Many people turn to prescription opioids—pain killers like OxyContin, Vicodin, and Percocet—to treat chronic pain. The powerful drugs are well known for their ability to diminish severe pain. But you may be surprised to learn that one in four people using opioids misuse them.
“Some patients don’t use these medications when they should because they feel they don’t need treatment or are afraid they’ll be associated with the stigma attached to opioid abuse," says Robert Twillman, Ph.D., FAPM, executive director of the American Academy of Pain Management. "On the other hand, some patients continue taking their medications longer than they need them because their prescriber hasn’t told them how to gradually decrease their dose and they are afraid of opioid withdrawal or that their pain will return. Unfortunately, misusing opioids is more common than you might think. The total number of people affected is difficult to estimate because most aren’t being treated for dependence or addiction.”
Opioids block pain signals in your brain. Over time, your body may build up a tolerance to the drug, requiring higher doses to achieve the same pain relief. It’s common for your body to adapt to the presence of opioids, which can lead to physical dependency and withdrawal symptoms such as nausea, insomnia, and anxiety if the drug is stopped abruptly. Addiction, however, is a disease characterized by compulsive use of the drug to experience euphoric effects.
Opioids: Beneficial or harmful?
A fine line exists between the benefits and harms of prescription opioids, such as oxycodone (Percocet, OxyContin), hydrocodone (Vicodin), and morphine.
Experts agree that long-acting opioids, which provide sustained pain relief for eight to 12 hours, are a mainstay of treatment for relieving cancer pain and easing end-of-life care. Short-term use of short-acting opioid analgesics (with effects lasting three to four hours) can relieve acute pain, such as that experienced after surgery or from a severe injury, when nonopioid pain relievers like acetaminophen aren’t enough.
The line between benefits and harms becomes blurry when it comes to longterm opioid therapy for older adults with back pain,arthritis and other painful, chronic conditions. Little high-quality evidence is available that supports the long-term use of opioid pain relievers for chronic noncancer pain. Yet, more than 16,000 people die from prescription pain reliever overdoses each year—that translates to 44 people a day, according to data recently published by the Centers for Disease Control and Prevention (CDC).
What’s more, the number of prescriptions for opioids—which are actually narcotics that fall in the same class of drugs as heroin—has nearly quadrupled from 1999 to 2013. In 2012, approximately 259 million opioid pain prescriptions were written—enough to supply every American adult with a bottle of pills. These statistics have led some experts to question whether doctors are overprescribing the drugs or not doing enough to ensure their patients are using the drugs properly once they’re prescribed.
“The goal of taking prescription opioids, particularly in the long term, is not only to minimize your pain but also to improve your everyday function and quality of life. If opioids don’t improve your function, or actually begin to interfere with it—maybe you’re excessively drowsy all the time, you lack motivation or you withdraw from family and friends—it’s time to reassess whether these medications are the right choice,” Twillman says.
“Quality of life is often a more desirable—and achievable—goal than total pain relief. Consider accepting that you may never be 100 percent pain free. Instead, ask your doctor about coping strategies for the pain that isn’t relieved, such as behavioral therapy or relaxation techniques. If you’re on a high-dose opioid, ask your doctor if the drug can be tapered to a safer dose. And ask about other treatments that might give you better results with a lower opioid dose.”
How dangerous are opioids?
Prescription opioid pain relievers are particularly threatening to the health of older adults because they can interact with other drugs they commonly used.
Combining opioid pain relievers with benzodiazepines--antianxiety medications such as Xanax, Valium, Klonopin, and Ativan—is particularly dangerous. Other health consequences include opioids’ possible side effects, including dizziness, sedation, falls, memory impairment, constipation, itching, nausea, and vomiting.
You don’t need to have an opioid use disorder—the clinical term for opioid abuse or dependence—to accidentally overdose on prescription pain relievers. For example, forgetting that you took a pill and then taking another can be fatal. High doses can cause slow breathing, or respiratory depression, that can lead to death.
How to identify opioid misuse
If you’re taking opioids, you may feel that you need higher or more frequent doses to relieve your pain. According to the Diagnostic and Statistical Manual of Mental Disorders, a person with opioid use disorder has significant impairment or distress as a result of two or more of the following signs within a 12-month period:
• Opioids are often taken in larger amounts or over a period longer than was intended.
• A persistent desire or unsuccessful efforts to cut down or control opioid use.
• A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
• Craving, or a strong desire or urge to use opioids.
• Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school or home.
• Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
• Important social occupational or recreational activities are given up or reduced because of opioid use.
• Recurrent opioid use in situations in which it is physically hazardous.
• Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
If this sounds like you or someone you know, speak with your or your loved one’s doctor. Never attempt to stop using prescription opioids on your own.
If you’re afraid to stop taking the drugs because you fear the pain may return, it may be helpful to know that, while you may experience a temporary increase in pain, you’ll also see improvements in side effects and well-being.
Some people also mistake the discomfort of withdrawal symptoms for pain. Your doctor can help you taper off the drugs or prescribe a lower, more manageable dose. He or she may prescribe a drug to ease withdrawal symptoms, such as buprenorphine, methadone, clonidine, or naltrexone, which can aid you in returning to normal function. Treatment will likely include some form of counseling to help you understand why the addiction occurred and develop coping skills to prevent a relapse.
Substance abuse programs at inpatient or outpatient treatment centers can help with addiction.
If you’ve been diagnosed with opioid use disorder but suffer from a condition that causes severe pain and requires opioids, your doctor will work with you so you can use the medications safely.
Doing so successfully often requires intensive treatment that involves both pain and addiction specialists.
The dos and don’ts of opioid safety
Opioids can be used safely for chronic pain if you follow certain precautions and consider all risks, including the potential for addiction, with your doctor. Take these steps to avoid misuse:
• DO discuss the goals of treatment with your doctor. You and your doctor should also agree on when treatment should be stopped if it doesn’t achieve those goals and what constitutes success or failure.
• DO tell your doctor if you or a family member has a history of substance abuse. This puts you at higher risk for addiction.
• DO consider alternative or adjunct therapy. Ask your doctor about other drugs or therapies for acute or chronic pain. Also, you may be able to use another drug or nondrug treatment along with a lower dose of an opioid.
• DO take the medication as directed. Talk with your doctor before changing dosage or frequency. If you miss a dose, don’t double up on doses.
• DO watch for side effects and signs of dependence or addiction. Alert your doctor if you experience signs such as changes in mood, energy or concentration, unusual blackouts or forgetfulness.
• DO store drugs in their original packaging. Put them in a locked cabinet or location where others can’t easily access them. Keep track of how much you’ve taken and how much should be left. Never share opioids.
• DON’T consume alcohol. Opioids and alcohol are a deadly mix.
• DON’T cut, chew, crush or dissolve medications. If you use a pain patch, be sure to remove the old one before applying the new one—and ask your doctor or pharmacist how to properly dispose of used patches. Since they still contain a fair amount of the drug, you’ll need to ensure that children, pets, etc., cannot come into contact with them.
• DON’T mix opioids with benzodiazepines. Sedatives like Xanax, Valium, and Klonopin, prescribed to treat anxiety, depression, and insomnia, can slow breathing and be fatal if mixed with narcotic pain relievers.
Bob Twillman, Ph.D., FAPM, executive director of the Academy of Integrative Pain Management, is responsible for overseeing federal and state pain policy developments and advocating for those supporting an integrative approach to managing pain. He also serves as chair of the Prescription Monitoring Program Advisory Committee for the Kansas Board of Pharmacy.