The Problem of Reliance on Opioid Painkillers for Chronic Pain

It all seems so easy; if something hurts, you just take a pill and soon your pain will fade away as if by magic. And even if your pain is severe or chronic, no problem—prescription painkillers are built to handle these heavier loads, and if you pay a visit to your family doctor he or she will be more than happy to write you a prescription for a powerful narcotic painkiller that will wipe out almost all of your dreadful discomforts in no more than a few hours time. This is the model for pain relief and healing that most of us seem to have embraced, and for the most part, physicians have gone along with the program. But when you come to rely on prescription painkillers to make your pain go away and help you to feel better, dark ominous clouds will soon begin to form on the horizon, and before you know it, a massive storm front may come rolling in, sweeping away your health and self-control in a swirling maelstrom of runaway drug addiction. The problem of prescription drug addiction is especially acute when the medications being consumed are painkillers from the opioid family. Legal pain-relieving drugs from this class such as oxycodone (OxyContin), hydrocodone (Vicodin), fentanyl and methadone share a chemical signature with heroin and, like their famous cousin, they are highly addictive and can cause a number of troubling or dangerous side effects when used repeatedly, including:

  • Respiratory depression (extreme breathing problems)
  • Sleep apnea
  • Constant drowsiness or chronic lack of energy
  • Constipation
  • Sexual dysfunction
  • Confusion/difficulty focusing
  • Overdose, sometimes leading to death

Risks like these are common with pharmaceutical medications. However, few prescription drugs are being distributed as widely and freely—some might even say casually—as opioid painkillers, which have become tremendously popular with doctors and patients alike because they seem to have the power to make the pain go away in the blink of an eye; until it comes back again, as it almost always does with opioids. It should be remembered that short-term relief for pain is quite different from long-term liberation from a source of misery, and rather than helping pain victims get back to normal functioning, opioid painkillers essentially water their own gardens — an obsessive need for more and more opioids is the only thing that grows in the place where health and healing should be blooming. No Pain, but No Gain According to a recent study completed by a team of researchers from the Johns Hopkins Center for Drug Safety and Effectiveness, over the last 10 years, the number of pain-related visits to physicians has not decreased, despite the fact that the percentage of those visits that have ended with patients receiving prescriptions for “miracle” painkilling drugs like Vicodin and OxyContin has risen from one in 10 to one in five. In 2010, medical patients made 164 million pain-related visits to physicians in the United States, meaning that in that year alone, about 33 million new prescriptions for opioids were issued. The important point here is that many patients are returning to doctors again and again to get more opioid medications after their initial orders run out, which shows that opioids are only a temporary band-aid for pain and not any kind of permanent solution. And of course the more opioids people take and the longer they take them, the more likely they are to succumb to addiction. Tellingly, opioid prescriptions for new incidences of musculoskeletal pain have gone up dramatically since 2001 while the use of non-opioid drugs for such ailments has dropped by almost 30 percent, even though no evidence exists to suggest that opioids are especially effective when used to treat this type of pain. Numbers like this reveal that physicians are increasingly coming to view opioids as some sort of eternally useful chemical crutch; this is not good news for pain sufferers, who deserve to be presented with a full range of options before being put on addictive narcotics. Toward a Smarter and Safer Approach It is unfair to suggest that medical professionals are indiscriminately handing out dangerous drugs simply because doing so makes things easier and convenient. Clearly the situation is more complex than that; but nevertheless, over the last decade the number of people being admitted to emergency rooms, checking into treatment facilities, or dying prematurely because of opioid overdose and addiction has risen by 300 to 400 percent. And if indeed the long-term prognosis for patients taking opioids for pain is not particularly bright, as the Johns Hopkins study would seem to indicate, in most cases the benefits of using opioids may come nowhere near outweighing the risks. Modern medicine’s over-reliance on opioids could be preventing more effective treatment approaches from getting their just due. For example, two separate studies carried out by the Veterans Administration and the Mayo Clinic found that patients enrolled in multidisciplinary programs designed to reduce pain and improve physical functioning with physical therapy and behavior modification were able to obtain excellent results in both areas. Study participants who had been using opioids to relieve their pain were often able to eliminate their need for these drugs, as their pain tended to subside as their functioning improved. Non-addictive non-opioid painkillers are now being underutilized thanks to the surge in popularity of narcotics. But it is not just possible but entirely likely that treatment programs integrating these safer drugs with healing-oriented approaches — such as those used in the VA and Mayo Clinic studies — would yield results for most patients that would be at least equal if not superior to anything that could be achieved through strict reliance on potentially addictive opioid medications.

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