LIE: "New Study Shows Opioids Never Work for Low Back Pain and Should Never be Used"

A new study came out of Australia the end of June 2023 called OPAL. The authors claim this study proves opioids don't work for low back pain and should never be offered, even as a last resort. The study has major design flaws and also is being seriously misapplied by the authors and media. 

This article contains the following information:

 OPAL Study Explained

A brand new study was published in the Lancet a few days ago. The full pdf of the study is here.

The Opal Trial - Opioid analgesia for acute low back pain and neck pain. This study has already been misapplied and the authors have made inappropriate conclusions based on this tiny flawed study.

This is a brand new study out of Australia. six-week study, around 300 people completed it. They're making the claim that based on this, nobody should ever receive opioids for acute low back pain. No doubt this will be misapplied to all pain, including chronic and post-op.

Dr. Chad Kollas, who is on DPF's board, posted a long helpful thread yesterday, that can help anyone trying to discuss this study. Let us know if you have any questions. This study is already being used as a weapon, so it's helpful to know how to address it.

Here is another updated Twitter thread by Dr. Chad Kollas.

There was a lot of discussion about this study on Twitter. We dug into the study a little bit, and found out that one of the authors of this study also was an author on Australia's deprescribing guidelines that just came out a few days ago. There are a few interesting things about this. First one being a co-author of those guidelines is a  US Psychologist named Jason Doctor, who is anti-opioid. He's co-authored articles with PROP members. More interestingly, though, on those guidelines, if you look at the disclosures, you'll see several of the authors are funded heavily by Indivior, maker of Suboxone. Another ridiculous fact is the Lancet asked for specific comment from Dr. Jane Ballantyne and Dr. Mark Sullivan from PROP. The only reason anyone asks for their input is to get the anti-opioid spin.

We knew this trial was rigged. If you look in this article the following statement exists: "“The OPAL trial is a direct response to one of the main findings from The Lancet series: while we have good evidence on harms with opioid analgesics such as addiction, overdose, and death; we have no evidence on whether opioids are effective for a new episode of spinal pain."

The series of studies in the Lancet this study was based on are listed in the link. The last of the series has Roger Chou and Judith Turner as authors. Also, Jane Ballantyne authored a study with the lead author, Christine Lin in 2019. Ballantyne and another author, Maher, spoke together at a conference in 2014. 

Our org spent the day looking up information to try to figure out the actual motive. The study itself is kind of odd. They use a medication that's isn't even approved for acute pain in Australia, and wouldn't be used for acute back issues. Watch this two-minute news clip from Australia.

DPF found that Australia has been in the process of suing Pharma over opioids. Why does this matter? Well, it just so happens, the medication they chose to use for this study is a product made by Purdue. Our guess? They're pushing toward lawsuits like we did here in the USA. Oh, and Jason Doctor, one of the authors of the guidelines - he's been an expert witness in litigation in USA.

We will add more to this article as we break down the study.

Here are important links with all of the Lancet articles and OPAL along with supplemental information:


March 21, 2018   Lancet article – “Low Back Pain – A Major Global Challenge  pdf

June 9, 2018       Lancet LBP series article – “What LBP is and Why we Need to Pay Attention-    Appendix

June 9, 2018       Lancet LBP series article – “Prevention and Treatment of LBP – Evidence, Challenges, Promising Direction”  - Appendix

June 9, 2018      Lancet LBP series article – “LBP a Call for Action”  - Appendix

December 15, 2018 -  Lancet Article – “LBP Authors Reply”    Appendix

2018 - Editorial by authors of the Lancet LBP series called "The Lancet series on low back pain: reflections and clinical implications"

March 21, 2019  - Article claiming OPAL was part of Lancet LBP series

July 3-6, 2019 - In the updated call to action published in PAIN, they mentioned An international forum that was held in Canada to discuss the Lancet Back Series and research involved "International Forum for Back and Neck Research." 

December 2019   BMJ – Evidence Review –“87 Opioid deprescribing in people with chronic non-cancer pain – a systematic review of international guidelines”

September 2020  - IASP PAIN Journal – “The Lancet Series Call to Action to Reduce Low Value Care for LBP – an Update”

November 14, 2020   Lancet Article – “Lessons Learned from the Lancet LBP Media Strategy

November 2021 –    “Lesser of Two Evils- Framework Analysis of Consumers’ Perspectives on Opioid Deprescribing and the Development of Opioid Deprescribing Guidelines”

2022    “Opioid Analgesic Stewardship in Acute Pain -Clinical Care Standard (Australia version of AHRQ)

October 2022- Article published about the International Back and Neck Forum held in 2019 about Lancet LBP Series "Back to the Future: A Report From the 16th International Forum for Back and Neck Pain Research in Primary Care and Updated Research Agenda"

June 15, 2023    “Introduction to Clinical Care Standard for LBP – Australia

June 25, 2023  Wiley Online Journal – “Clinical Practice Guideline for Deprescribing Opioid Analgesics: Summary of Recommendations”

June 28, 2023“Opioid Analgesia for Acute Low Back and Neck Pain (OPAL Trial) – A Randomized Placebo Controlled Trial-     Appendix 

June 28, 2023     full pdf of OPAL Study

Link to DPF Patreon Page

Link to Video Podcast about OPAL

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