Part 3 - Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Crafted Graph

by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 3rd post in a series about opioid, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesThis is Part 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Crafted GraphI believed, and was taught, opioids had no intrinsic ceiling effect, and didn ' t think there was much difference between someone being on 100 mg of morphine a day or 1000 mg. I wish this was the case, but the number of patients I can recall the last 20 years who were on very high opioid doses who were doing ' great ' (had excellent pain relief leading to important functional improvements and minimal side effects) is minimal (but not zero, mind you). Like, less than 5% of patients I ’ve placed on very high doses. (I’ll be the first to admit I don’t have an exact definition of what that is, I don’t think that’s possible, but generally I’m talking about many hundreds of morphine milligram equivalents a day.) Most patients remained in terrible pain and had significant, ongoing disability despite the high doses (and undoubtedly for ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs