Understanding our opioid crisis

Prescription opioids, also known as painkillers, are recognized as a legitimate medical therapy for selected patients who experience pain that does not respond to other treatments. The moderate to severe pain may be acute, chronic, cancer-related, postsurgical or vascular, to name but a few types.  For these, doctors may prescribe opioid tablets, capsules, oral or injected solutions or suppositories.  However, because of overprescribing and misuse, an opioid-addiction epidemic has developed in the United States, often resulting in death. The health and economic burdens of opioid abuse on individuals, their families and society are substantial.

How did we get here? As with other drugs and alcohol, opioids like hydrocodone, oxycodone and fetanyl, a synthetic opioid that is 50 to 100 times stronger than morphine, can make people feel relaxed and/or euphoric, which is why they are increasingly used “recreationally.” Specifically, opioids bind to and activate receptors on cells located in many areas of the brain, spinal cord and other organs, blocking pain signals and releasing dopamine, the body’s pleasure chemical.  This release can make the user want to repeat the experience, reinforcing dependency.  

But there are plenty of harmful side effects to opioids, including drowsiness, confusion, nausea, constipation and slowed breathing (hypoxia).  The last, which is characterized by too little oxygen reaching the brain, can have short- and long-term psychological and neurological effects, including coma, permanent brain damage or even death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether the damage can be reversed.  

Older adults are at higher risk of accidental misuse or abuse, because they typically have multiple prescriptions and chronic diseases, increasing the risk of adverse drug-drug and drug-disease interactions, as well as a slower metabolism that affects the breakdown of drugs. For all these reasons, the American Medical Association (AMA) estimates that 3 to 19% of people who take prescription pain medications develop an addiction to them. 

What makes this particularly tragic is that its causes, and thus its solutions, are more complex than the exploitive pharmaceutical companies/overprescribing physicians scenario would suggest. This scenario has played its role, as has the rejection of supporting behavioral therapies by insurance companies, which led to the rise of Big Pharma. ,poverty, racism, lack of education and opportunity and an adolescent society with no tolerance for anything but a quick fix, has only fueled the crisis. In other words, the problem isn’t just medical and psychological. It’s socioeconomic and cultural.

Interestingly, the very behavioral therapies for pain management that insurance companies once frowned upon can help people modify their attitudes related to drug use, increase healthy life skills and persist with other forms of treatment. Cognitive behavioral therapy helps modify the patient’s drug-use expectations and behavior and also effectively manage triggers and stress. There is also multidimensional family therapy, developed for adolescents with drug-use problems, that addresses a range of personal and family influences on  drug-use patterns and is designed to improve overall functioning. These behavioral approaches may take longer to achieve results than our pill-happy culture might like. But they can affect long-lasting results. Otherwise, we just end up putting Band-Aids on things and not really fixing anything. Also, there is a certain amount of irony in prescribing prescription medicines to those who are addicted to prescription medicines.   

There are ways to avoid prescription drug abuse. When taking any medication, read the instructions and take the dosage exactly as prescribed by the health-care provider. Do not break, chew, crush or dissolve opioid pills. If the medication causes drowsiness, do not drive or use any machinery. 

Contact your provider if you experience any side effects and use the same pharmacy for all your medications, so its computer system can alert the pharmacist if taking two or more medicines could cause a dangerous interaction.   

As we begin a new year, try to recommit to those aspects of life, proper nutrition, exercise, meaningful work, a comfortable home, family, friends, beneficial leisure and a financial plan that supports all of this, that will mitigate against physical and psychological ills. 

When it comes to opioids, an ounce of prevention really is worth a pound of cure. 

For more, visit giovanniroselli.com.