The Opioid Epidemic

April 20th, 2017

If you’ve watched the news any day in the past few months, you’d think we have an epidemic of opioid addiction.  Sadly this is all too true.  Over 30,000 people have lost their lives each year from opiate overdoses.  Many of them were using pills or patches that were at one time prescribed in a medical office.  Those who become hooked on opiates are not all “poor and uneducated” as most people assume.  This disease knows no boundaries and has touched many peoples lives often hidden behind closed doors or as closely held family secrets.  Scientists believe there are some people who are more sensitive and vulnerable to opiate addiction, but we haven’t found a good way to identify those individuals yet.  Some people can take them and be perfectly fine, but others can become hooked within a matter of weeks.  Opiates also increase healthcare costs, even aside from overdoses.  The side effects can even be severe enough to require hospitalization.  Isn’t that shocking, that a drug initially prescribed to treat pain can lead you back to the hospital in worse shape?

How did we get to this point?  Well, for a long time medical professionals including myself were trained to treat pain at any cost.  We were taught that a patient in pain was considered a failure on behalf of the provider.  By prescribing opiates, medical providers felt they were using a highly effective pain medication.  However, it turns out opiates are unnecessarily strong for most types of pain and the risk of addiction or the pills falling into the wrong hands was far greater than the benefit.

Here are some tips to protect yourself and your family.

• Just say “No”.  If your medical provider offers to prescribe opiates (oxycodone, tylenol #3, percocet, percodan, just to name a few), ask for other alternatives that are not addictive.  If you have not maxed out on tylenol (acetaminophen) which is used at a maximum dose at 2000mg or naprosyn (Aleve) or ibuprophen (Advil, Motrin), try using those first.  You could also ask your healthcare provider to prescribe a few days worth of opiates (maybe 5-10 tablets) just in case your pain worsens and take them only if you absolutely need it.  If you need more, you can call them back later.
• Assess your pain.  We usually gage pain on a scale of 0 to 10 where 0 is no pain, and 10 is “severe” pain (crying or doubled over in pain).  Opiates should never be given for any pain less than 7 on the scale.  If you have not tried acetaminophen or NSAIDS (naprosyn or ibuprophen) or both in combination, you should try these first.  Consider other ways of treating pain.  An ice pack or heating pad can dull the pain of a sore knee or back.  I also love using Bengay patches or Biofreeze gel.  Acupuncture, massage, and biofeedback are also helpful for certain types of pain.
• Do not ask for opiates.  You may have had surgery in the past and opiates helped for the pain afterwards.  Now you have “really bad” knee pain, and think back to your last experience.  You think, “Hey, if it worked for me very well then, maybe I should try that first.”  Don’t use this logic, assess each painful experience separately.  Again, consider trying tylenol first.  Maybe that’ll be enough.  Opiates are “big guns” and should be reserved for intense pain after all other medications have been tried.
• Dispose of unused medications appropriately.  Many studies about addiction show that addicts get their first try of opiates by raiding their parent’s medicine cabinet.  We all have unused medications in our cabinet.  Take a look today and put all the pills into a bag.  Bring them to your local pharmacy or medical office and ask to dispose of them.  Every pharmacy is required to provide safe disposal of medications with a “no questions asked” policy.  DO NOT throw pills down the toilet, doing so can pollute the groundwater and introduce dangerous chemicals into the food chain.
• If you must take opiates, be aware of the side effects.  They can make you drowsy and give you a drunk feeling.  You absolutely cannot drive afterwards!  You can also feel nauseous and vomit.  I had a patient who told me she couldn’t stop vomiting for 24 hours after taking one oxycodone and it was so severe that she even had to go to the emergency room to get IV fluids.  Lastly, constipation is very common.  You must take laxatives of some type if you do end up taking opiates.  If you do not have a bowel movement for more than 2 days, you must seek medical attention as this can lead to severe backup of wastes in your intestines, at times this can require surgery to cut open the intestines.  Not an easy surgery, and infections are common.  Do not combine opiates with alcohol or other medications such as benzodiazepines (xanax, clonopin, valium, just to name a few).  This can lead to deep coma or your lungs to stop working.
• Teach your children the dangers of these medications.  Opiates are highly addictive and can create permanent damage to a developing brain.  If you suspect your child may be addicted, seek professional help immediately through your local health center.