Cocktail of simple over-the-counter drugs as effective as heavy opioids in treating pain

Americans are already taking way more opioids than they should in the first place — new study shows many are not even as effective as you’d think.

Credits: j_lai / Flickr.

Since the early 1990s, the US has gone through a dramatic opioid crisis. What started as a case of national over-prescription turned into a full-blown epidemic, with approximately 80 percent of the global pharmaceutical opioid supply being consumed in the US. For a country with only 5% of the world’s population, that’s extremely concerning.

Of course, the easiest way to avoid becoming hooked on opioids is to avoid taking them in the first place. In surprisingly many cases, even a few days of prescription can lead to an addiction. However, some patients don’t have the luxury of not taking opioids — in the case of people arriving in the emergency room or with broken limbs, opioids are required to ease the excruciating pain. Or so we thought.

A new randomized, double-blind clinical trial found that a combination of ibuprofen (Advil) and acetaminophen (Tylenol) was just as effective at dealing with acute pain as three other common opioid treatments. The authors suggest that in some cases, medics could simply skip the opioid treatment, offering instead the two very common over the counter drugs.

This change could have a significant impact in tackling the opioid crisis, as well as opening new, simpler avenues for pain management. Considering that every day, opioid overdoses kill an estimated 91 Americans, it could make a big difference.

“This change in prescribing habit,” they write, “could potentially help mitigate the ongoing opioid epidemic by reducing the number of people initially exposed to opioids and the subsequent risk of addiction.”

In the study, researchers had 416 patients (ages 21 to 64 years) with moderate to severe acute extremity pain in two urban emergency departments. The patients were randomly assigned to receive:

  • 400 mg ibuprofen and 1,000 mg acetaminophen
  • 5 mg oxycodone and 325 mg acetaminophen
  • 5 mg hydrocodone and 300 mg acetaminophen; or
  • 30 mg codeine and 300 mg acetaminophen

Oxycodone (commonly sold as OxyContin and Percocet) and hydrocodone (Vicodin) are two of the most commonly used opioids.

Two hours after each treatment, researchers assessed the pain the patients were in, finding no significant difference between the four groups. In other words, whether they took opioids or a cocktail of ibuprofen and acetaminophen, the pain still dropped significantly, with minimal differences. The reason why the two work so well together is because they act in different ways, working on the brain and nervous system respectively.

Authors point out that data from the World Health Organization suggest that opioids are much more effective at dealing with pain, but this study casts a big question mark on that data.

Of course, while they pose a much lower risk than opioids, Tylenol and Advil also shouldn’t be abused.

Journal Reference: Andrew K. Chang et al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. doi:10.1001/jama.2017.16190


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