Prescription Narcotics, Stay Away or Use With Extreme Caution!
March 17th, 2016This week, the CDC issued a guideline urging medical providers to use extreme caution when prescribing narcotics for pain. Many people think that just because a medication can prescribed legally that it is different from “street” drugs such as cocaine and crystal methamphetamine (“crystal meth”). This couldn’t be further from the truth. Prescribed narcotics can cause overdose-related deaths and be just as addictive as their illegal counterparts. The CDC statistics show that from 1999 to 2014, over 165,000 deaths can directly be attributed to prescription medications!
Don’t get me wrong, in the right context pain medications can be helpful but everyone should always try medications such as NSAID’s (non steroidal anti-inflammatory medications), which can actually be more helpful when inflammation is involved, or acetaminophen (Tylenol). NSAID’s should not be used in certain groups including people with kidney disease or history of stomach ulcers, and if you think you may need doses higher than what is recommended on the packaging, you should consult your healthcare provider. A misconception I see often in my practice is that people assume that just because they hit the maximum dose on their bottle of Advil (ibuprofen) or Aleve (naprosyn) that the medications aren’t effective. What they don’t understand is that the over the counter label instructions have lower maximum dosages with the assumption that it is not directed by a healthcare provider. In fact, there are much higher dosages and more potent forms of NSAIDs available by prescription only which are very effective at treating pain.
Acetaminophen should be taken at doses lower than 4000 mg in 24 hours, or 2000 mg in 24 hours for people with liver disease. I also find that topical medications such as capsaicin cream and Biofreeze gel are greatly underutilized for minor musculoskeletal injuries. If you are seeing your healthcare provider for pain and they want to prescribe you a narcotic pain medication, ask them if there are any alternatives or if you can take a stepwise approach to pain relief. Maybe for the first day you could try NSAIDs and tylenol and see if that suffices. If the pain persists, you can follow up with your provider to reassess and see if a low dose narcotic may be right for you in conjunction with continuation of NSAIDs/tylenol.
We often don’t hear about the severe side effects of narcotics. They can cause everything from hallucinations, impaired driving leading to accidents, non-stop vomiting, falls, and even severe constipation requiring a trip to the ER. Many times, the risks of these and overdose far outweigh the benefits.
Narcotic medications also have another negative side effect. Take a look in your medicine cabinet right now. Almost all of us have at least one orange bottle of pills with a white safety cap prescribed for a medical illness. Maybe it is something you are currently taking on a daily basis, but more likely than not it is for some issue in the past. You just didn’t get around to throwing it out or figured you may need in the future. Now imagine if your teenage child got a hold of it. He/she could abuse it. Think that won’t happen to your child? Think again, this is becoming more commonplace. In fact, many studies have shown that a significant proportion of current illegal drug users started off by stealing old prescribed medications from others. I recommend that if you have any unused medications, particularly narcotics, you should bring them to your local pharmacy for safe disposal. Do NOT throw them down the toilet or in the garbage as they can enter the drinking water supply. Don’t save up prescription medications thinking you will use them later, the risk of your child becoming addicted/poisoned is not worth it!
