You’d have to live under a rock not to have heard about the ‘opioid epidemic’ in America today. This epidemic began in the new millennium, not because of greedy drug companies or reckless prescribers, but because compassionate physicians wanted to help their patients who suffer with chronic pain. It wasn’t until the 1990’s that the medical community began to speak out about the need to manage severe pain for cancer patients. Up until then, opioids were not readily available.
Several physicians took a leading role in arguing for better pain relief for patients suffering from chronic pain, not only from cancer, but for chronic conditions such as back pain and related pain. Researchers and physicians from pain societies began to think that opioids could be used safely for long periods of time, as the addiction potential was not recognized. Opioid advocates, pain societies and pharmaceutical companies began exaggerating the benefits of chronic opioid therapy while minimizing the risks, especially the risk of addiction. What followed was a period of compassionate use of opioids for patients who suffer from chronic pain, whatever the source. Until then, there was no relief for millions of Americans suffering from chronic pain.
Fast forward to the present, and the epidemic of prescription opioid abuse is well recognized in the medical and scientific community. As a result, the National Institute on Drug Abuse, NIDA, a member of the National Institutes of Health (NIH) in the United States Department of Health and Human Services, has taken on the addiction issue with their ‘NIH Initiative to Help End the Opioid Crisis’. Opioid use, misuse, addiction and overdose are an ongoing and quickly evolving public health crisis today. It is estimated that at least 2 million Americans are addicted to opioids, and about 25 million suffer daily from chronic, unremitting pain. Heroin use and addiction are now on the rise as people seek a cheaper and more readily available street drug over prescription opioids. The NIDA initiative will provide scientific solutions to help end the opioid crisis, supporting a wide range of research on addiction and pain, from basic research to the complicated neurological pathways involved in pain and addiction. It is hoped that this will accelerate the development of better pharmacological treatments for pain and opioid use disorder. Substance use disorder in general occurs when someone takes a medicine beyond what the prescriber intends (to relieve pain), typically to relieve anxiety or distress or to get high. The opiate use disorder (DSM 5 Opioid Use Disorder) checklist includes:
- Inability to reduce or control use
- Craving or strong desire to use opioids
- Development of tolerance
- Trouble meeting social or work obligations
- Having legal problems due to drug use
- Recurrent opioid use in situations in which it is physically hazardous
What are Opioids?
Opioids are a class of drugs that are used to treat chronic and/or severe pain, such as after surgery or a severe injury Opioids include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as codeine, morphine, hydrocodone (Vicodin®), oxycodone (OxyContin®), and many others, all chemically related to each other.
Opioids are narcotics, which block feelings of pain. Opioid drugs work by binding to specific proteins called opioid receptors on cell surfaces in the brain, spinal cord, gastrointestinal tract and other areas of the body. Once the drug binds to the appropriate receptor, the receptors send signals to the brain to block pain, slow breathing, and have a calming and anti-depressing effect. Some patients may feel euphoria, which may lead to a craving and habituation. It is important to note that opioids are safe when used for brief periods of time. They are extremely effective in blocking moderate to severe pain. Their use has skyrocketed over the past decade, along with an increase in the number of prescriptions given mostly to Americans.
If you’ve already abused another substance, like alcohol, you are at higher risk. You may also be at risk if you’ve experienced childhood trauma, have family with addiction problems, or if you are diagnosed with a mental illness. Young people have especially been affected by this health crisis, as the availability of prescription opioids decrease; they may turn to street drugs such as heroin. Older people are affected as well, as it is estimated that 22-23 million Americans have chronic pain and take opioids for their conditions.
A property of opioid drugs is their tendency to induce tolerance. Tolerance occurs when the person no longer responds to the drug as strongly as he or she did at first, thus necessitating a higher dose to achieve the same effect.
How do people stop using opioids?
If you are habituated to a prescription opioid, talk to your doctor about slowly tapering off the drug. Slow tapering can completely eliminate uncomfortable withdrawal symptoms. Usually the slower you taper, the less withdrawal symptoms you will have. There are other ways to detox as well. The opiate freedom center is a terrific resource for people who are having trouble with their dependence or addiction to opioids. Perhaps the most important thing to note is that you have to want to eliminate opioids from your medicine chest and your life.
What can I do about my back pain?
Back pain is one of the most common complaints in America today. Physicians advocate physical therapy in addition to exercise to maintain the muscles that support the spine, removing pressure from discs and joints. Physical therapy may include core strengthening, aerobic exercise, stretching and flexibility exercises, and testing the limits of pain tolerance. As long as the exercises are done in a controlled, progressive manner, exercise and specific exercises for the back are helpful for recovery and maintaining your health. Another benefit of exercise is the release of endorphins, which can help reduce reliance on pain medications. Endorphins also elevate mood and relieve depression symptoms. Get moving and you’ll feel better soon.
Other non-surgical methods to treat chronic back pain include mindfulness and meditation, lifestyle modifications, injection based treatments, alternative treatments, and pharmacological treatments using NSIADS instead of opioids. Talk to your physician today to lead a more active life, even with chronic pain.