Do Opioids Impact Life Expectancy?
Meet Rachel and Lorna
Meet Rachel * and Lorna. They are very different women, but they have one thing in common: they both used opioids.
One morning, Rachel maneuvered her maroon Civic into a parking place at a local breakfast joint to buy opioids from her dealer. Accompanied by her two-year-old daughter and her brother, she had never felt more like a criminal. While Rachel never turned to heroin or other street drugs, she used prescription opioids for non medical reasons.
After seventy-six-year-old Lorna awoke, she rolled over to sit up, and a severe bolt of lancinating pain radiated down her right leg into her foot. Since Lorna lived on a farm, her doctor was 90 miles away which made it torturous for her to travel to his clinic. Fortunately, this was before hydrocodone was rescheduled, and her son was able to obtain a prescription by making a phone call. Lorna had to have an emergency lumbar discectomy to remove the herniated disc pressing on her L4 nerve root. After the operation, she continued to experience moderate pain but small amounts of opioids made the pain tolerable.
Two Different Worlds
Rachel and Lorna’s needs for an opioid were rooted in entirely different situations. Rachel began receiving pain medication for normal surgical pain but, because of her genetics and environment, she continued using opioids for the wrong reasons. Lorna’s need for opioids was more rudimentary: she used them so that she could perform the normal activities of daily living.
Rachel and Lorna represent two different worlds that are often conflated when policies are enacted to curtail the opioid crisis. Recently, the Washington Post wrote, “America’s opioid problem is so bad that it’s cutting into the U.S. life expectancy.” This is a troubling statement.
Do Opioids Decrease Life Expectancy?
Sometimes, pain is chronic. Chronic pain is a chronic illness. Chronic illnesses, generally, are associated with shorter life spans. In fact, life expectancy decreases with each additional chronic condition. The average decline in life expectancy is 1.8 years with each additional chronic condition ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent across gender and race.
People in severe chronic pain generally have multiple other co-morbid medical illnesses. Therefore, it’s unsurprising that life expectancy for people in chronic pain has been reported to be 10 years less than for the general population.
The claim that opioids reduce life expectancy needs to be closely examined in context. It is important to understand how the illicit use vs. the legitimate use of opioids is contributing to the problem. Intuitively, we would suspect that Rachel’s use of opioids would be more likely than Lorna’s to negatively affect her life expectancy.
To further complicate matters, people who are prescribed opioids because of chronic pain may, in fact, live longer than people with chronic pain who don’t use opioids. The failure to appropriately treat chronic pain probably has an adverse effect on life expectancy.
Suicide and People With Chronic Pain
One reason for this is suicide. People with chronic pain are at least three times more likely to die of suicide than the general population. Suicides have reached an all-time high in the United States. In 2015, more than 44,000 suicides occurred. This figure is about 3 times greater than the number of people who died for reasons related to prescription opioids.
Recently, it was reported that suicide was 7 times more likely to be the cause of death in the elderly population with severe pain than it was for the seniors who were not experiencing severe chronic pain. The number of suicides related to severe pain in the elderly population was more than the number of suicides associated with psychiatric disorders, depression, or anxiety disorders. Only bipolar disease created a greater risk of suicide.
That said, because of their illnesses, even those who treat their pain with opioids will likely have shorter lifespans than the general population. That’s generally true for people who take medication for any chronic illness.
Medications Come With Risks
It’s a fact that people with chronic illnesses usually take medication for their illnesses. Unfortunately, despite the medication, most people with chronic illnesses statistically die earlier than those who do not have chronic illnesses. Ultimately, medications are supposed to improve the quality and length of life for someone with a chronic illness, which makes them a reasonable strategy worthy of consideration despite the fact that each medication comes with its own risks.
Concluding that anyone who uses an opioid has a shorter life expectancy because of the opioid is not only inaccurate, but it’s counterproductive to our society’s shared mission of reducing harm from opioids. It is as erroneous as relating the treatment of cancer to the premature deaths of people with cancer. Although you can draw a correlation between cancer treatment and deaths from cancer, the former does not cause the latter. Always remember what your high school biology teacher taught you: correlation does not prove causation.
* You can read Rachel’s story in my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (Oxford University Press).
I have chronic pain, nerve damage, both feet numb with pain and I cannot get a prescription for more than 3 oxycodone a day. Oh, don’t get me wrong, I’m appreciative of that amount. I would faint if my Doctor really treated me. My back is deteriorating due to an op. I’m 75 and my doctor afraid I could be led down the path of hard drugs. Yeah, I can see me on the corner looking to score. Life is hell.
Despite all the rhetoric about “the opioid epidemic” that the government has spent billions of dollars to further promote their false propaganda advertisements under the guise of “protecting us from our selves”, the majority of the data used to support their false assertion is disproportionately inaccurate. The governments intentional disinformation campaign and subsequent actions to significantly reduce the use of opioid medications is adversely affecting the quality of life for millions of Americans and causing the untimely deaths of thousands more as a result of suicide.
I am a 58 year old male diagnosed with severe spinal canal stenosis in both my lumbar and cervical areas which causes excruciating pain and loss of any quality of life. I have had extensive back surgery (L-4 -S1 fusion, Laminectomy, discectomy, etc.) and now require a second surgery (L-2 – L-4 fusion) which will require six months of recovery at a minimum. To say that my life has become a living and excruciatingly painful one is an understatement. Despite having MRIs, CAT-scans and voluminous doctor’s notes and reports, it has become nearly impossible to find a doctor who is willing to prescribe opioid medication (the ONLY THING THAT HELPS) let alone listen to anything I have to say. I don’t know how much longer I can deal with this problem and hope I can find a doctor who is more interested in treating me than he does fearing government sanctions. Our government can’t even handle it’s own affairs and has no right interfering with mine.
Unfortunately, Michael, this is still going on in this country. My wife has taken pain meds for over 20 years to combat her cluster migrain headaches, which are said to be the most painful affliction known to man. (I know that sounds crazy, but it’s the opinion of a litany of learned pain institutes.) When I went to get the script filled for her yesterday, the CVS pharmacist refused to fill it even though it had been CVS who had been filling it for at least 15 of those 20 years, and they had just filled it without issue last month! The pharmacist not only refused to fill it, but he went further telling me (and others within earshot) that not only was my wife’s doctor is breaking the law by prescribing pain meds for migrains, but he went further still saying that he was going to call the DEA and have her license revoked. The law clearly states that a pharmacist CAN NOT simply deny a prescription outright without first speaking with the patient’s doctor, something he did not do. So not only did he break THAT law, but he slandered the doctor as well. This is why I will be in contact with our state’s Pharmaceutical Board, as this is reprehensible and unprofessional to say the least. BUT MORE IMPORTANTLY, THE ACTIONS OF THIS PHARMACIST NOT ONLY PUTS MY WIFE’S HEALTH AT RISK, BUT POSSIBLY EVEN HER LIFE. (Patients who have been long time pain medication users have died as a result of withdrawals from that medication.)
No longer does the doctor do what is in the best interest of the patients. Instead, the doctors must first do the bidding of the insurance companies, then the bidding of the pharmacies and LASTLY, address the needs of the patients WHO SHOULD BE AT THE FRONT OF THAT LINE. What is happening here in the United States is a horrific breakdown in doctor/patient care, yet without those very patients, the doctors, the insurance companies and the pharmacies would all be without jobs. But here, my wife and are making the plan to leave for the hospital in a couple of days when the last of her pain medication runs out. After over 20 years of having this debilitating condition UNDER control, it is suddenly and without warning, quickly spiraling OUT of control.