Lessons of the Opioid Addiction Epidemic
January 18, 2017
(article published via Asheville Citizen-Times)
Opioids, which include Oxycontin, Percocet, Vicodin and morphine, are powerful painkillers. In the past, opioids were mainly used for patients with cancer pain, at the end of life, or after major surgery. But starting about 20 years ago, there was a big push for doctors to prescribe opioids for acute and chronic pain of all types, such as headaches, fibromyalgia, arthritis and back pain.
At the same time, doctors were told, incorrectly, that these medications were not addictive. As a matter of fact, doctors were told that less than 1 percent of patients on long-term opioid therapy became addicted or dependent on the medications. Furthermore, starting patients on these medications, doctors were told, would return them to normal function. They would get their lives back.
But after prescribing opioids to millions of patients for noncancer pain, we have learned the following: These medications ARE addictive. One third of patients prescribed opioids for 2 months or more — just 2 months — become addicted or dependent on the medications.
Moreover, when family members of these patients are polled, they believe that even a larger percentage of patients on long term opioids are addicted or dependent on the medication — 50 percent instead of 33 percent. Less than 25 percent of patients on long-term opioids return to full employment, so they are not the cure-all we were promised.
If you are a young person (younger than 25) and take an opioid for any reason — after a surgery, tooth extraction, etc. — you are 50 percent more likely to become addicted in your lifetime. The young brain should not be exposed to opiates unless absolutely necessary.
Now, pain is very personal and emotional for many people. There are many people whose lives have been changed for the better because of opioid therapy, but the above statistics are sobering.
Furthermore, opioid medications and their cousin, heroin, have led to a surge in overdoses and overdose deaths. Deaths from opioids and heroin now surpass deaths from car wrecks, homicide or suicide in this country. It is a national and local crisis.
Because of evolving understanding of opioid pain medications and the drastic increase in people living with addiction, and overdose deaths, providers are becoming more cautious about prescribing these medications. We will explore this and the community response to the opioid crisis in an article in this space next month.
E. Blake Fagan is a family physician and the chief education officer at the Mountain Area Health Education Center (MAHEC). He received his medical degree from Vanderbilt University and is a graduate of MAHEC’s Family Medicine Residency Program in Asheville. He is a Western Carolina Medical Society board member.
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