Introducing a New Use for Placebos in the Opioid Crisis

Researcher Info

Jordyn Hannah

Class of 2025

Implications of changing ethical code surrounding placebos in general practice healthcare in order to combat the opioid crisis

The opioid crisis continues to take more and more lives and become more and more expensive. The Pierce County Emergency Services responded to 3,312 suspected opioid overdose calls between January 2023 and May 2024 alone. Researchers have taken various stances to this problem -- stances in which placebos have never been considered because of the ethical framework surrounding them.

This research aims to present a potential change to the AMA Principles of Medical Ethics (2. 1. 4) to Pierce County, so that general practices surrounding opioids may be refined. In future research — if accepted by testing here — it may be helpful to slowing/stopping the opioid crisis.

Problem Statement

There is a problem both with overprescription and overpricing of opioids in healthcare today. Despite the high addiction associated with these drugs, these issues continue to rise. Even after opioid overdose was declared an epidemic by the CDC in 2012, prescription opioids remain a foot in the door into this deadly addiction.

Research Question

What would be Pierce County’s response to a potential replacement ethical code of conduct regarding placebos, in an effort to address the opioid crisis in a way that doesn’t compromise patient/provider trust?

Definitions

AMA Principles of Medical Ethics: The written protocols that hold physicians to a specific ethical standard in order to protect patients.

Placebo: a substance that with a similar appearance to a drug, but holds no active ingredients. (Ex: sugar pill, saline injection, etc.)

Opioid: a class of painkillers that are commonly abused/overdosed

Overdose: taking more than the suggested drug dosage, often resulting in serious physical effects/death

Method

Descriptive research through a survey will provide a mixed methodology of qualitative and quantitative data.

Hypothesis & Assumptions

If people in Pierce County are asked their opinion on the edited ethical code presented in the survey, then they will approve of it's changes and will want it put into general practice in an effort to prevent the progression of the opioid crisis.

Significance

The statistics of deaths and lives being ruined because of prescribed opioids only continues to rise. These conditions are controllable, and yet it's been a crisis for nearly 12 years. It's time to take a different approach to this situation and placebos may hold the key. The only reason they have not been considered is because of the barriers that have been put in place. Could they be beneficial without these barriers? This is what this research attempts to discover.

Replicable method, process, or approach

After the revision of the AMA Physician's code with the following elements in mind: patient and provider trust, no challenges from other related sections, and maintaining as many elements as possible, the public will analyze it to decide whether the changes stand in society today. To do so, a sample group of 20 participants from each of the 5 most populated cities in Pierce County (Tacoma, Lakewood, Puyallup, University Place, and Bonney Lake.) will be surveyed, totaling to 100 opinions. To ensure all participants are knowledgeable on the topic, each will be given an informational flyer, created to form an unbiased opinion on placebs and opioids. Their responses will then be analyzed in a way that directly suggests whether or not the hypothesis is refuted.

Experimental Hypotheses to be used in analysis:

Hypothesis - If people in Pierce County are asked their opinion on the edited ethical code presented in the survey, then there will be a larger distribution that will approve of its changes and will want it put into general practice in an effort to prevent the progression of the opioid crisis.Null hypothesis - There is no difference between opinions on the changed AMA code and the original AMA code, and equal parts people will approve and disapprove of each.

Findings*

Because of the equal distribution of age groups and variation in opinions/experiences as shown below, it can be said that the test group collected was lacking initial bias to the topic.

This study decided to assume a normal distribution and statistical significance from the group that was able to be tested in order to meet the conditions of a chi squared test for homogeneity. This way, the raw numbers could be contextualized to the situation, suggesting a trend, rather than the direct effect that was planned. The table below was constructed in order to run the test. From this test, the following values were found: X^2 = 7.6389, p = .1057, df = 4. Because this p value is above both of the typically used power values of .05 and .1, the null hypothesis failed to be rejected.

*After collecting nearly all responses of the 100, the program being used for collection of responses was revealed to only allow access to 25. Therefore, findings must be approached cautiously, as it can no longer be said that they are representative of the whole population.

Implications

Looking back at the original research hypothesis of “If people in Pierce County are asked their opinion on the edited ethical code presented in the survey, then they will approve of its changes and will want it put into general practice in an effort to prevent the progression of the opioid crisis”, we are able to conclude that this hypothesis is wrong. Evidence shows that people do not particularly favor one version over the other. Although this means that people don’t specifically support the revision, it also shows that they don’t generally dislike it, and with a few more changes, it may be more approved of in the future.

Conclusion

Officially, this research is inconclusive on how to move forward in the future. The experimental null hypothesis failed to be rejected, and from the calculations, there is not convincing evidence that the distribution of those who thought positively of the code changes is different from those who didn’t. Therefore, it cannot be concluded that this research should be moved forward with in the future.

Limitations

Small final sample

fell below the limit of the Central Limit Theorem.
findings must be approached with caution.
some trends directly contradict the computed results.

Surveyor bias

only surveying those who seemed approachable for safety purposes.
may have unintentionally left out opinions necessary to understanding the true population.

Prescription process importance

study did not highlight other potential factors of addiction.

Survey bias

researcher stayed near responder for survey.
respondent may feel pressured to answer a certain way.

Next steps

When surveying, it was clear that this topic was one Pierce County felt strongly about. Further development of this idea should definitely be pursued. In order to do so, there are a few aspects that need to be further looked into. First, there must be more research on placebos in themselves. Most research regarding them relates to their abilities in clinical trials. In order to move forward with this idea of implementation to general practice, their impacts in those scenarios must be solidified. On that thread, discovering if placebos could become addictive must be looked into. Because they interact in similar ways to opiates, they have the same risk until proven otherwise and cannot be moved forward with until that happens. Finally, it may be necessary to further edit this code to garner more support from Pierce County, as the current revision didn’t show clear support in calculations.

Otherwise, it is clear that the opioid crisis is worth spending the time on. As discussed earlier, no solution has been found to make a large difference in the long run. With as many lives as this crisis is impacting, especially in Pierce County, it is absolutely vital that research continue to be done here. It is going to take abstract thinking such as this idea regarding placebos to halt the trends currently being seen with opioids. Placebos are an idea worth exploring in the future, and this project provides the building blocks for the findings to come.

Key Sources

Beecher, H. K. (1955). THE POWERFUL PLACEBO. Journal of the American Medical Association, 159(17), 1602. https://doi.org/10.1001/jama.1955.02960340022006

(2004, September). Buprenorphine: Potential for Abuse [Review of Buprenorphine: Potential for Abuse]. U.S. Department of Justice. https://www.justice.gov/archive/ndic/pubs10/10123/10123p.pdf

Dumas, E. O., & Pollack, G. M. (2008). Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective. The AAPS Journal, 10(4). https://doi.org/10.1208/s12248-008-9056-1

Opioid addiction caused by overprescribing, not recreational abuse, is key driver of painkiller and heroin overdose crisis. (n.d.). Heller.brandeis.edu. https://heller.brandeis.edu/news/items/releases/2015/overprescribing.html

Sullivan, M. D. (2021). Opioid Overprescribing or Underprescribing After Surgery? Mayo Clinic Proceedings, 96(5), 1108–1110. https://doi.org/10.1016/j.mayocp.2021.03.023

Use of Placebo in Clinical Practice | ama-coe. (n.d.). Code-Medical-Ethics.ama-Assn.org. https://code-medical-ethics.ama-assn.org/ethics-opinions/use-placebo-clinical-practice

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