DEAR DOCTOR K:
The news media say that we suddenly have an epidemic of addiction to prescription opioid painkillers. These pills have been around for a long time. What’s changed?
Developing treatments that reduce or eliminate pain has been one of the great accomplishments of medical science. Until the past couple of centuries, our ancestors had no way to relieve the pain from a major injury, or from a disease like cancer.
The first pain medicines, like morphine, were typically given by injection. But then opioid pain pills (and syrups) became available. Examples include hydrocodone (used in Vicodin), oxycodone (used in Percocet), methadone, codeine and morphine. These prescription drugs reduce the brain’s recognition of pain by binding to certain receptors in the body.
These medicines were initially used to treat acute, short-lasting pain from injury and longer-lasting pain from cancer. However, over the past 20 years the medicines have been increasingly prescribed to treat chronic pain conditions (like arthritis) other than cancer. Some people seek these medicines, however, not to treat their chronic pain, but to sell them to other people. Some of those people just enjoy getting high. Others have an opiate addiction from heroin, and use the pills to prevent opiate withdrawal.
One problem with opioids is that a person can develop a tolerance to these drugs. That means that over time, a person needs higher and higher doses to achieve the same degree of pain relief.
A second problem is that the body can become physically dependent on these drugs. That causes withdrawal symptoms if the drug is stopped.
A third problem is that use of opioid painkillers is the biggest risk factor for addiction to heroin.
Finally, an accidental opioid overdose (such as forgetting that you took some pills a few hours ago) can lead to death.
I spoke to my colleague Dr. Wynne Armand, associate physician at Harvard-affiliated Massachusetts General Hospital, about the current opioid epidemic. She noted that much of the current problem stems from the fact that so many more of these drugs are prescribed today. Four times as many prescription painkillers were prescribed in 2015 in the United States than were prescribed in an average year in the 1990s.
Health officials are working to educate health care providers on safe prescribing. They are also educating the public about the risks of opioid painkillers.
Anyone who takes an opioid pain medicine should follow these guidelines to reduce the risk of abuse and overdose:
- Store medication safely.
- Never share your medication with anyone else.
- Take the medicine exactly as instructed.
- Ask your doctor if a lower dose might be an option.
- Ask your doctor about other ways to manage pain. Many non-drug options can help.
- If the medication is not working well, talk to your doctor.
- Do not take overlapping prescriptions from multiple providers.
If you suspect you may be developing an addiction, ask for help as soon as possible.