Initial prescription associated with long term opioid usage (via Paolo)

Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use – United States, 2006-2015.
Shah A, Hayes CJ, Martin BC.
MMWR Morb Mortal Wkly Rep.
2017 Mar 17;66(10):265-269.
doi: 10.15585/mmwr.mm6610a1.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28301454
Full text PDF: https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6610a1.pdf

Rothman adds:

The study has gotten some attention in the popular media as well- here’s what your patients may have read:

Ars Technica’s Beth Mole: With a 10-day supply of opioids, 1 in 5 become long-term users
https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/

Vox: The risk of a single 5-day opioid prescription, in one chart
http://www.vox.com/2017/3/18/14954626/one-simple-way-to-curb-opioid-overuse-prescribe-them-for-3-days-or-less

CNN: Prescriptions may hold clues to who gets hooked on opioids, study says
http://www.cnn.com/2017/03/20/health/opioid-prescriptions-predict-chronic-use-study/

Valium for acute back pain…

“….added nothing above and beyond Naproxen (which we can presume based upon very little distinction within the NSAID class is equivalent to Motrin).
http://www.annemergmed.com/article/S0196-0644(16)31214-8/abstract
[PubMed]

In previous studies this held true for opiates as well.

So take home points—

1) Low back pain (very probably) does not need benzodiazepines
2) Low back pain (very probably) does not need opiates
3) Low back pain (most certainly) never requires an opiate/benzo combo
4) Low back pain (most likely) really only needs NSAIDs and time (probably mostly the time)
5) Don’t give more than 400mg of Motrin.”

-Dr. William Paolo

“And remember…prescribing benzodiezapines for back pain isn’t necessarily ‘safer.’ National statistics show an increase in benzodiezapine related deaths; perhaps partly attributed to their increased prescribing in response to an overall decrease in opioid prescribing.”

-Dr. Ross Sullivan