Work with your doctor when it comes to opioids

In today’s day and age it’s difficult to go through an entire day without hearing some mention of the opioid epidemic in the United States.

Most recently it has been reported that Americans have a greater chance of dying by accidental opioid overdose than a motor vehicle crash. When you truly think about that statement it is incredibly alarming. What is even more concerning and alarming is despite the overwhelming presence of opioids and their risks in the national media most patients don’t understand how these numbers, statistics and risks affect them directly. Many patients who are on and have been on prescription opioids feel that these statistics and numbers do not apply to them.

One of the most well known side effects of opioids is addiction. Most patients are aware of what addiction is to a degree. However, most patients are unfamiliar with two other severe side effects of opioids; dependence and tolerance. Dependence should be distinctly characterized from addiction because most patients who are on higher dose opioid regimens are dependent on their medications. Dependence can simply be described as the body developing a need for the medication.

When someone is exposed to opioids chronically at higher doses the body makes adaptive changes to the medication. When they go without the medication they can experience withdrawal symptoms. Patients who are addicted to opioids are also dependent but there is important distinct differences with addiction. Addiction usually includes taking the medication for other reasons than intended. For example, to experience euphoria instead of pain relief. Patients who are addicted to opioids have difficulty taking the medication as prescribed and continue with the behavior despite potential harm it is causing them.

Dependence is a normal side effect of higher dose opioid regimens while addiction is a serious complication from exposure to the medication that warrants very different treatment. Lastly, tolerance is simply the human body getting used to the the opioid medication the longer the patient is exposed to it. Many patients who have been on opioid medications for years will report that the medication is no longer as effective as it used to be. Tolerance is one of the major issues with using opioids to treat chronic pain.

One of the most common misconceptions is that if a patient takes their prescription opioid as prescribed then they cannot overdose. Opioid medications have a side effect called respiratory depression. Which means that the medication slows down breathing. This effect by itself can be relatively harmless BUT it can also be the most intrinsically dangerous side effect of opioids (aside from addiction, dependence, tolerance). If you’re healthy, the body has many compensating maneuvers that help minimize this side effect. But, if you have sleep apnea, take sedatives, drink alcohol or really have any type of medical condition which adversely affects your body’s ability to absorb oxygen, pump oxygen, or breathe you are at higher risk for overdose than someone who doesn’t, even when the opioid medication is taken as prescribed.

The respiratory depression side effect is also dependent on the opioid dose, meaning, people who are on higher opioid dose regimens are higher risk for overdose than those on lower doses. This is one of the main reasons that the CDC has come out with specific opioid guidelines regarding opioid dosages. One of the most dangerous scenarios is a patient who is on opioids for pain, a benzodiazepine such as xanax or klonopin for anxiety and has untreated or undiagnosed sleep apnea. Opioids naturally slow down the breathing, sleep apnea can obstruct the movement of air in to the lungs or depress the respiratory drive further and benzodiazpines exaggerate the slowed breathing effect of opioids. This is a perfect example of how someone can overdose even while taking the medication as prescribed.

Speaking of the CDC guidelines, another common question patients ask is why the new rules affect them. One of the most important reasons is what was explained in the previous paragraph. Additionally, what healthcare providers know about opioids today is vastly different than what we knew ten-to-twenty years ago. This has lead to dramatic changes in the way opioids are prescribed and how healthcare providers treat pain. As more and more data becomes available it is turning out that opioids are not as effective for the treatment of chronic pain as what we once thought they were. Additionally, many of the risks that are so readily apparent today were not known years ago. From a patient care standpoint the new rules and guidelines affect all patients on opioids because we know drastically more information about opioids than what we did years ago. Bottom line is everything we do in healthcare is about risk versus benefit. As more time goes on we are learning about more risk and less benefit when using opioids for the treatment of chronic pain.

My typical recommendation for patients who have been on opioid medications chronically is to have a conversation with your healthcare provider about your specific risks because they may be very different than another person on the exact same type of medication. If you’re on a high dose opioid regimen talk to you healthcare provider about seeing a pain management specialist or trialing a gentle reduction in your dosage. Of course, this doesn’t apply to everyone on opioid pain medication but it should be something discussed with your healthcare provider to see if it is right for you. Obviously, do not make changes to your medication regimen without discussing with your healthcare provider.

Maximizing non-opioid treatment options for your pain is incredibly important. Exercise, stretching, eating a healthier diet, weight loss, physical therapy, aqua therapy, chiropractic therapy, occupational therapy, acupuncture, massage, non-opioid pain medications, injection therapy and surgery can be incredibly important treatment options to help with pain that can minimize the need for medications. Your healthcare provider would be more than happy to discuss these options with you to minimize the need for opioids.

If you’re not on opioids and require surgery or have a severe injury with pain that requires opioid medications your goal should be to use the medication for the shortest duration necessary. Don’t be mad or upset with your surgical team if they try to taper your post-surgical pain medication quickly after surgery or injury. If you’re on opioids and know that you will require surgery in the future talk to your healthcare provider about trying to taper and discontinue your opioid medications in advance of surgery. Your post-operative pain management and surgical outcome will likely be improved.

If you’re someone on opioid medications and require them for quality of life and activities of daily living make sure to take them as prescribed, do not drink alcohol with them and avoid any sedatives. If you have untreated medical conditions be compliant with treatment. Have a detailed discussion with your provider or pain management specialist to try and find ways to minimize your risks to the medication but also treat your severe pain. Lastly, try to have patience with your healthcare team as we try and navigate the opioid epidemic with you.

Information: Idaho Pain Clinic, idahopainclinic.com or 208-263-9757