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True or False: Opioids Are No Better Than Over-the-Counter Medicines for Treating Pain?

True or False: Are opioids more effective in treating pain than over-the-counter (OTC) pain medications?  Luckily, the answer here is a solid “false.” If you are suffering from chronic or acute pain, OTC pain medications Tylenol and Advil may be just as effective as a prescription painkiller for helping to relieve your pain.

Opioids Are the Number #1 Solution for Pain – But Evidence Does Not Support It

Currently, prescription opioid medications are the number one solution for chronic pain in America. When people go to the doctor complaining of aches and pains, doctors are quick to throw opioid drugs at the problem– often without a detailed description of the risks and dangerous of using the drugs even at their prescribed doses. This explains how such widespread problems have gripped the nation as it relates to opioid addiction. Despite high prescribing rates, evidence suggests that opioids are not always the only option. A recent study, published in the Journal of the American Medical Association (JAMA), investigated the effectiveness of opioids versus non-opioid medications in treating pain among patients with chronic back pain or hip or knee osteoarthritis pain. Opioids tested included generic Vicodin, oxycodone or fentanyl patches, while nonopioids included generic Tylenol, ibuprofen and prescription pills for nerve or muscle pain. The researchers found that, over the 12-month study period, opioids did not deliver superior results for improving pain-related function. The findings, they concluded, do not support the practice of starting opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain. Another study published in JAMA similarly found that prescription opioids do not necessarily offer better results when compared with OTC medications, and in particular for acute pain. For adult patients in the emergency department with acute extremity pain, there were no clinically important differences in pain reduction after two hours with ibuprofen and acetaminophen or three different opioid and acetaminophen combination analgesics. In an accompanying editorial, Demetrios N. Kyriacou, MD, PhD, from Northwestern University Feinberg School of Medicine in Chicago, Illinois, said the investigation offers “important evidence” supporting the use of nonopioid painkillers for selected patients in the emergency room setting. “The demonstrated effectiveness of the ibuprofen and acetaminophen combination for moderate to severe pain may also translate to outpatient management and other clinical settings of patients with acute pain,” he wrote. “However, this will require future investigations.” OTC pain relievers are commonly used for treating arthritis pain, headaches, back pain, sore muscles and joint pain. Aspirin, ibuprofen (Advil, Motrin IB), and naproxen sodium (Aleve) are nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are extremely effective because they reduce swelling and relieve pain.

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Opioid Misuse and Abuse Kills People Everyday

Determining the necessity of opioids is a critical need given how many people suffer from addiction to these medications. Data from the National Institute on Drug Abuse (NIDA) estimate that between 26.4 million and 36 million people abuse prescription opioids around the world—with more than two million people in the US struggling with addictions stemming from prescription painkillers. Beyond that two million, 467,000 others are thought to be addicted to heroin in America. It is alarmingly easy to get a hold of prescription drugs, which is a major reason why the epidemic is occurring in the first place. Over-prescribing doctors and inadequate regulations are making it easier and easier for anyone to get their hands on prescription medications and increase the likelihood of abuse. In 2010, more than 210 million prescriptions for opioids were dispensed in America. In that same year the Centers for Disease Control and Prevention (CDC) found that 5% of people in the US age 12 or older used prescription painkillers for reasons other than medical problems.  Around 40% of all opioid-related deaths involve a prescription opioid, and these medications are responsible for about 46 deaths each day. The most common drugs involved in prescription opioid overdose deaths include:

  • Methadone
  • Oxycodone (such as OxyContin®)
  • Hydrocodone (such as Vicodin®)

Opioid abuse can be devastating for individuals, families and communities. Some of the more common effects that accompany opiate abuse include:

  • Job loss and unemployment
  • Incarceration
  • Domestic abuse
  • Divorce
  • Child abuse
  • Homelessness

Chronic Pain in the US: A Pervasive Problem

Chronic pain is one of the most commonly reported health issues in the US. Data from the 2012 National Health Interview Survey show that most American adults have experienced some degree of pain – either acute or chronic – at some point in their lifetime. Drilling down further, about 25.3 million US adults, or 11.2% of the total adult population, reported experiencing pain each day for the preceding three months. Almost 40 million adults, or 17.6% of the entire adult population, say they have experienced extreme pain. People with severe pain are more likely than others to have worse health status overall. With pain being such a common complaint, it is not surprising that doctors are over prescribing prescription opioids to help people feel relief and live normal lives. Unfortunately, even legitimate prescribing practices can ultimately lead to dependence. With that in mind, the CDC has ramped up efforts to help curb overprescribing. “We’re trying to chart a safer and more effective course for dealing with chronic pain,” said Dr. Tom Frieden, former director of the Centers for Disease Control said in an interview with the Associated Press. “The risks of addiction and death are very well documented for these medications.” The goals of having prescribing guidelines include:

  • Determining when to initiate or continue opioids for chronic pain outside of end-of-life care
  • Opioid selection, dosage, duration, follow-up, and discontinuation
  • Assessing risk and addressing harms of opioid use.

The CDC’s most recent guideline says the following about opioid prescribing: “Evidence on long-term opioid therapy for chronic pain outside of end-of-life care remains limited, with insufficient evidence to determine long-term benefits versus no opioid therapy, though evidence suggests risk for serious harms that appears to be dose-dependent.” The recommendation calls for non-opioid therapy and non-pharmacological therapy to be first-line treatment options for chronic pain. Instead of selecting opioids by default, providers should only consider prescribing them if the anticipated benefits for both pain and function are expected to outweigh risks.

Signs and Symptoms of Opioid Addiction

Whether an opioid prescription is appropriate or not, it is important to keep an eye out for possible signs and symptoms of opioid abuse so that people get the help they need as soon as they need it. Those who are addicted to opioids often exhibit certain physical signs that you should recognize. These physical symptoms can include:

  • Unexplained exhaustion or drowsiness
  • Constricted pupils
  • Slow or otherwise labored breathing
  • Nodding off at random times or even complete loss of consciousness
  • Over-the-top elation or euphoria
  • Muscle spasms
  • Nausea and vomiting
  • Sweating
  • Seizures
  • Constipation
  • Itching
  • Insomnia and inability to sleep normal hours

Other than these physical symptoms, there are a few behavioral patterns to watch out for that could indicate opioid addiction. These include:

  • Visiting several different health providers in order to obtain prescriptions – sometimes referred to as “doctor shopping”
  • Unpredictable and dramatic mood swings
  • Discovering empty pill bottles in weird locations or even just having more pill bottles than usual
  • Unexplained and sudden financial issues
  • Social withdrawal or general isolation
  • An increasing inability to do well in school
  • Lethargic behavior
  • Inability or unwillingness to keep up with family or social responsibilities

Unfortunately, the long-term effects of opioid abuse can be very harmful for people and cause permanent damage. Some of the long-term health risks associated with opioid misuse and abuse include:

  • A compromised and weakened immune system, which can leave the body vulnerable to certain dangerous illnesses and diseases
  • Gastrointestinal and digestive issues, including constipation, bleeding ulcers or bowel perforation
  • Health issues that relate to intravenous administration, including embolism events or contraction of blood borne illnesses (like HIV or hepatitis C). This occurs when opioids are injected with needles
  • Dangerous respiratory issues
  • Kidney and liver damage
  • Higher propensity for seizures
  • Damage to memory function

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Mental Health and Opioid Misuse and Abuse

One of the common underlying causes for addiction is the presence of a co-occurring mental health issue. This is also referred to as a “dual-diagnosis.” According to the Substance Abuse Mental Health Services Administration (SAMSHA), the National Survey on Drug Use and Health reported that more than 7.9 million people in the US had a co-occurring disorder in 2014 – the most recent year for which this data is available. Bipolar, anxiety disorders, depression, PTSD, eating disorders, and schizophrenia are among the most common mental health issues implicated in a dual-diagnosis. These disorders can affect individuals in various ways, but the common denominator between these conditions and substance abuse and addiction is self-medication. People who have mental health disorders often self-medicate with drugs or alcohol to find relief from their symptoms. In most cases, a mental disorder is present before the substance abuse begins – although it is common for people to start using drugs or alcohol before they are officially given a diagnosis. While drugs or alcohol may provide temporarily relief for those who suffer from mental health issues, substance abuse actually prolongs symptoms and makes them worse. It can be difficult for a healthcare provider to determine which symptoms are caused by the addiction and which ones are brought on by the mental health disorder. In addition, someone with a dual-diagnosis will have to battle their addiction and overcome the complications of their illness.

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Treatment for Opioid Misuse and Abuse

According to the American Society of Addiction Medicine, “Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” Addiction and recovery from prescription opioid abuse is not a journey anyone should have to go through alone. Although physical addiction plays a role in opioid misuse and abuse, there are typically underlying psychological reasons why addiction became a problem. Counseling for prescription drug abuse can help people work through their substance abuse problems and maintain a healthy, sober lifestyle for life. Intensive outpatient programs (IOP) are also a viable option for people working through addiction. Through IOP, you will be assigned a case manager tasked with creating an individualized treatment plan that caters to your individual needs. There is no “one size fits all” method for treating addiction – each person has their own unique story and addiction experts recognize that. Your case manager will conduct an intake assessment to get to know you better so they can devise a plan to support you in your efforts to conquer addiction. Beyond counseling services, medication-assisted detoxification can help to promote a safe and sustainable recovery for prescription opioid addiction. Vivitrol, a drug targets the part of the brain that cravings stem from, can help someone work through the withdrawal process. Unlike some other treatment medications, the drug itself is non-addictive. Subutex is another opioid-replacement therapy shown to be effective in treating addiction, although it does have addictive potential. Abuse and misuse of prescription medications, including modafinil, is becoming of the fastest growing health epidemics in the US due to the high potential for abuse and lethality. Getting treatment for yourself or a loved one is, by no stretch of the imagination, an easy task. Nevertheless, it could become one of the best decisions you will ever make for yourself or your loved one.