Safe Use Saves Lives and Reduces Complications
Opioids, or narcotic medications, are powerful pain killers. They can be an appropriate and effective part of managing pain, but the overuse and misuse of these prescription drugs has become a public health crisis. Since 1999, the use of opioids has quadrupled and more than 165,000 people have died from their use. The Center for Disease Control (CDC) estimates that 40 Americans die from opioid overdoses every day. To improve the safety of opioids, the CDC released new guidelines in March for how these medications should be prescribed.
The CDC guidelines are intended to help curb the trend of over-prescribing opioid medications for “low-risk” procedures (like joint surgery using an arthroscope, gallbladder removal, carpal tunnel surgery and dental procedures) and the treatment of chronic pain. Patients and providers are encouraged to discuss the risks and benefits of opioid therapy, safely improve pain management plans, and reduce the risks of long-term use and misuse. These new guidelines do not apply to patients who are receiving active cancer treatment, palliative care or end-of-life care.
Opioids: An Overview
Opioids are medications that reduce feelings of pain. Examples include oxycodone (OxyContin/Percocet), hydrocodone (Vicodin), oxymorphone (Opana), morphine, and fentanyl. They are often recommended for short-term acute pain relief, such as after surgery or a severe accident or injury. Because of the risk of physical dependence and tolerance (the need for higher doses to receive the same level of pain relief), the use of opioids for the long-term treatment of chronic pain gets to the heart of the new CDC recommendations: opioids should be prescribed and used very carefully.
A cautious approach towards opioid use is also recommended because they cause side effects, some of which can require treatment with additional medications. The most common side effects are nausea, vomiting, dry mouth, constipation, dizziness, confusion, and depression. Opioids also cause sleepiness which can make it difficult to function at work, operate machinery, drive and manage family commitments. Because opioids slow breathing, it is risky to mix them with alcohol and other drugs (sedatives, tranquilizers, anti-histamines). Accidental overdoses often involve the use of opioids in combination with other drugs. Many patients find that the unpleasant side effects and loss of income (when unable to work) are not worth the benefit of taking opioids.
What Patients Can Expect
With a goal to save lives and reduce complications associated with opioid use, the CDC has encouraged providers to shift their focus to providing safer care for all patients, not just “high-risk patients.” An emphasis has been placed on prescribing lower dosages, close monitoring of patients taking opioids, and discontinuing the medication when the risks outweigh the benefits.
In its recommendations, the CDC addressed when to start or continue prescribing opioids for chronic pain. The CDC reminds us that opioids are not routine for chronic pain, and that over-the-counter (OTC) medications like ibuprofen or acetaminophen should be tried first with other strategies such as physical therapy, exercise, cognitive behavioral therapy, massage and yoga. Providers are encouraged to set goals with patients for reducing pain and increasing physical function.
The CDC suggests providers prescribe the lowest possible effective dose of immediate-release opioids (instead of long-lasting ones) to reduce the amount of time that opioids stay in the body. The CDC cautions that the decision to increase the dose should be carefully assessed. Regular follow-up might include monitoring progress with pain management and activity goals as well as reducing or discontinuing the medication.
If you take opioids, your provider may require more office visits, extra assessments, urine drug testing, and a written pain treatment plan. Be sure to let your provider know if you have a family or personal history of substance abuse. Because of the risk of overdose and death from opioids, it is important to take them only as prescribed and never mix them with alcohol, benzodiazepines (Valium/Xanax) or sleep aides. Taking too much or more often than prescribed can dangerously slow breathing and cause death. Store opioids safely out of the reach of children and pets, and do not share pills with others. Never crush or split opiates as that can change how the drug is absorbed and can lead to overdose.
Managing Chronic Pain
Living with chronic pain is very challenging to say the least. It can affect your whole life — your mood, sleep, activities, relationships, ability to work and enjoy life. If you struggle with chronic pain, discuss the risks and benefits of all your options with your provider. While not all pain can be cured, most pain can be managed so that it interferes less with your daily life.
Read More About Chronic Pain
These KnovaSolutions newsletters offer additional information about chronic pain:
- Chronic Pain: An Overview
- Two Types of Chronic Pain: Neuropathic and MusculoSkeletal Examined
- Living With Chronic Pain: A Focus of Inflammatory and Compressive Pain
KnovaSolutions is available to assist you or members of your family identify safe and effective ways to manage pain. Let us know how we can help, call 800/355-0885.
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The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.