Are Opioids the Right Solution for Chronic Pain?

Although used for thousands of years, it wasn’t until the 1800s that the first medicinal opioid, morphine, was developed.  Since then, governments and medical authorities have implemented a patchwork of laws to govern the use of these powerful painkillers. Currently, non-medicinal opioid use is illegal, but many Americans are circumventing these laws by abusing pharmaceutical substitutes like Oxycodone, Fentanyl or Vicodin. Dependence upon medicinal opioids is a national epidemic with an estimated 8.2 million Americans abusing these prescription pills. The widespread misuse of prescription meds –more than 52 million Americans have used prescription drugs non-medically—has contributed thousands of more cases of opioid addiction on a daily basis. This culture of addiction has forced more physicians to question the use of prescription painkillers. Although chronic pain is a health issue that plagues almost 100 million Americans, according to the Institute of Medicine of the National Academies, there is a huge health risk with prescription opioid use.  The Centers for Disease Control and Prevention reports that 14,000 people died from prescription painkiller overdoses in 2014 alone, and many more suffer from long-term health issues like organ failure, diminished cognitive function, mental illness, and respiratory failure. Considering the pressing need for these medications and the significant risks of misuse, the medical community has developed guidelines for painkiller prescriptions. Can the pain be managed using alternative therapies? – Physicians wrote almost 207 million prescriptions for medicinal opioids in 2013, and while many of these were probably recommended following the failure of other pain management therapies, many physicians—primarily those with limited training in pain therapies—are too eager to use opioids. The American Academy of Pain Medicine recommends that opioid therapy be reserved for patients who do not respond to other treatments. Does the patient or their family have a history of addiction? – An intensive discussion with the patient should uncover any addictive predisposition in the patient or their family, which are risk factors for opioid dependence. Is there a history of mental illness? – A history of depression, anxiety or other mental health problems is also an indicator of potential opioid dependence. The National Bureau of Economic Research reports that mental illness is the cause for consumption of alcohol (69 percent), cocaine (84 percent), and cigarettes (68 percent). Is the course of treatment longer than 12 weeks? – Use of opioids for a period longer than 12 weeks dramatically increases the risk of dependence.  Some professionals would argue that dependency can occur much earlier depending on the frequency and dosing. Furthermore, there is mounting evidence that opioids are more detrimental than beneficial in long term therapies. Limit prescription periods – Doctors most commonly prescribe painkillers to manage acute pain like an injury or surgical recovery.  Most patients only need a few days’ worth of medication rather than a 15 or 30 days’ supply.  Among 27 percent of these short term pain sufferers end up consuming these medications long term increasing their dependency risk. Implement a drug withdrawal strategy – Physicians should have a plan to taper off a patient who may be dependent upon the drug or where long term opioid therapy is not indicated.  If necessary, consult with a Pain Medicine specialist to design a safe, comfortable, and effective opioid tapering plan if suitable for the patient.

Written by:  Robert Moghim, M.D., CEO- Moghim Medical Consulting Inc.

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