Taking Ownership and Being Part of the Solution
You’ve heard the news reports about the dangers of opioid medications such as codeine, morphine, methadone, fentanyl, hydrocodone and oxycodone. While opioids can be an appropriate and effective treatment for pain, the U.S. has the highest rates of opioid use in the world. According to the National Institute on Drug Abuse, about 80% of the world’s prescribed opioids are used in the U.S. Great risk comes with such widespread use. From 2010 to 2015, more than 500,000 people died from opioid overdoses.
The Center for Disease Control (CDC) issued guidelines intended to help curb this trend in 2016 (see our newsletter). However, it will take more than government guidelines to solve this problem; prescribing doctors and patients can work together to be part of the solution.
Ways Opioids Are Over-Prescribed
- For low-pain procedures, such as tooth extractions, where non-narcotic medications are sufficient to reduce pain.
- Being sent home with a 30 day supply of pills (and a refill!) for post-operative pain when a 5-10 day supply is more than adequate.
- When a person receives opioid prescriptions from multiple providers.
Some states have a centralized database that allows providers to check a patient’s prescription history before prescribing opioids.
Back Up, Why Are Opioids Risky?
Opioids are a type of narcotic medication that work by stopping pain messages from being sent to the brain and therefore reduce feelings of pain. They are used to treat moderate to severe pain that may not respond well to other pain medications. However, these pain medications produce habit-forming feelings of euphoria and are frequently abused: taken at a higher dose than prescribed, for longer than needed, in different forms, without a prescription and/or in combination with other medications or illicit drugs.
Regular opioid use can lead to dependence and tolerance (needing higher doses to receive the same relief), and, if misused, result in accidental death. Side effects include drowsiness, confusion, constipation, nausea/vomiting, and inability to safely drive and operate other equipment. These side effects can make it impossible or difficult to fulfill work and family responsibilities. If opioids are abruptly stopped, severe withdrawal symptoms can occur, which cause some to restart the drug.
Opioids do not mix well with alcohol and other medications like antihistamines, sleep aids and some antidepressants. Further, opioid use can lead to addiction (even when used as prescribed) and drive people to engage in other behaviors that may have negative consequences, including the use of heroin. In fact, a rise in heroin use has been linked to recent attempts to make opioids less available. Drug addiction puts stress on all members of a family, and almost certainly affects the ability to maintain consistent employment.
Since the journal Pediatrics reported that most teenagers who abuse opioids first received them from a provider (for tooth extractions/sports injuries), it is especially important to carefully evaluate the pros and cons of prescribing opioids for this age group.
Got It, Now What?
The best way to reduce the use of opioids is through open discussion between patients and healthcare providers. If you are having surgery or suffer from chronic pain, you can express your preference to use opioids in the smallest effective dose for the shortest amount of time.
Let’s say you are having surgery soon. This is your chance to work out a pain management plan with your provider — in advance! Let’s also assume that you’ve already determined that having the surgery is the right decision for you based on your situation (see our newsletter about making healthcare decisions). A pain management plan should include:
- Discussion about current medications, your health history (physical and mental health) and any addiction concerns. This is a good time to mention a desire to minimize the use of opioids.
- Information about medications that will be used during surgery.
- An overview of the amount and duration of post-operative pain to be expected.
- Discharge instructions, including what medications you will be taking when discharged.
- Discussion about whether opioids will be needed at home and for how long, and how/when you can begin alternating them with ibuprofen and/or acetaminophen.
- Description of other pain therapies such as ice, elevation, physical therapy, acupuncture etc.
For those who take opioids for chronic pain, it is helpful to seek a provider who is well versed in all aspects of pain management, including alternative therapies. It is also useful to regularly evaluate the risks and benefits of continued use of opioids. Such regular discussion with your provider may enable you to transition from or reduce reliance upon them. Here are sample questions for reviews:
- Are you taking the medication as prescribed? What are your side effects and how are you managing them?
- Has your pain changed? What actions or positions trigger discomfort and what relieves it? How is your pain responding to the medication?
- What is your long-term pain management plan? Are there changes you can make that will move you towards less reliance on opioids?
- If you are concerned about addiction, how can you get help?
Opioids: Not the First Line of Treatment
Research shows that opioids are not any more effective than non-opioid alternatives, such as ibuprofen or acetaminophen, for treating many soft-tissue injuries and musculoskeletal problems.
Long-term use of opioids may cause an increased sensitivity to pain — a condition called hyperalgesia.
Therefore, the first line of treatment for pain might include a combination of therapies, such as ice, heat, gentle stretching, acetaminophen (Tylenol), and/or NSAIDS (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin, Aleve). Only take NSAIDS if they are safe for you given your health conditions and other medications.
National Institute on Drug Abuse
Because of the health, safety, economic and social costs of opioid addiction, it is essential that people with opioid dependence have access to appropriate treatment. Many states are working to improve access to addiction care. As with all health concerns, a primary care provider can help patients find the care they need.
Let Us Help
Your KnovaSolutions clinician can assist you with identifying questions and/or talking points for discussions with your doctor and provide information about non-narcotic pain management options. We’ll help in any way possible and offer an empathetic ear too! Call us at 800/355-0885, Monday through Friday, 8 am-5 pm.
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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.