Death rates from opioid use have more than tripled since 1999, and by claiming the lives of favorite celebrities such as Prince, Heath Ledger and Philip Seymour Hoffman, opioids have made national headlines.
Plus, for the first time in American history, life expectancy in the U.S., which has consistently risen over the years, dropped for white Americans, according to the Centers for Disease Control and Prevention (CDC). CDC data also shows that the use of prescription opioids has skyrocketed, increasing more than tenfold since the turn of the century.
Forgive the morbid statistics, but the abuse of prescription and nonprescription drugs, primarily opioids has been thrusted into the national spotlight. And you already know the names of many of these drugs: morphine, fentanyl and oxycodone, which are available only by prescription, and heroin, which is a common street drug.
What Are Opioids?
Opioids are drugs that bind to specific receptors located on the membranes of nerve cells. This interaction initiates a series of biochemical changes within the cells that translate into pain relief. These cell receptors and the ensuing changes within the nerve cells are all part of the body’s own system for managing pain — you’ve probably heard the term “endorphin” used to describe these endogenous chemicals that help us manage pain — and when we use an opioid we are simply taking advantage of this preexisting system.
Opioids can be natural (e.g., morphine), synthetic (e.g., methadone) or semisynthetic (e.g., oxycodone).
What’s So Bad About Opioids?
Pain relief, obviously, is a very good thing, but the problem with opioids is twofold:
1. They're Deadly
They can have serious side effects, including respiratory depression and death. In fact, more than half of these serious overdoses occur in patients using the drugs exactly as their health care providers prescribed them and within accepted guidelines. A majority of the overdoses also occur in patients taking opioids along with another psychoactive medication, such as a benzodiazepine (e.g., Valium).
2. Using Starts Out Innocently, Then Quickly Spins Out of Control
They are addictive, meaning that you begin to need more and more of the drug to feel its effects (the body essentially adjusts to the current dose and demands greater amounts to achieve the same results) and will go through the agonies of withdrawal if you stop. People become addicted to these drugs often quite innocently by taking them to relieve pain, but soon become hooked on them because they also reduce anxiety and can produce a state of euphoria.
Addiction often leads to illegal behaviors, such as “doctor shopping” to obtain more prescription medications or theft and prostitution to afford the cost of street drugs (usually heroin). The addiction can be so profound that a person’s entire day can revolve around getting more of the drug, foregoing the obligations of work and family life.
If These Drugs Are So Dangerous, Why Do Doctors Prescribe Them?
We just don’t have many good options for pain control. For minor pain, acetaminophen or a nonsteroidal anti-inflammatory drug like naproxen will usually suffice. For some specific types of pain, such as the pain caused by inflamed nerves that we see with shingles or diabetic neuropathy, antidepressant drugs (e.g., amitriptyline or fluoxetine) or antiseizure drugs (e.g., gabapentin) can be very helpful.
But for other kinds of pain, especially more severe pain or the chronic pain that we often see in cancer survivors, opioid drugs remain the most effective option.
Most people who take opioids for severe or chronic pain can do so safely and effectively under the supervision of their health care provider. Unfortunately, however, many people turn to street drugs like heroin when they’re unable to get a prescription refill, or they begin to misuse their prescription opioid — taking higher and higher doses or taking it more frequently — because of the high they get from it.
Many people get hooked when they ask to “borrow” a pill or two from a friend or family member.
What’s Being Done to Reverse This Trend?
The CDC in Atlanta has issued new guidelines for the use of prescription opioids. Among the recommendations:
Whenever possible, nonopioid drugs along with nonpharmacologic therapy (e.g., exercise or cognitive behavioral therapy) should be used to control chronic pain. Opioids should only be used if they are necessary and prove to be beneficial (e.g., in patients with cancer-related pain or in those who are terminally ill).
1. When opioids are used, use the lowest possible doses. For acute pain (e.g., from a bad ankle sprain), they should not be prescribed for more than seven days.
2. Prescribers and patients must understand the risks of opioid therapy, and, except in rare instances, they should not be combined with other psychoactive drugs and alcohol.
3. Prescribers and patients must keep in close touch. The patient’s urine should be periodically monitored for the use of other drugs, and prescribers should be on the alert for evidence opioid misuse; naloxone can be offered to patients at high risk of opioid overuse.
4. It’s important to recognize that chronic pain can have a devastating effect on patients’ lives, but at the same time withholding medications that can relieve pain is also not acceptable. If opioid therapy is deemed appropriate for you, consider signing a partnership agreement with your doctor that stresses all of the above points, making it clear that you’re in it together.
By working together with your health care provider, often with the assistance of specialists in the management of chronic pain, you can dramatically lower the risks associated with opioid therapy and achieve results that are safe and acceptable.