The opioid epidemic began in the late 80's and early 90's with the misguided notion that opioid painkillers can be used safely and effectively in the long-term treatment of chronic back pain or other forms of non-cancer pain. In the following years more than 300,000 deaths in the related opioid overdose epidemic have rebutted the idea that opioids can be used safely on a mass basis. The CDC stated that in 2016 more than 40% of all opioid related overdoses involved a prescription opioid, with more than 46 people dying every day from overdoses involving prescription opioids.
A research article from March of 2018 in the Journal of the American Medical Association compared opioid vs non-opioid drugs over 12 months on pain-related function, pain intensity, and adverse effects. The study was a randomized clinical trial that involved 234 subjects. The study found that opioids provided no better pain relief for patients with low back pain or painful osteoarthritis than safer pain relivers such as nonsteroidal anti-inflammatory drugs and acetaminophen. Opioids are perceived as strong pain relievers, but the data showed no benefits of opioid therapy over non-opioid medication therapy for pain. Furthermore, opioids provided no advantage in terms of function at the 12-month follow-up mark. Therefore, the data does not support opioids' reputation as "powerful painkillers."
The data from this study supports the recent recommendation in the American College of Physicians guideline that opioids should be an uncommon treatment - a treatment of last resort - for patients with low back pain. It is the first clinical trial comparing opioid and non-opioid medication with long-term follow-up. It provides strong evidence that opioids should not be the first line of treatment for chronic musculoskeletal pain. Opioids are not achieving the benefits for which they are marketed.
It is important to point out that 80% of heroin addicts in America begin that process with a physician prescribed opiate for pain. Also, there is evidence that chiropractic spinal adjusting is better than 5 times more effective than NSAIDS in the treatment of chronic neck and back pain. Also, there is evidence that spinal adjusting activates the same pain receptors that opiate drugs use, creating pain relief without opiate drug receptor adaptation, addiction, and death.