Reply to Blatt

Abstract

exposure to prescription opioids. 1 This study compared a group on long-term opioid therapy at a pain center with a group whose initial exposure to opioids was for chronic pain but who were currently receiving treatment of opioid addiction. The Addiction Center Research Inventory 7,8 was completed by both groups. The Addiction Center Research Inventory scores were much higher, indicating more euphoric effects from opioids, in those who later became addicted to opioids. Yet the group that was not addicted also reported frequently experiencing hedonic effects of opioids. 30% recalled "I was full of energy," 25% noted "things around me seemed more pleasing than usual," 35% "felt more clear headed than dreamy," and 25% recalled "feeling more excited than dreamy."The Kaiser Family Foundation performed a phone survey of recipients of chronic opioid prescriptions. This was self-published on the website of the Kaiser Family Foundation in December of 2016. 2 20% of survey respondents reported that a major reason for using prescribed opioids was "for fun or to get high," 14% "to deal with day to day stress," and 10% "to relax or relieve tension." An additional 14%, 8%, and 3%, respectively, reported that it was a minor reason to use prescribed opioids for these purposes.In a phone survey of retired National Football League players, 4 participants were asked if they used opioid medications for any of the following purposes: to function; to change mood, be happy, or get high; to relax, calm down or relieve stress; to sleep; or for pain. Roughly 25% exposed to prescribed pain medications during their playing career were currently prescribed opioids. Of those, 45% disclosed current misuse of opioids. 35% of those currently misusing opioids reported that during their playing careers they used opioids to relax or relieve stress, whereas 22% reported opioid use to improve mood.These articles seem to have substantial agreement with Frimerman et al., in that all show a very high rate of hedonic effects of prescribed opioids. However, patients in the 2 phone surveys reported a wider variety of hedonic effects than were evaluated in this study and a higher rate of opioid misuse.The authors suggest 2 important clinical implications of these data: to routinely discuss the possibility of hedonic effects with patients and cognitive behavioral or mindfulness interventions for those patients who seek the pleasurable or calming effects of opioids. These seem to be very reasonable responses to their findings and the impact of misuse on clinical outcomes.I propose another clinical implication: The information that is discussed here, and in the extensive body of research cited in their references, is not already widely shared in the locations where it would seem most likely to be seen by the medical community: in opioid management guidelines, standardized informed consent documents, and medication management agreements. 3,5,9 By contrast, the risk of addiction is already covered in these documents. Similarly, ordinary risks common to opioids...