Opioid crisis: addiction & chronic pain
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Opioid crisis: addiction & chronic pain

December 27, 2019


So let’s start off by defining what an opioid
is. An opioid medication is essentially any medication that works on the morphine receptors
in our body. Some people may be alarmed to learn that some of the drugs they’re taking
for their pain management actually fall in this category. We generally define opioid
drugs as weak or strong medication preparations. The weaker ones include codeine phosphate,
dihydrocodeine and tramadol. The stronger morphing preparations include
morphine as a tablet itself or as a liquid, oxycodone, buprenorphine and fentanyl. The
number of people using opioids in the United Kingdom at any one time is largely an unknown,
but what we do know is that the prescribing trend over the last ten years for these types
of drugs for non-cancer pain has increased dramatically. This is a particular problem
as we’re starting to learn that long-term use of these drugs cause real harm and problems
for the majority of individuals. So generally speaking, opioids are prescribed
for the management of pain of some sort. There are certain conditions where doctors might
consider using opioid medications, but these are very rare and these include the management
of certain respiratory disorders or cardiovascular issues. In general, as I mentioned, opioids
are prescribed for the management of pain and this pain could be what we term acute
pain, end-of-life or cancer pain, or for chronic long-term mechanical pain. So let’s start off by defining a few of the
terms in the question. Acute and chronic are terms often used by patients to try and define
the severity of their symptoms. Medically, we use these terms to define time. So an acute
episode or acute pain is pain that lasts up to about three months and if it lasts longer
than three months, we define as chronic. With regards to use of opioid medications,
there’s very good evidence for the use of these medications in an acute episode. So
an example of that would be after trauma or a broken bone, for example or after surgery. Interestingly, there’s very little evidence
that these drugs are helpful in chronic long-term pain management, but what we do know is that
the use of these drugs in the long-term can be extremely harmful indeed. Nobody truly understands how addiction occurs
to a substance or a drug. We do know that patients bring with them certain behavioural
characteristics that might predispose them to developing addiction. That includes known
addiction to certain substances such as alcohol or smoking. Other elements are important such as a background
of anxiety or depression and these traits do predispose an individual to developing
addiction to drugs such as opioids. We also know that complex neurological changes occur,
such as an increase in the development of certain neurotransmitters or changes in the
brain circuitry that predisposes an individual to development of addiction. The important message here is that even if
you don’t believe that you have these behavioural traits, these neurological changes means that
everybody is at risk of developing addiction when placed in front of these drugs for a
long period of time. So the fact that an individual has chronic
pain, so that’s pain lasting more than three months, means that there’s no simple mechanical
fix for their pain. Often patients bring baggage with them. So their thoughts about their pain
changes, their behaviour changes, the way they walk or partake in activities, all change.
So when dealing with an individual with chronic pain, we look at all of these elements to
try and help that patient manage their pain better. So the kind of tools that we use to help patients
with chronic pain include psychological strategies, physical therapies, looking at alternative
drugs especially discussing around the subject of opioids and for a group of patients injections
may also form a part of their management strategy. The first thing is to identify that you are
a high-risk individual for addiction and that can be simply you’ve noticed you’ve been taking
these drugs for a long period of time or you’ve changed your behaviour around the use of these
drugs. For example, you start to become anxious about going away on holiday or making sure
you have enough tablets. The good news is that for the majority of
people, a slow weaning programme is enough to remove yourself from these drugs very safely.
For a very small percentage of people, we may need to bring an additional help to try
and withdraw these medications without the development of withdrawal side effects and
that may even require the use of substitution drugs to help bring you off these medications
safely.

Only registered users can comment.

  1. I've been on methadone for 17 years and it's killing me and is impossible now for me to stop I have depression suicidal thoughts stomach issues heart problems and not getting help my Dr's want me out as fast as I go in I cannot get prescribed anything that helps for my depression or anxiety or panic attacks. It's ridiculous can someone else help me???

  2. I had always felt I needed opioids, ever since I was a child. On December 19, 1942, my cock went crooked in the night and cracked and I screamed, after which I was fed several opioids to ease the pain. I still abuse them to this day and steal them from my wife who does not care because her brain is swiss cheese from all the aluminum I poisoned her with over the years. Life could not be better than it is now, this is hardly a crisis.

  3. Sugar inflames low blood circulation areas like JOINTS AND SPINAL BACK PAIN. https://www.weightandwellness.com/resources/articles-and-videos/sugar-aches/

  4. My wife, daughter and I are suffering from extreme pain as a result of the panic over opioids. Yes there have been deaths from overdoses however the lack of intervention however the medical power brokers are choosing not address the root of the problems. More to the point WHAT ARE THET DOING ABOUT THE 1,500,000 Canadians who suffer from chronic unremitting pain. Physicians are being pressured to bend to political will because of the run away opioid overdose bandwagon. Governments and medical associations are "throwing the Baby out with the bathwater"! They are the leaders but they do not address the needs of law biding Canadians who suffer from chronic pain and are facing an uncertain future fraught with pain.

    The deaths from opioids do not even reach the levels of deaths from; alcohol, meth/crack, nicotine, undiagnosed and untreated illnesses, acquired hospital infections, poor safety standards for vehicles.

    But I sit here unable to do anything while in back and leg pain. I get frantic with the pain while the "do-gooders" spin their crap about opioids. Tylenol does not work for this level of pain! The doctors and their organization have cast aside their knowledge and skills to follow government imposed limits. In being opiodphobic medicine has given up on treatment of pain to become clerks!

    All this because some parents cannot have to make a cause out of their child's lack of judgment and direction in making life decisions. I don't care! You ought to have dine a better job when they were little tots. This group of self centered ill-informed individuals are making life HELL for the chronic pain suffer.

    There you have my rant! Be upset and angry for when your turn comes there will be nothing for you other than smiling "do-gooders"!

  5. When a patient develops a narcotic tolerance, the doctor can increase the dosage to provide the same pain relief but the risk of sideeffects increases ..please visit here https://naturalsynergycure.com/go/

  6. I'm tierd of having my pain meds cut over a bunch of junkies shooting illicet brown and black crud in their arms and dying from it,that has nothing to do with me.

  7. I've had chronic pain from undiagnosed fibromyalgia since I was 20yrs old. I tried every medication and therapy available. I preferred natural treatments as I did not want more chemicals in my body in addition to what we are exposed to in the environment. I did take codeine in the form of cough syrup when I had pneumonia on several occations. I found this to be effective for the pain I experienced from my constant coughing; the muscle pain in my chest & the burning of my airways. I was prescribed Percocet when I developed gall stones. The pain of passing a stone for 6 hours was excruciating. Despite never taking an opioid stronger than codeine, the Percocet barely contained my pain until my surgery. The morphine they gave me post-operatively had to be increased from the initial dose, but was very effective. By the time of discharge, I was no longer experiencing enough pain to complain about, but I was given codeine. My fibro pain continued to plague me upon my return to work. I tried every OTC to no avail & tried my left-over codeine, despite the side-effect of nausea. It was take that or go home. I had already been written up for absenteeism due to severe fibro-fatigue & pain. Codeine was effective, but I ended up vomiting & suffered through that the rest of the day. It was this side-effect that I rarely took opioids & that codeine was effective for moderate to severe pain until my late thirties. I had a breast augmentation when I was 38yrs old & was prescribed Vicodin 5mg. I was in agony & the Vicodin was not effective. I suffered through the weekend as I was alone & could not go out to an ER or pharmacy. I supplemented the Vicodin with ibuprofen without relief. I then used my left-over Vicodin for my fibromyalgia with good results, but the nausea was still a problem. I was finally diagnosed with fibromyalgia when I saw a colleague of Robert Bennett, MD at OHSU where I worked at the time. He prescribed Ultram (tramadol) & temazepam for sleep. I had taken benzodiazepines with opioids previously without problems with over-sedation. When I was diagnosed with PTSD, panic disorder & anxiety I was prescribed Xanax & had to discontinue to temazepam. While the tramadol was effective for my fibro pain, I was experiencing many intolerable side-effects which are now called serotonin syndrome. I had to change to methadone & discontinue the Xanax which left me with having to deal with my PTSD & panic attacks. I do subconscious things like holding my breath until I become dizzy & think I may pass-out until I realize I'm not breathing. I become removed from the world; removed from reality. This is obviously dangerous if I'm driving – I've blown through red lights; walked into traffic. I was on methadone 10mg 4xdaily for 5yrs, but couldn't deal with my PTSD & panic attacks any longer. I had several nervous breakdowns during the more than 20yrs it took to be diagnosed & medicated. I found a fibromyalgia clinic & was prescribed clonazepam & morphine ER 30mg 3xdaily; morphine IR 15mg 6xdaily for breakthrough pain. Obviously, we came to this dose after trying other medications & working our way to meds & doses to help me become functional. I did not lay around in a half-coma, drooling & incoherent. I worked in my garden; landscaped my yard; played with my dog; sewed garments; made jewelry & my favorite activity of cooking with fresh ingredients. Many chronic pain patients take between 200mg-300mg morphine equivalents per day. Some medical professionals believe I was on too high a dose & should not be taking benzodiazepines. We did not come those doses overnight. It was 10yrs of trial & error. I was on the same dose of morphine for more than 5yrs. Now they've taken all my medication away from me with this opioid & benzodiazepine hysteria. I've never overdosed, been over-sedated or abused my medication in any way. Those so-called doctors that manipulate facts then say post-operative pain & chronic pain can be treated without opioids are making some outrageous claims. I am now 63yrs old with two grown sons I had through natural childbirth. If I had chose to have more, I would take drugs! I tried everything for my chronic pain & PTSD. I've suffered for more than 40yrs desperately trying everything legitimate & crazy. I put "magic" crystals in my car & my house. No stone was left unturned. I shouldn't have to live out my retirement in mental and physical pain.

  8. all drugs should be legal and feely available to anyone who functions ell on them. they are gods gift to those in pain. YOU dont know what you are talking about! BS!

  9. this video is the most ignorant thing i have ever seen…such bull shit! tHIE INFORATION IS A LIE AND TOTLY NONSENSICAL part of the war on drugs, and causes many of the elderly to die in excruciating pain……needlessly! a travesty

  10. Just accept pain for what it is. Just tough it out! What garbage.
    I've been on opioids for 3 years. I finally have the ability to live life. I don't care about addiction. I am pain free. Everyone had an opinion they want to apply to everyone and thus make a diagnosis based on the prevailing political flavour no on true assessment.

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