The news headlines about the heroin and opioid addiction epidemic just touched the edge of my awareness until two recent events brought it closer to home. The soccer coach of a little boy I know died of a heroin overdose. One morning he was at soccer practice. That night he was dead. Apparently he had become addicted to heroin because it was cheaper than his prescription pain killers—an increasingly common problem in his suburban county.
Then my own doctor offered me a prescription for hydrocodone for my long-term neuropathy pain. I turned down the offer, but I wondered what might have happened if I had accepted. My neuropathy pain is never going to get well, so it would have been easy to become dependent on a medicine that can’t solve the underlying problem.
An estimated 44-46 people in the United States die every day from overdosing on painkillers such as morphine, oxycodone, and hydrocodone.
According to an article in the AARP Bulletin, Peter Jaret says for people 45-85, the hospitalization rate for prescription pain medication overdoses increased fivefold from 1993 to 2012. The highest death rate was for people age 45-54, “more than four times the rate for teenagers and young adults.”
Undoubtedly some of those deaths were breast cancer patients and survivors trying to manage real breast cancer pain with their doctors’ help. Breast cancer patients tend to be older women in their sixties who trust their doctors’ suggestions for managing pain. Most of the time, prescriptions for pain taken exactly as directed will not lead to a problem. How can you make sure that you are not among the people who will run into dangerous problems?
Determine the type of pain you have. Is this pain likely to be temporary? Strong pain killers that you take for a few days following surgery are not likely to cause problems. Take what you need to rest and heal. But also pay attention to the level of pain you have. If you're not tipping the pain richter scale then consider taking an over-the-counter extra strength pain reliever.
Let your doctor know about other medications you take. Older women may already be taking other medications, and breast cancer survivors may be on follow-up drugs like aromatase inhibitors. Your oncologist needs to know what your cardiologist has prescribed and vice versa. Using one pharmacy to fill your prescriptions can be helpful because the pharmacist will have a list of everything you are taking. Your liver and kidneys have to work harder to clear medications out of your system when you are taking several, so you might need dosages adjusted to avoid an overdose.
Be sure to follow directions exactly. More is not better! Never double up on doses. If pain killers make you groggy, you might want to ask someone to help you take the correct dose at the right time so that you don’t overdose.
Look for alternatives to opioids for chronic pain. One theory about why so many doctors are quick to prescribe a pill is that patients want simple solutions, and doctors don’t have much time to talk through all of the possible pain management strategies with their patients. Let your doctor know that you want more than a pill.
Your oncologist is an expert in saving your life from cancer, but is probably not up on all the latest in pain management techniques. A referral to a pain management clinic may be really helpful. If you have post-mastectomy pain, a physical therapist may be able to help you manage. There are several types of non-narcotic drugs that may reduce chemotherapy-induced peripheral neuropathy pain. Also investigate how yoga, exercise, acupuncture, massage, and other complementary approaches can eliminate or reduce your need for medication.
At the end of life, don’t worry about addiction. One of the blessings of pharmaceuticals is their ability to reduce pain in dying patients. Yet sometimes the patient or her family will worry about addiction from morphine or other strong pain killers. A hospice or palliative care nurse will know the best ways to manage pain at the end of life, so trust their expertise.
Make sure no one else is harmed. Be sure you keep your medications secured. Ask your doctor or pharmacist about the best way to dispose of any extra pills you don’t need. They should not be flushed or thrown away because they can affect water quality.
September is pain awareness month, and October is for breast cancer awareness. Once these two months are over, real people will continue to face the issues about how to manage their pain from breast cancer. Honest discussions with doctors and careful adherence to the best pain management techniques can help you get the relief you need without undue complications.
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Jaret, P. “46 Americans Die Each Day from Painkiller ODs: Deaths for ages 55-64 rise 700%. AARP Bulletin. September 2015, pp. 6,8.
Prescription Drug Overdose. Centers for Disease Control and Prevention. Accessed October 7, 2015 from http://www.cdc.gov/drugoverdose/epidemic/index.html.