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Mental Health Matters: Be careful with analgesic opioid use

Andy Whyman, MD
Special to the Bonanza

And you thought the 1918 flu pandemic that killed millions worldwide was bad. Well, let me tell you, having just spent four days in bed, barely having the energy to achieve the basics, this flu strain has to be a close cousin to that marauder.

But I digress. Seems that having outlasted the flu, I arose only to experience searing low back pain that my low back exercises couldn’t touch. What next? Ah! The medicine cabinet: Two Tylenol and four hours later … and the pain is no better.

But just then, what do I discern? Lovingly cradled in the corner of my medicine chest is a bottle of the opiate derivative oxycodone, the fruit of a recent visit to an excellent dermatologist who stitched me up after excising a nasty little skin cancer.

So, what do I do? I caress that bottle of 10 pills, the exact amount that was originally prescribed, and then place it back in the medicine chest.

“ Opioid analgesic prescribing has risen dramatically since the 1990s, principally due to an increase in their use to treat chronic, non-cancer pain. ”

I do not dispose of those 10 beautiful pills. After all, perhaps my back pain will become intolerable. Or maybe some other pain-driven syndrome will visit me in the next 10 years and, voila, my salvation will be at hand.

That’s the thing about prescription analgesic opioids: Used appropriately, they are one of the true miracles of modern medicine, capable of relieving crushing pain rapidly and effectively. Surgical pain, cancer pain, terminal illness pain … all bow to opioid derivatives.

However, like so many modern technical marvels, used casually, used cavalierly, used inappropriately, they can kill you … and prescription opioids do that too.

Here’s the downside: All opioids, because they have euphoric, analgesic and addictive properties, are subject to abuse. And we use and abuse these drugs in astounding numbers.

Opioid analgesic prescribing has risen dramatically since the 1990s, principally due to an increase in their use to treat chronic, non-cancer pain. Such treatment remains highly controversial, but it has spawned a new multibillion-dollar profit center for the pharmaceutical industry.

Retail sales of prescription opioids in the United States between 1997 and 2007 dramatically increased: Methadone sales were up 1,293 percent; oxycodone (brand names Oxycontin and Percocet) 866 percent; fentanyl (brand name Duragesic) 525 percent; hydromorphone (Dilaudid or Exalgo) 319 percent; and hydrocodone (Brand names Vicodin or Norco) 280 percent.

The extent of opioid analgesic use in America exceeds any other period in the country’s history or the rest of the world. By 2013, one of 25 adults was prescribed an opioid for chronic pain, and sales are over $9 billion per year.

With 4.5 percent of the world’s population, the U.S. consumes more than 80 percent of the world opioid supply, including 99 percent of all hydrocodone, 80 percent of all oxycodone, and 58 percent of all methadone.

These numbers do not reflect a valiant effort to control a sudden viral explosion of chronic pain. Instead, they signify the growing nationwide problem of prescription opioid abuse, diversion, addiction and overdose.

This public health menace has, in turn, created new opportunities, or markets, depending on your perspective, for both regulatory and law enforcement agencies.

The sea of opioids finds its way everywhere. Between the early 1990s and 2003, opiate analgesia abuse increased 94 percent, and first-time non medical opioid analgesic users 12 to 17 years of age increased by 542 percent.

Between 2004 and 2011, the Emergency Room admission rate from substance misuse or abuse, adverse reactions, drug-related suicide attempts, and substance abuse treatment increased 153 percent. The top three opioid analgesics accounting for these admissions were oxycodone, hydrocodone, and methadone.

In 2008, a large survey of high school students found that 12.3 percent had used opioid analgesics for non-medical reasons.

Opioid diversion from the prescribed user has become an alarming problem: Among those 12 and older, 54 percent of non-medical users obtained prescription opioids from a relative or friend for free, 10 percent bought them from a friend or relative, and only 4.3 percent bought them from a drug dealer or other stranger. Another 4 percent stole them from a friend or relative.

So, here is my arguably sage advice:

1. Use short term prescription opioids for moderate to severe acute pain.

2. For chronic pain that is not cancer or terminal illness related exercise extreme caution in the use of prescription opioids.

3. If your non-cancer chronic pain seems to require prescription analgesic opioids, know there are lurking dangers of which you may not be aware. Seek the services of a specialist in pain medicine who does not stand to gain financially.

4. If you are one of the small, but significant number of people who benefit from long-term opioid use for chronic non cancer pain, be well aware of addictive complications.

5. If you have unused opioids in the medicine chest, get rid of them safely.

6. If you have opioids in the medicine chest and you have children, beware.

7. If your spouse uses opioids for chronic pain relief, and you’re not included in the treatment plan, seek independent professional advice.

8. If your child exhibits chronic pain, exercise extreme caution in allowing prescription opioid treatment.

9. Most people who seem to require opioids for chronic non cancer pain have associated emotional problems. Make sure your doctor understands this and is comfortable making mental health referrals.

Over the years, I have examined thousands of patients with chronic pain syndromes: Too many of them became addicted to prescription opioids by physicians who didn’t know better and/or didn’t care, and too may or them didn’t understand either their addiction or how it, not pain, was destroying their life.

Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. It appears every other week in the North Lake Tahoe Bonanza and Sierra Sun. He can be reached for comment at adwhyman143@gmail.com.


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