Is there a way to prevent overdose deaths from prescription opioids, while still providing quality healthcare to chronic pain patients? This is an ongoing controversy surrounding this issue in the United States.
Despite the increasing death toll from opioid overdoses, many patient activists maintain that no guidelines should be placed on physicians and pain clinics. It has been said that “the drug overdoses are from methamphetamines and other illegal drugs not prescription drugs,” even though, in 2017, there were 42,249 overdose deaths related to prescription opioids compared to 34,679 overdose deaths related to methamphetamines and heroin combined.
Some argue that these individuals are ‘patients,’ not ‘addicts.’ A line is being strained between the two, contradicting the realism that some patients are or have become addicted to prescription painkillers. Addiction does not differentiate, and often is not a matter of choice. It is very possible to develop a physical dependence on opioids over time, which can lead to dependence.
Much like the early history of heroin in medicine, prescription painkillers are now being seen for their dangerous, adverse effects. Many patients have been diagnosed with a disorder known as Substance Use Disorder (SUD) with prescribed pain relievers, in which their chronic use of the drugs causes clinically extensive damage, including health complications, disability, and failure to reach responsibilities at home, work or school.”
Opioids are commonly used ‘nonmedically,’ which means using a medication without advise or prescription from your provider—or simply for the high that is felt when the medication is taken. In the U.S. today, opioid medications are the most abused prescription medication. In 2015, 227 million opioid prescriptions were prescribed in the United States. By 2011, there were five times more treatment admissions for opioids than in 2001. In 2014, three million people were nonmedical users of prescription opioids.
There are two different types of painkillers: narcotic opioid drugs and over the counter drugs such as aspirin and ibuprofen. Aspirin works by going to the site of the pain and blocking pain signals from being sent to the brain. Although we may still have an injury, our body isn’t letting our brain know it. Opioids work in a similar manner by blocking pain signals to the brain; however, they also alter the way the pain feels to the brain. This can translate to a feeling of euphoria, reduced inhibitions and a feeling of wellbeing. It is these feelings that drive people to misuse opioids.
Opioid drugs are most dangerous when used for a reason other than an injury or pain. But even when some people are prescribed these medicines and it still increases their risk for addiction (or even overdose) by not taking take them as prescribed such as, taking more pills at once, taking them more often, or combining them with other medications or alcohol. There is still a possibility of a patient becoming an addict even when they take the medication as prescribed.
In the United States, there are around 150 million people suffering from chronic illnesses and pain such as, chronic back pain and osteoarthritis. For some, long-term opioid treatment has provided relief without threatening their quality of life. But, other patients start to need higher doses more frequently to numb their pain, which can lead to dependence and addiction.
There is a small amount of data to support the positive side of opioids, but there is a large amount proof of their dangers and addiction potential. One study found that, among people who were treated with opioids for 6 months, 55% were still using the opioids 3 years later. Among 23 existing studies, up to 38% of patients developed a physical addiction.
As proof of this dependence, evidence also suggests there is a relationship between opioids and abuse of heroin—the prescription drugs’ illegal cousin. According to NIDA, four recent studies show that more half of adolescents who are addicted to heroin say they abused prescription painkillers before experimenting with heroin, and some took up heroin because it is less expensive and easier access.
As opioid addictions and overdose deaths remain at increasingly high levels, there are many ways to bring awareness and knowledge to the recent epidemic.
Health information on safe opioid use could be provided to the patients. Instructional and training classes could be required for patients to know how to use medications safely and correctly, especially information about proper storage and appropriate disposal of medications that are no longer needed. The classes would also address the risk of long-term pain medication treatments.
Maximizing the use of non-medication treatments. Physical therapy, occupational therapy, water aerobics are just a few examples of ways to possibly treat pain.
There are numerous non-opioid medications that are over-the-counter or prescription, such as aspirin, acetaminophen, ibuprofen and steroids, and some find that these medications treat their pain when taken.
When assessing a patient with the likelihood of pain medications being prescribed, there are steps that should be taken to prevent addiction. Medication should be coordinated to the specific patient’s needs. This should begin with a thorough medical history, including past and current medications. Ask if there is a history of opioid abuse or addiction. A psychiatric status is also very important to address if there is a possibility of pain medication being prescribed.
A physical exam is also necessary. Keep in mind symptoms and signs of possible opioid abuse such as skin lesions, poor oral hygiene and the urgency of the patient wanting pain medications.
Over all, there is a need remain unbiassed and move beyond a simple-minded view of addiction. Whether a patient or non-medical user, when opioid dependence develops, the door to asking for help needs to be open.