescriptions can be deadly.