Opioid misuse is all too common and costly.
What are Opioids?
Opioids, such as morphine, methadone, oxycodone , hydrocodone, and codeine, are used to alleviate pain. Hydrocodone products are typically used as a prescription for injuries and dental pain, while morphine is generally for post-surgical recovery. Codeine is for milder pain, and sometimes the drugs are used to relieve severe diarrhea or coughs. The medications work by reducing “the intensity of pain signals reaching the brain” and they also “affect those brain areas controlling emotion”.1 Sometimes the terms narcotic and opiate are used synonymously for opioids, although the term “narcotic” can have “pejorative connotations”. Other uses for opioids include anesthesia, treating addictions, reversing opioid overdose, and suppressing constipation induced by opioids. Extremely strong doses are approved in veterinary use to immobilize large mammals. There are many side effects associated with opioids, such as sedation, nausea, itchiness, respiratory depression, euphoria, and constipation. Dependence and tolerance can develop, leading patients to require larger doses in order to avoid a withdrawal syndrome if the drugs are abruptly stopped. The euphoria, unfortunately can lead to people using the drugs recreationally, and they can ultimately lead to addiction. Another issue with opioid misuse is the possibility of accidental or even fatal overdose, especially if these medications are combined with “other depressant drugs”. These substances are, therefore, “highly controlled”. Because of the demand, there is “illicit production (and) smuggling”. As of 2011, “4 million people in the United States used opioids recreationally or were dependent on them”. This was “attributed to over-prescription of opioid medications and inexpensive illicit heroin”. Because of these fears of side effects, opioid addiction, and over-prescribing, “opioids are similarly blamed for under-treatment of pain”.2
Opioids and Chronic Pain
There has been recent news that “brief opioid exposure can cause (an) increase in chronic pain” and “recent escalation of opioid prescriptions in humans may be a contributor to chronic pain” with drugs like “morphine, oxycodone and methadone”.3 One study suggests it is important to watch doctors in order to reduce opioid abuse. In fact, states that kept track of prescriptions for pain, and the doctors writing those prescriptions, “saw a 30 percent decrease in the rate of prescriptions for…controlled substances”. It is thought that this is due to the monitoring system raising awareness about opioid misuse, making doctors more cautious about prescribing medications that could be abused and that could cause dependency. Reducing opioid misuse is important because “the drugs killed more than 47,000 people in 2014”.4 Also recently, it was found, by the FDA, that “Pfizer’s opioid painkiller (Troxyca ER) can be manipulated for abuse”. This painkiller is experimental and long-acting. While it has “some abuse-resistant properties”, addicts are still able to extract the oxycodone from the medication. Pfizer has another long-acting morphine-based drug called Embeda, that was approved by the FDA.5 Because of the problems of overdose, drugs like Naloxone (Narcan) are used to help the overdosing patients breathe. This medication is given by first responders and emergency workers, but in Indiana, “Aaron’s Law…allows Hoosiers to obtain prescriptions for a life-saving drug… if they believe someone they know is at risk of overdosing”. The nonprofit Overdose Lifeline “prepares free Naloxone kits to distribute to families and caregivers”.6
Alternatives to Opioid Drugs
There are many alternatives to opioids (Vicodin, OxyContin, codeine) when dealing with chronic pain. Medications, psychological help, and lifestyle changes are all important alternatives to medications, because 10-15% of the people treated with opioid medications can become addicted, and others can misuse the drugs for recreational purposes. Some patients may benefit just from acetaminophen or NSAIDs. Others might use anti-depressants, anticonvulsants, or corticosteroids. Lidocaine and capsaicin are two topical pain-relieving treatments available. Aside from medications, neurostimulators might alleviate pain by implanting electrodes to “interrupt nerve signals and provide pain relief”. Chiropractic care, massage, and acupuncture are some alternative treatments that could benefit patients with chronic pain. In addition, exercise and physical therapy “can improve functionality and mobility”. Yoga and tai chi might relieve joint pain, back pain, fibromyalgia, and arthritis.7 The American Chiropractic Association recommends that patients discontinue opioid use due to developing “higher tolerance” and other issues.8 The state of Oregon is encouraging patients to use alternative care first, and only to consider opioids as a “last resort”. The state is actually funding alternative treatments through “Oregon’s version of Medicaid – the Oregon Health Plan”. Even though the alternative care (chiropractic, massage, acupuncture, physical therapy, naturopathic care, nutrition, yoga, spinal manipulation) may cost more than the pain pills, “the hope is to save money by reducing the number of people who become addicted to opioids”. Oregon wishes to reduce opioid misuse and abuse, and there is the research that shows that pain medications are not as effective as people assume for treating chronic pain.9 Cognitive-behavioral therapy may be another useful alternative to medications.10
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