Understanding the Opioid Epidemic
What You Need to Know About Prescription Painkillers
Prescription opioid misuse has become an epidemic in the United States, due in large part to its role in chronic pain relief. Chronic pain – that which lasts longer than three months or past the time of normal healing – is itself a serious public health concern in the United States. Fighting the opioid epidemic involves not only raising awareness about the risks of opioid use, but also pursuing alternative forms of chronic pain management.
To help address these dual needs, the Centers for Disease Control released new guidelines for treating chronic pain and prescribing opioids that aim to improve the safety of opioid prescriptions and increase the use of other effective treatments.
“The new CDC guidelines – combined with physicians’ increased awareness and retraining about other alternatives to pain management – are important steps in our fight against this epidemic,” says Jeffrey Johnson, DO, medical director of inpatient addiction and substance abuse services at Northwestern Medicine Central DuPage Hospital.
What Are Prescription Opioids?
Prescription opioids are painkillers. Codeine, morphine, hydrocodone and oxycodone are the best known. Hydrocodone and oxycodone are also known by brand names Vicodin and OxyContin or Percocet, respectively.
Opioids should only be prescribed for severe pain that does not respond to other pain relievers, and only prescribed under the direct supervision of a healthcare provider. Still, opioids are one of the most commonly prescribed medications by primary care, oral surgery and emergency medicine physicians. According to the CDC report, one-fifth of patients who see a physician for non-cancer pain symptoms receive an opioid prescription. This is in part due to the wide availability of generic versions of the drugs, which are therefore more affordable than new alternative therapies. Milder pain relievers such as ibuprofen and acetaminophen can have long-term damaging effects when prescribed in the higher doses chronic pain would require and are therefore not recommended either.
Prescription painkillers come in many forms, like syrup, tablets, capsules, patches and injections that make them relatively easy to administer. This, combined with a certain degree of instant gratification, increases these painkillers’ appeal to the patient compared to alternative treatments that may involve recurring appointments.
Addiction and the Epidemic Effects of Chronic Opioid Use
A full quarter of ER patients do not know that opioids can be addictive, according to research from Northwestern University Feinberg School of Medicine.
It’s important to note that not everyone who uses opioids will become addicted, though chronic prescription painkiller use can develop in three forms: tolerance, dependence and addiction. Most people will experience tolerance, which means the body has become used to the dose and the drugs do not work as well as they did when originally prescribed. Tolerance can require your dose to be increased and may also lead to dependence, which occurs when your body relies on the painkiller to the point that missing a dose results in symptoms of withdrawal. Addiction, then, is the compulsion to use the medicine even when the body is no longer dependent on it.
An estimated 54 million people have used prescription medications for non medical reasons at least once in their lifetime, per the National Institute on Drug Abuse.
While part of this has been due to a drastic increase in the number of prescriptions written and subsequent sales, there has also been an influential rise in the social acceptability of taking prescription painkillers for different purposes. Both of these factors have put opioids in the hands of more and more people who are at risk for developing dependency or addiction.
“Opiates are highly effective for acute pain, but if you take them long enough, your tolerance increases and you need more of the drug for relief,” says Dr. Johnson. “Misuse of opiates can cause chronic digestive problems, depression, increased tolerance (whereby you need more of the drug to seek the same high) and in some cases, a rebound effect that actually increases the pain.”
Alternative Treatment Forms
Prescription opioids may be the easiest and most affordable pain management option for many patients, but there are alternatives that can be worth pursuing before turning to medication. Physical therapy, relaxation exercises and behavioral therapy are just some of the pain relief options that people are turning to instead of opioids, though the effectiveness varies and not all patients experience the same success. New medication to offer an alternative to opioids is also being developed.
The impact of the opioid epidemic is undeniable and it’s more important than ever for physicians to present the risks and discuss alternatives with their patients. In certain cases, prescription painkillers may remain the best form of treatment, but an increased awareness and a willingness to treat first without opioids from both physician and patient could help minimize the number of people experiencing opioid dependency or addiction.
If you or someone you know is struggling with chronic pain or prescription painkiller dependency, reach out to the Northwestern Medicine Pain Medicine Center.