PART 3 – OPIOIDS
Except for Marijuana, controversy surrounds Opioids more than any of the previous medications discussed in Parts 1 and 2. Suicides, accidental overdoses, and misuse of Opioids by prominent celebrities fill the headlines and invoke a strong media reaction. This escalated attention cautions healthcare physicians to seek other options for their patients.
The American Academy of Pain Medicine, National Institutes and Health, American Chiropractic Association, and American Society of Addiction Medicine provide chronic pain and prescription opioids statistics. These statistics cover the United States only:
Chronic pain statistics indicate more people suffer from pain than the combination of diabetes, heart disease, and cancer. Excluding acute pain conditions and children suffering from pain, 50 million to 100 million adults suffer from chronic pain. Of those adults, 27% seek treatment for lower back pain, 15% for severe headaches to migraine pain, and another 15% for neck pain. Alarmingly, these numbers continue to grow daily.
Research of the prescription pain pill epidemic for 2015 shows 20,404 people died from Opioids overdoses. Prescription opioids account for substance abuse disorders by two million people. Increased national crime, pharmacy burglaries, and overdose deaths were tied to Opioids abuse.
Since the rise of prescription drug overdoses, especially prescription Opioids, views have changed among healthcare providers for prescribing Opioids for the treatment of chronic pain. However, Opioids are prescribed in cases of short-term to help patients recover from fractures or post surgery.
Your primary care physician will no longer prescribe Opioids for moderate to severe chronic pain. Instead, you’ll be referred to a Pain Management Facility where specialists evaluate and monitor prescriptions of Opioids.
Many chronic pain patients find themselves suffering more and receiving little or no assistance of treatment for their pain due to the abuse and misuse epidemic. As the fear of overdosing heightens many physicians, including specialists, seek other options to treat chronic pain. Physical therapy, minimally invasive procedures, and lifestyle changes are the preferred options. However, these options, exhausted by most chronically ill patients, bring little to no relief.
So, how do chronic pain patients find relief? If Opioids are the only option available for severe chronic pain then understanding the risks involved with these drugs is mandatory. The specialists associated with Paindoctor.com (and most pain management specialists) treat chronically ill patients using a 12-step Opioid Checklist to ensure patient safety. (You can find the risks of Opioids listed after the checklist.)
Taking Opioids is a risk. But most chronic pain sufferers take that risk to acquire a fraction of the quality of life they enjoyed prior to the onset of chronic pain.
What are Opioid medications?
As the oldest known class of drugs in the world, Opioids refer to either morphine or other opium poppy-based medications – narcotics. Opioids suppress the pain perception by reducing pain signals as they are transmitted through the nervous system.
Below are some types of Opioids (and their generics) used for chronic pain treatment. ALL of these medications require a prescription.
–Hydrocodone (Hysingla ER, Zohydro ER)
-*Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
–Hydromorphone (Dilaudid, Exalgo)
–Oxycodone (Oxycontin, Oxecta, Roxicodone)
-*Oxycodone and Acetaminophen (Percocdet, Endocet, Roxicet)
–Oxycodone and Naloxone (Targiniq ER)
–Morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
–Methadone (Dolophine, Methadose)
–Fentanyl (Actiq, Duragesic, Fentora)
–Codeine (only available in generic form)
(*Includes Acetaminophen in the compound. Avoid other products containing acetaminophen (ex: Tylenol) due to increased risk of liver problems.)
For pain relief all day and through the night your doctor may prescribe specific doses of your pain medication. However, there is a chance you may experience “breakthrough” pain. Breakthrough pain is a flare of pain experienced even though you receive round-the-clock pain medication.1 In this case, you may be given a prescription with “as needed” instructions.
Regular visits to the pain specialist are a requirement of care if you are prescribed Opioids. These visits include questions asked by your specialist:
- Are you responding to the Opioid?
- Are you experiencing any side effects?
- Have you developed a medical condition or potential interaction that may increase the risk of side effects?
- Are you taking the medication as directed?2
NOTE: Never change the dosing of any Opioid medication without first checking with your physician. If your pain isn’t managed by the medication prescribed, your physician may change the dose or try another Opioid drug.
Opioids can be dangerous if taken with 1) antidepressants, 2)antihistamines, and/or 3)sleeping pills. Be sure your doctor knows all medicines you are taking. Other prescription drugs, over-the-counter drugs, and herbal supplements may cause additional problems when taken with Opioids.
When you’re ready to quit the Opioids, your pain specialist will advise a slow weaning off from the Opioids to help your body adjust to the removal of the pain medications. Withdrawal symptoms occur if you stop the Opioids abruptly.
As reviewed in Parts 1 & 2 of this series, most medications have side effects and Opioids are no different. Common side effects include:
*Dry Mouth *Constricted pupils (miosis)
However, there are more serious side effects including:
**Urinary retention **Hearing loss
**Respiratory depression **Hallucination
**Hyperalgesia (increased sensitivity to pain)
**Abnormal heartbeats (arrhythmias)
LARGE doses can induce:
***Serious respiratory problems ***Depression
***Oxygen deprivation ***Unconsciousness
Taking Opioids for the long-term may cause tolerance, dependency, and/or addiction.
Tolerance occurs when the need for Opioids causes increasing the dosages.
Dependence is a physical or psychological effect. A physical dependency occurs when you (abruptly) stop taking your Opioid medications resulting in a withdrawal syndrome. Psychological dependency occurs as an emotional need for the drug when there is no physical need.
A small percentage of patients who use Opioids long-term may suffer from addiction.3 The characterization of addiction is a constant pattern of inappropriate Opioid use and may include the following serious problems:
- Loss of control of using Opioids
- A preoccupation of acquiring more Opioids even though pain relief is achieved
- Although adverse physical, psychological, or social consequences may occur, the patient continues using Opioids
- Overdose and death increases as an adverse effect
Should you take Opioids? If you suffer from moderate to severe pain, Opioid drugs can make a significant difference in your pain levels. However, you must take them safely and follow your doctor’s instructions carefully to avoid the negative effects of Opioids.
Next week, we’ll explore Marijuana and its treatment of chronic pain. Have a great week!
1Opioid (Narcotic) Pain Medications article, WebMD, LLC, 2017
2Opioid (Narcotic) Pain Medications article, WebMD Medical Reference, Minesh Khari,MD, April 30, 2017
3“What are Opioid Medications? Article, paindoctor.com