Statement of purpose The overprescribing of opioids has led to increased addiction, overdose death, and violent crime. To create a culture of safety, communities would benefit by decreasing the number of opioids prescribed.

Often when considering policy to control the overprescribing of opioids, we hear from opioid supporters who claim that by reducing the number of opioids prescribed, we will hurt those in pain who need these medications. This talk will show that for the great majority of people with pain, opioids are not a good option and that by reducing the prescribing of these medications, we will actually be treating pain better.

Methods/Approach Review of medical literature to examine the efficacy and dangers of various classes of pain medications including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.

Results Efficacy

• NSAIDs are the most effective pain medications.

• Opioids and acetaminophen have similar efficacy.

• The combination of an NSAID and acetaminophen is the best for pain relief.

Side-effects

• NSAID medications can cause gastrointestinal, renal and cardiac side-effects. The GI and renal effects are dose-dependent and low dose ibuprofen has a side-effect profile similar to placebo.

• Acetaminophen can cause liver damage in higher doses.

• Opioids surprisingly also have GI, renal, and cardiac side-effects. In addition, opioids have powerful psychotherapeutic effects that can lead to dependence and addiction.

Conclusions In the treatment of pain, NSAID medications like ibuprofen and naproxen are both more effective in the treatment of pain and are safer than opioid pain relievers.

Significance and contribution to the field In both policy development and community action, we must not let rhetoric and emotion supplant science and knowledge in the discussions on opioid prescribing, opioid abuse, opioid addiction, and opioid overdose. Abundant scientific research has shown that policies and activities that reduce the number of opioid prescriptions will improve the treatment of pain, and reduce the multiple adverse economic and public health effects of opioids.