Opiates include the strongest, most powerful painkillers on the market. They include such well-known drugs as morphine, oxycodone, and codeine. The street drug heroin also falls into this category. Even though doctors frequently prescribe opiates to help patients manage acute or long-term pain, there are many risks of opiate use that carry the potential for serious health impacts, including addiction. Here are the most common signs of opioid addiction.

Signs of opioid addiction

Opioids rank as the most commonly prescribed medication in the U.S., according to research from the University of Pennsylvania. This highly addictive class of drugs relieves pain effectively for some, but can also lead to physical and mental addiction.

Opiates work by latching onto opioid receptors located in your brain, spinal cord, and gastrointestinal system. They essentially change how your perceive pain. Because these powerful drugs work so closely with the inner workings of your body, you may quickly grow accustomed to operating while under their influence and need the pills to function properly.

The most common signs of opioid addiction are:

• Uncontrollable cravings to take the drug
• Inability to control your opioid use
• Use that’s having a negative effect on your personal relationships or finances
• Doctor shopping for more medications
• Social withdrawal or isolation
• Use that leads to risks of overdose

Physical signs of opioid addiction are just one way opiates latch onto your life. These drugs also work by triggering the reward pathways in your brain and producing euphoric feelings of pleasure and relaxation that lead to uncontrollable cravings. Once off the drugs, people often find themselves yearning for those happy feelings and take the drugs not to cure pain, but to return to pill-induced peace. Physical and mental addiction can devastate a person’s life as he or she forsakes responsibilities and commitments in favor of getting high off opiates. Even medications offered legally by prescription can result in devastating addiction.

The following video gives more information about the signs of opioid addiction on a global scale.

Withdrawal symptoms 

If you do stop taking opioids, you may experience symptoms of opioid withdrawal, including:

• Agitation
• Anxiety
• Nausea
• Insomnia
• Muscle aches
• Abdominal cramping
• Diarrhea
• Vomiting

If you are taking opioids and want to stop use, always work with a doctor to gradually wean yourself off these medications.

Health problems from long-term use 

Signs of opioid addiction aren’t the only thing you have to be careful about. Many actually won’t become addicted to opioids, but they will experience long-term dependence that leads to health problems.

Opiate use has been linked to a variety of health issues, including:

• Constipation
• Sleep disorders
• Fractures
• Hearing issues

Long-term use of opiates also interferes with the body’s system of hormones, researchers have found. A 2013 study completed by researchers in the UK found that patients taking opioids for chronic pain experienced decreased hormonal activity in their reproductive systems as well as low bone mass, which can lead to osteoporosis and fractures.

Risks of overdose and death

Opiate use and resulting deaths have continued to climb in recent decades. In 2010, about 38,000 people died from prescription painkiller overdose, up from 37,000 deaths in 2009, according to 2013 statistics from the Centers for Disease Control and Prevention (CDC). Opiates were linked to 75% of those deaths.

Opioid-related deaths occur most commonly among people who intentionally misuse prescription painkillers. However, sometimes a medical professional mistakenly prescribes an inappropriate amount of the drug or a patient misreads the medication’s instructions and accidentally overdoses, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

People who frequently take opiates develop a tolerance for them, meaning they need to take ever-increasing amounts of the drug to achieve the same effect. When people stop taking the drugs, their tolerance drops again. If a patient with a lowered tolerance takes an amount of the drug they were accustomed to during a period of high tolerance, serious physical harm can happen, including overdose.

Find help 

If you’re looking for ways to manage opioid use, you’re not alone. The large number of people looking for help has resulted in a vast array of resources to help you reduce the number of painkillers you take or give you strategies to stop taking them all together. Here are four tips on how you can manage your use especially if you’re experiencing signs of opioid addiction.

1. Talk to someone you trust

Whether that person is a doctor, family member, or other medical health professional, recruiting someone you trust into your arsenal of support can help you manage any overwhelming feelings you may encounter while trying to control your opioid use. A trusted advisor can help you find avenues of support. They can also help guide you if you feel you have nowhere to turn.

You can also find addiction resources at DrugAbuse.com, Addiction.com, American Addiction Centers, Recovery.org.

2. Slow down opioid use under a doctor’s care

If you’ve been using opioids for a while to manage pain, you may have a physical addiction. This means that your body has become so accustomed to operating under the influence of opioids that it needs them to operate normally. If you stop opioid use cold turkey, you may experience opioid withdrawal. This uncomfortable period, which can include anxiety, anger, nausea, and vomiting, can last for about 30 hours, according to the National Institutes of Health.

To alleviate these feelings, doctors sometimes work with patients to gradually decrease the number of pills taken, in a process called tapering. An alternative is to stop using opioids completely, but take another medication to lessen the side effects of withdrawal instead. Talk to your doctor to determine the best course of action to follow.

Also find a pain specialist who is dedicated to combining multiple therapies to manage your pain. Medications shouldn’t be your only treatment. The best doctors will combine lifestyle strategies, interventional pain management treatments, and complementary therapies to help relieve your pain. The following video discusses our approach to opioid use.

3. Find a support group

Support groups, including your local chapter of Narcotics Anonymous or groups formed by your local health center or hospital, can help you connect with others going through similar issues.

If you prefer the anonymity of an online support group, many do exist. AddictionSurvivors.org runs an opioid-specific support group, where you can find answers to all your questions, including how to taper off your opioid use and even resources to proceed through the popular 12-step recovery program without attending in-person meetings. ChronicPainSupportGroup.com offers a Facebook-based support group for those suffering from chronic pain and its side effects.

4. Consider alternatives to opioid use

If you turned to opioids to manage chronic pain, know that many healthier, safer alternatives can also help alleviate pain. Researchers say that methods ranging from meditation to yoga to a healthy diet, based on unprocessed, whole foods, can help lessen your pain and improve your quality of life.

Alternative methods of treatment, including injected medicines called nerve blocks that interfere with nerves as they send messages of pain, may also help reduce the number of opioids you take.

To work with a doctor who specializes in an interventional approach to pain management, and can help you manage your opioid use, click to find a pain doctor in your area. 

Chronic pain is one of the nation’s most pervasive health problems, affecting about 100 million people. To alleviate patients’ suffering, pain medicine doctors have over the last few decades frequently prescribed opioids, a class of powerful and dangerously addictive medications. As the number of prescriptions has piled up, so have the rates of addiction and related deaths. Now, the medical community — and pain medicine doctors especially — are growing aware of opioid safety concerns. The tide is turning against the dangerous pills that, as new research shows, may not even be effective against long-term pain.

How did opioids become so popular?

When opioids first came on the market, they were typically offered to people experiencing acute pain. Patients recovering from surgery or a short-term medical condition were given the pills for short durations of time until the condition causing pain ended.

Then, in 1986, a study published in the medical journal Pain characterized opioids as safe for long-term use in “selected patients” with limited risk of addiction, reports The New Yorker. Six years earlier, the New England Journal of Medicine had published a short letter to the editor reporting that a slim percentage of patients receiving narcotics became addicted.

These two incidences created a fertile ground for drug manufacturers, who began marketing opioids as safe for patients with chronic pain, including back pain, which is very common and a leading cause of disability. The drug companies also funded industry non-profits, including the American Pain Society and American Academy of Pain Management, to further the idea that opioids were safe for long-term use. Doctors, trying to treat incredibly complex pain conditions against a backdrop of ever-tightening schedules, had little time to devote to patients with confounding, chronic medical conditions.

Opioids seemed like an easy, effective method to help patients, and the limited research available seemed to support the idea that the medicines were relatively safe. Then the number of people addicted to narcotics began skyrocketing, along with opioid-related deaths.

What are current opioid overdose rates? 

Since 1990, the rates of death from drug overdose have tripled, reaching the highest they’ve ever been, according to PsychCentral. In 2011, 17,000 people died from opioid overdoses. And from 2007 to 2010, the number of people hospitalized for opioid addiction jumped by four times. In 2015, according to the most recent research from the CDC, 15,000 people died from overdoses involving prescription opioids.

Widespread opioid addiction has also contributed to a rise in heroin addiction since those addicted sometimes turn to street drugs that are cheaper and don’t require prescriptions, reports Time.

U.S. accounts for the majority of global opioid use

Opioid use is a huge problem in the U.S., and it seems to affect the nation more than it does other countries worldwide. The U.S. accounts for about 80% of global opioid use and 99% of all globally used hydrocodone—a commonly prescribed opioid, according to The Journal of the American Academy of Orthopaedic Surgeons.

Orthopedic surgery is the branch of medicine related to the musculoskeletal system, and orthopedic surgeons rank third in types of doctors who prescribe opioids, according to the study. Much of chronic pain emanates from the musculoskeletal system, and so while it makes logical sense for orthopedic doctors to prescribe opioids and other pain pills, doctors are concerned about the widespread rates of misuse and overdose.

Detrimental effects include patients’ growing tolerance for the drugs, which means patients require increasingly high dosages to achieve the same amount of pain relief. Another concern is the burgeoning black market for opioids, which often results when patients with prescriptions sell or give the pills to people without prescriptions.

Additionally, researchers have found that many patients who have undergone surgery for their spine or to replace a joint and who take opioids may face worse health outcomes than if they didn’t take the pain pills. Researchers said that in the face of mounting data, the medical community must come together and find a way to limit the number of opioids used to treat musculoskeletal pain.

Why are opioids so dangerous?

Opioids are powerfully addictive, not just mentally, but physically. Every time a person takes an opioid, the body becomes accustomed to it, which means ever-higher dosages are required to achieve the same effect. Narcotics also provide a relaxed, euphoric feeling that frequently hooks people to the drug.

No medication, not even opioids, can completely make pain go away, and so people often take more and more of the drug to stop their pain, feel that drug-induced euphoria, or possibly because the body needs the drug to operate normally—a situation known as physical dependence.

As the public health impacts of opioid addiction have risen, public awareness has also grown and doctors now say they are less likely to prescribe the medications.

Why do people misuse opioids? 

As many as 25% of all people who take opioids misuse the pills, according to research published in the journal Pain. Meanwhile, about 10% of those taking opioids grow addicted to the drugs. The harmful impacts are so pronounced that researchers questioned whether so many people should be receiving prescriptions for these potentially lethal drugs.

Opioids kill pain by attaching to the brain’s opioid receptors, which alleviates suffering but can also create a sense of euphoria. This sometimes leads to patients taking the pills not only to reduce pain, but also to escape the struggles of daily life and enjoy a peaceful sense of wellbeing.

Meanwhile, opioids can also create a physical dependency, which means the body becomes accustomed to operating with a certain level of drug in its system. When a person stops taking the pills, the body may go into withdrawal. The brain produces a natural type of opioid, but taking the pill form alters production levels. This can lead to physical withdrawal symptoms after opioid use stops, according to the National Institute on Drug Abuse.

Other types of misuse include snorting crushed pills, injecting the powder, or mixing opioids and alcohol—a potentially lethal mix.

Pain researchers are calling for additional studies to further flesh out the risk factors for opioid misuse and dependency so doctors can have a better idea of who they should avoid prescribing the medications to. Study authors write:

“We are not certain that the benefits derived from opioids, which are rather unclear…compensate for this additional burden to patients and health-care systems.”

Why fewer pain medicine doctors are prescribing opioids

Part of the problem, and a huge factor in the rise of opioid prescriptions, is that there are no effective, safe medications to help people living with chronic pain. There has been a shortage of research into potential medications not in the opioid class of drugs, and doctors aren’t well prepared to safely handle chronic pain, says NIH. Pain medicine doctors, who are specialists in the care for chronic pain, must be at the forefront of efforts to find new alternatives to opioid medicines.

Chronic pain is not one condition, but an umbrella term for a sensation that can be caused by anything from a slipped spinal disc to disruptions in nervous system functioning. Not all pain is created equal, and the treatment should reflect that, NIH concluded.

The agency recommended increasingly individualized care for chronic pain that focuses on the whole person, the physical and emotional, since pain affects both of these aspects.

The report also encouraged greater use of alternative and complementary therapies for chronic pain from pain medicine doctors including physical therapy, massage, acupuncture, and chiropractic treatment. These modalities are becoming more common, but are still difficult for many patients to access. According to the New Yorker:

“Health insurers are part of the problem here: they reliably cover prescription narcotics, but not necessarily these other medical tools.”

Opioids don’t help most types of chronic pain

While opioids may be a common way of treating chronic pain, emerging research casts doubt on whether the pills even work.

A research paper from the National Institutes of Health (NIH) has concluded that opioids have little to no benefit for treating chronic pain. In the past, several studies have found the opposite, but NIH says those studies lacked rigorous methodology or didn’t last long enough to collect accurate data. Dr. David Steffens with the University of Connecticut says bluntly,

“There’s no research-based evidence that [opioids] are helpful.”

Our pain doctors discuss how a team-based, comprehensive approach is best for treating chronic pain.

Emergency programs join fight

While deaths related to opioid overdose rose to 16,651 in 2010, up from 4,041 in 1999, researchers believe they have uncovered new ways that emergency departments could help reduce these startling statistics.

Research published in the Western Journal of Emergency Medicine found that emergency departments have the ability to save lives through educating patients and distributing rescue kits with naloxone, a nasal spray that counteracts the effects of opioids.

The study evaluated the success of a program from Boston Medical Center (BMC), which has, since 1993, referred eligible emergency department patients for drug interventions and treatment. In 2009, BMC also began distributing naloxone kits to those patients who were at risk for overdosing on opioids.

Researchers from Boston University, in concert with BMC, analyzed data from the patients and found 73% of those surveyed had received a naloxone rescue kit. More than 50% of patients receiving kits called 911 after witnessing an overdose, and 33% of those patients administered the naloxone kits in an attempt to save a life.

Researchers said the sheer number of people reached through this targeted program, and who through it understood how to react in an emergency, offered hope for curtailing rising overdose death rates among opioid users. Study author Dr. Kristin Dwyer says:

“Our program reached a high-risk population that commonly witnessed overdoses, called for help, and used naloxone to rescue people, when available.”

Doctors hope additional, larger studies will shed further light on how many lives can be saved through outreach efforts.

What are the current rates of opioid prescriptions?

After decades of increasingly common opioid use, data now emerging paints a scary picture of rising addiction and overdose rates. Meanwhile, pain medicine doctors aren’t even sure if these dangerous pills are helping patients reduce pain. With the risks clear and benefits uncertain, the medical community is committed to helping people find new ways of fighting pain and fending off addiction.

Knowledge is power, and understanding the truly devastating effects of opioid use and abuse is the first step in helping those whose lives have been impacted by the powerful narcotics. With pain medicine doctors increasingly aware of both opioid dangers and the addiction epidemic, experts say more are exercising greater caution before filling out a prescription.

About half of all doctors surveyed by Johns Hopkins Bloomberg School of Public Health said they were less likely to write an opioid prescription today than they were a year ago, according to PsychCentral. Nine out of ten doctors said a prescription drug abuse problem plagues their communities, driving home the risk of taking the drugs long-term. Caleb Alexander, a Johns Hopkins epidemiologist says:

“The health care community has long been part of the problem, and now they appear to be part of the solution to this complex epidemic.”

A study by Columbia University corroborated the Johns Hopkins research, finding that rates of opioid prescriptions have stabilized over the past ten years after peaking in 2007. Interestingly, most doctors surveyed believed in their own ability to safely write opioid prescriptions all while agreeing that the drugs are over-prescribed, reports Forbes. Pain medicine doctors must continue to lead this charge of finding safer, more reliable alternatives of pain management for their patients.

To learn more about other options you have for pain management, talk to one of our pain medicine doctors today.

Opioids are a hot topic right now as the Centers for Disease Control recently released new guidelines for healthcare providers to follow before and during any opioid therapy treatment. This is especially important because these suggested guidelines lay down specific steps for providers to follow. Many of these focus on treating chronic pain in general. The reason for these new guidelines and the overall coverage of opioids in the media is that opioid overdose has been labeled a serious public health issue. The Department of Health and Human services have reported that drug overdoses are now the leading cause of injury death in the U.S. Almost 20,000 overdoses are from the legal prescription of opioids.

The basics of opioids and how they can lead to opioid overdose

Opioids are pharmaceutical painkillers that are used to treat severe pain. This class of drugs includes medication such as morphine, codeine, and oxycodone. Opioids work by attaching to proteins called opioid receptors and can produce a pleasant euphoric feeling as well as numb the perception of pain.

Opioids are often used for acute care such as for those who have undergone major surgery or suffered a severe injury. However, they can be used in long-term care if a physician feels their use is worth the risk. Opioids do have some common side effects that include:

• Drowsiness
• Nausea
• Mental confusion
• Constipation
• Depressed respiratory functions

Dependence versus addiction

These two words are often interchanged by many people, but vary differently in practice. Dependence refers to a physical dependency that is created due to a habitual use of opioids over time. Addiction, which oftentimes can include dependency, refers to compulsive drug seeking and the reckless disregard of the consequences from this behavior.

Those who become dependent on painkillers will experience withdrawal symptoms when the drug use is suddenly reduced or stopped. These symptoms can range from mild to severe depending on the drug and potency. However, this can be mitigated by other drugs or by slowly ramping down the opioid use over time.

A main factor in opioid overdose is when patients become dependent on the opioids for relief and develop a differential tolerance to its pain-relieving effects, but the negative side effects are still as prevalent. This means the body has become resistant to the pain-reducing effect and now requires higher doses to obtain the same level of pain relief. This can cause problems, as physicians will have to make a judgement call on whether an increased dose is justified and safe for the patient.

How an opioid overdose occurs

Opioid overdoses can occur in a variety of different ways. Many people who overdose are patients that have a legal prescription provided by a doctor.

Some of the most common ways to overdose are to accidentally take too much, such as in the case of elderly patients who might not remember if they have taken their meds. Mixing opioids or other drugs together can also result in an overdose. The most publicized way to overdose is by misusing or abusing opioid drugs, such as by taking them without a prescription or taking the drugs for a longer period of time than required.

Signs of an opioid overdose

There are many symptoms of an overdose, but there are three signs, known as the opioid overdose triad, that can help you identify an overdose. These include:

• Pinpoint pupils
• Unconsciousness
• Respiratory depression

Additional symptoms of an overdose that you should be aware of include:

• Unresponsive to outside stimulus
• Vomiting
• Choking sounds
• Slow or erratic breathing
• Slow or erratic heartbeat
• Fingernails and lips turn blue or purple
• Vomiting
• Clammy or pale face

Responding to an opioid overdose

It is highly unlikely that you will be able to treat yourself in an overdose situation. You should plan ahead and make sure that loved ones or caregivers understand how to recognize if you are having an overdose and what to do in case it happens.

The primary thing to do if you are faced with a loved one who is experiencing an opioid overdose is to call 911 immediately. An overdose usually takes several minutes to a few hours to be fatal, so getting medical attention from a trained professional quickly is critical.

You should tell the dispatcher exactly what you see. Note if the person is unresponsive, turning blue, not breathing, or any other symptoms that are occurring. Make sure you clearly give the address and then wait with the person until medical help arrives.

If the person overdosing stops or has weak breathing, it is best to start CPR as soon as possible. If not, you can put the person in what is known as the recovery position. You should lay them slightly on one side with their body being supported by a bent knee. Make sure their face is also turned. This will help keep the airways clear and prevent choking if vomiting occurs.

If available, it might be prudent to administer a drug known as Naloxone. This drug’s main purpose is to block the effects of opioids and combat opioid overdoses. It often works immediately, but can take up to eight minutes to be fully effective. While this might be an effective short-term solution, the person might re-overdose if a large quantity of the opioid was taken, as Naloxone only lasts for between 30 and 90 minutes. It is still extremely important to call for medical assistance even if this drug is available to you based on your doctor’s orders.

Opioid overdoses are dangerous and life threatening. How have you prepared to deal with an overdose of a loved one who uses opioids?

In March of this year, the Centers for Disease Control and Prevention released new pain management guidelines for health care providers relating to opioid use called the Guidelines for Prescribing Opioids for Chronic Pain. Specifically, these guidelines laid out suggestions on how physicians should curtail writing prescriptions for opioids. In the case of chronic pain patients, doctors are told to use opioid therapy prudently and continuously reevaluate if it is the correct course of action. It has been months since these new guidelines have been released and there has been a lot of lively discussions surrounding them. But what impacts are these new pain management guidelines having on the medical community and their patients?

Overview of the new CDC pain management guidelines

The new guidelines by the CDC have 12 recommendations for health care providers to follow concerning opioids. These boil down to the following goals:

• Use non-opioid therapies – The CDC suggests that doctors first use alternative treatments such as cognitive behavioral therapy or exercise before prescribing any kind of opioid. It also suggests that opioids are not used routinely for chronic pain patients and that they should be combined with other treatment options.
• Start low and go slow – If opioid therapy is used, doctors should use the lowest effective dose possible and avoid using extended release opioids. They should also limit the quantity prescribed to the minimum needed.
• Follow-up – Patients being treated with opioids should be monitored regularly and the risks versus rewards should be evaluated often. Patients not receiving meaningful benefits should be tapered off or removed entirely from opioid use.

Check out our article “New Opioid Guidelines – What You Need To Know” for a more in-depth review of each of these recommendations.

Response to these new pain management guidelines

The new pain management guidelines have certainly made big waves in the medical community and have sparked heated debate about their efficacy. Many people have weighed in on this topic from patients, nurses, and doctors with a mix of positive and negative comments about these new suggestions.

CDC director Thomas R. Frieden, M.D announced the new CDC pain management guidelines in an article describing the history and reasoning for more controls of opioids. He closes this article by saying:

“Management of chronic pain is an art and a science. The science of opioids for chronic pain is clear: for the vast majority of patients, the known, serious, and too-often-fatal risks far outweigh the unproven and transient benefits.”

Possible ramifications to new regulations

Numerous sources responded to these new pain management guidelines by highlighting all of the possible ramifications that will come about. A major point that has been raised by various sources believes that an increase in suicide rates is likely to occur. As patients lose access to pain medications, their quality of life might decrease so much that suicide might seem like the only option left.

One article from Pain Medicine New written by Lynn R. Webster, M.D., states:

“Pain News Network reports that dozens of patients have contacted the editor since March, when the guideline was made public, to say that their doctors have “fired” them on flimsy excuses, or that their doctors suddenly are weaning them off opioids or abruptly cutting them off from the medications. Worse is that some patients are so despondent and in so much pain that they have given up and looked to suicide as a way out.”

Others argue that the CDC has set dose recommendations that might be construed as hard limits to some doctors. These caps, set to 50mg per day in morphine and 90mg a day in rare occasions, could negatively impact patient care and quality of life. Bob Twillman, PhD, states in his article from The American Academy of Pain Management:

“The Academy commented extensively on these arbitrary threshold numbers, out of concern that they may prevent some people with pain from receiving adequate doses of opioids when those doses may be beneficial. While the numbers themselves are not especially draconian, the Academy’s concern has been that many primary care clinicians may interpret these thresholds as ceiling doses.”

Opinions of support

Some doctors have mixed feelings for the new pain management guidelines, but are supportive of the overall goal. The American Medical Association released a brief statement that questioned the scientific evidence supporting some of the new CDC guidelines and voiced concerns that there could be further consequences concerning paying for alternative treatments:

“While we are largely supportive of the guidelines, we remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care.

They go on to acknowledge that the opioid epidemic is a complex issues that will likely as time evolves stating:

“We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word.”

Not all clinicians feel that the new CDC regulations are in error and have thrown their full support behind the CDC. In a JAMA article, The CDC Guideline on Opioid Prescribing, Yngvild Olsen, M.D., states that:

“The CDC guideline for prescribing opioids for chronic pain is an important and essential step forward. With support from physicians across the country, as well as from policy makers at all levels, implementation of the recommendations in this guideline has the potential to improve and save many, many lives.”

Dr. Olsen does also mention that significant gaps in the health care system will have to be addressed before a large scale reduction of opioids will be safe to implement. This includes reimbursements for both chronic pain and addictions treatments alike.

How do you feel about the new CDC guidelines? Do you think it will help reduce opioid abuse or will it have more consequences than it is worth? Find our opioid therapy statement online.

There has been a lot of controversy over the last few years about the risks and benefits of opioid painkillers as well as how they are used in treating chronic pain. It is important to note, however, that this does not include certain patients such as those diagnosed with cancer or those who are undergoing end-of-life care. According to the Department of Health and Human Services, opioid abuse is a serious public health issue with drug overdose deaths being the leading cause of injury death in the United States. Opioid addiction statistics point to some chilling trends. It was reported that in 2012 over 259 million prescriptions for opioid pain medication were written, which is enough for every adult in the United States to have their own bottle. This is one reason why the CDC is concerned with an opioid epidemic in the U.S.

Opioid addiction statistics in the U.S.

Opioid pain medications are drugs that interact with the opioid receptors on nerve cells in the brain and nervous system. This class of drugs include pain meds such as hydrocodone, morphine, and fentanyl. This interaction generally produces a pleasurable effect that relieves pain as well as produces other side effects such as dizziness, nausea, vomiting, and constipation.

The American Society of Addiction Medicine released some facts and figures this year that shows a telling story of how opioids have affected the United States in the last two decades. Some of these stats include:

• Four out of five new heroin users started out misusing prescription painkillers. This led to heroin overdose deaths quadrupling from 2000 to 2013.
• Among women, the overdose death rate for prescription pain medication from 1999 to 2010 increased more than 400%. Between 2010 and 2013, female heroin overdoses tripled to 1.2 per 100,000 people.
• In one survey, 94% of people receiving treatment for opioid addiction said they chose heroin over prescription drugs because prescription drugs were far more expensive and harder to get.
• Adults are not the only ones affected by opioid addiction. In 2014, 467,000 adolescents were using painkillers for something other than medical reasons with 168,000 having an addiction. It was discovered that most adolescents who misused prescription opioids obtained them free from friends or relatives.

The Centers for Disease Control’s take on opioids for pain management

According to the CDC, since 1999, opioid prescription have quadrupled and over 165,000 people have died due to prescription opioids. In 2014 alone, 14,000 people died from overdoses involving prescription opioids.

Stats like these are why the CDC finalized new opioids guidelines for medical providers in March of 2016. The new guidelines were created to curtail the abundance of opioids being prescribed to patients, especially those that are given before other non-opioid treatments are tried. Here are some of the highlights:

• Doctors should try non-pharmacological treatment options before moving to painkillers. This is especially true for those who suffer from chronic pain.
• Before opioid therapy, physicians should establish treatments goals with realistic goals and a plan to discontinue opioid use.
• Doctors need to have an initial discussion as well as period check-ins about the realistic risks and rewards of opioid therapy. This should include the responsibilities of both the doctor and patient.
• To continue opioid therapy, there must be meaningful improvement or demonstration of efficacy of the treatment.
• Doses should be the lowest possible needed for patient relief and should be immediate-release opioids.
• Acute pain patients should only receive small quantity prescriptions that last for three days or less.
• Physicians need to carefully evaluate a patient’s potential for abuse, which includes looking at family history and prior dependency issues.

Opioids and chronic pain patients

Here at Pain Doctor, we feel it is important to reaffirm the fact that most chronic pain patients are not taking opioids to manage their condition. In fact, opioids are not a preferred method of treatment and we mostly use non-pharmacological therapy to help our patients find relief. If opioids are necessary, we use a 12-step compliance checklist to assure the safety and continued improvement of our patients.

Today, approximately 5% of chronic pain suffers use opioids for pain. However, the number of people using them for chronic pain management have decreased significantly since 2010. This can mostly be attributed to new research findings and stricter government controls on prescription opioids. Also keep in mind that opioids users are closely monitored by physicians and only use pain medication as part of an overall treatment plan rather than as a quick fix.

Given new research and controls, the medical community is looking for alternative treatment options to help manage chronic pain. This is partly due to the fact that research has shown that opioid use is less effective for managing chronic pain in the long term as well as the risk of addiction and abuse is cause for concern.

Finding help for opioid addiction

If you or a loved one is suffering from an opioid addiction, there are many programs available to provide help. The Substance Abuse and Mental Health Services Administration (SAMHSA) along with the American Society of Addiction Medicine (ASAM) provide numerous resources that can assist you in finding local treatment options.

Many of these resources are open 24/7 and can provide information about addiction as well as possible treatment options near you. They can also provide support to people who are trying to help their loved ones through an opioid addiction. Some of these include:

• National Suicide Prevention Lifeline
• National Helpline
• Substance Abuse Treatment Facility Locator
• Addiction Guide
• Addiction Center
• The Support Group Project

What are your thoughts on current opioid addiction statistics?

Pain is almost never a good sign and it affects more people in the U.S. than diabetes, heart disease, and cancer combined. The main treatment for pain comes from prescription pain medications most of which are known as opioids. These meds are extremely valuable when fighting chronic pain, but can lead to some serious side effects if misused, such as organ damage and addiction. Since prescription pain medication is becoming more widely used, more and more research is being undertaken to find out the good and the bad. Here are some major research studies that have come out in 2016 that dive into prescription pain medications.

New prescription pain medication research

1. How drug screenings affect pain patients

Opioid drugs are associated with some negative medical ramifications. Over the last decade, opioid-related deaths have been on the rise in the United States. In a move to find ways to curtail these preventable deaths, researchers from the University of Houston conducted a study on the effect of urine drug screening tests on opioid users.

The team analyzed 4,448 clinic visits by 723 pain patients. It was shown that when a patient is required to perform a drug screening on their first visit to a new clinic, they are much more likely not to show up for a second visit. No show rates for patients average about 10%, but the number more than doubled to 24% when a drug screening process was implemented. The no show rate for those who tested positive for illicit substances was even higher, clocking in around 34.5%.

2. Drug monitoring shown to reduce opioid deaths

The amount of prescription pain medication being given to patients has dramatically risen over the last two decades. In another attempt to curtail abuse and deaths, 49 states (all except Missouri) implemented some level of prescription drug monitoring program. A study led by the Vanderbilt University Medical Center set out to determine if these programs were effective or a waste of time.

The study revealed that the average state program reduced opioid related overdose deaths by 1.12 per 100,000 people. The more robust state programs that monitored four or more drug schedules were closer to 1.55 for 100,000 people. Researchers believe if all 50 states had these new robust programs, the monitoring system could prevent two opioid related deaths a day. As lead author Stephen W. Patrick M.D. states:

“Today, opioid overdose deaths are more common than deaths from car crashes. Our study provides support that prescription drug monitoring programs are part of what needs to be a comprehensive approach to the prescription opioid epidemic.”

3. State laws don’t always protect vulnerable populations

Across all 50 states, 81 new laws have been enacted between 2006 and 2012 to curtail prescribing and dispensing opioids to pain patients. The Dartmouth Institute for Health Policy & Clinical Practice reviewed these laws and compared them to changes in data among one of the most vulnerable and at-risk populations of opioid overdose or abuse: disabled Medicare beneficiaries.

The study revealed that these laws had no significant effect on the 2.2 million disabled Medicare beneficiaries, from the ages between 21 and 64. This is quite shocking considering this vulnerable population had ten times the average U.S. death rate from opioid overdose in 2008. According to Ellen Meara, PhD, the leading author:

“Opioid abuse is a growing threat to public health; prescription drug monitoring programs (PDMPs) and other laws are costly. Our findings indicate they don’t do much to curb opioid abuse or overdose, at least in this vulnerable population. States might invest more resources in evaluating the effectiveness of legislation.”

4. Parents often keep unused prescription opioid drugs at home

C.S. Mott Children’s Hospital National Poll on Children’s Health was administered to parents with children from ages five to 17 in January 2016. The poll was aimed at obtaining a deeper understanding of the experience parents have when giving pain medication to their children after events such as surgery, illness, and injury.

The poll discovered that children are frequently given more medication than is necessary and that many parents keep these opioids at home, which can lead to drug misuse among children. The poll showed that of the half of parents who had left over medication, only 8% returned it to a doctor or pharmacy. 47% kept the pills at home, 30% disposed of them via the trash or toilet, 6% used it for other family members, and 9% couldn’t recall what they did with it.

It was also reported that only 33% of providers discussed what the parents should do with the extra medication. This is significant because parents who did not receive instructions were twice as likely to keep these pills at home.

5. Nonmedical prescription opioid use almost doubled in last decade

The National Institute on Alcohol Abuse and Alcoholism conducted a study on nonmedical prescription opioid use (NMPOU) and its related disorder (NMPOUD). The symptoms for these include taking larger amounts than intended, taking drugs for longer time periods than needed, failure in other areas of life due to drug abuse, and increased tolerance or withdrawal symptoms.

It was found that NMPOU has increased by 161% between 2001 and 2013 while nonmedical prescription opioid use disorder has increased by 125%. The study also revealed that those suffering from these conditions are rarely treated: 5% of people misusing these drugs were treated in the last year and only 17% of those with NMPOUD are ever helped. According to Nora D. Volkow, M.D director of the National Institute on Drug Abuse:

“The increasing misuse of prescription opioid pain relievers poses a myriad of serious public health consequences. These include increases in opioid use disorders and related fatalities from overdoses, as well as the rising incidence of newborns who experience neonatal abstinence syndrome. In some instances, prescription opioid misuse can progress to intravenous heroin use with consequent increases in risk for HIV, hepatitis C and other infections among individuals sharing needles.”

Prescription pain medication research is extremely important. What do you think would be the next best research study to conduct?

As you may know, last year the Centers for Disease Control (CDC) published a draft of some very controversial new opioid prescribing guidelines for those with chronic pain. These guidelines were meant to reduce the number of people in the U.S. who are taking opioids, as dependency, overdose, and abuse were on the rise. While the overall tone was to help people in the U.S., there was a lot of fear and worry surrounding these guidelines as they could make prescriptions much more difficult to obtain for those with a legitimate need.

New CDC opioid guidelines – 12 recommendations for prescribing opioids for chronic pain

On March 15, 2016, the CDC posted a largely unchanged final publication of these guidelines after listening to partner organizations and public feedback. Let’s take a look at some of the key points and the overall message of these final and new CDC opioid guidelines.

In an accompanying press release to the new CDC opioid guidelines, CDC Director Tom Frieden, M.D. stated that:

“More than 40 Americans die each day from prescription opioid overdoses, we must act now. Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”

So what kind of information do these new guidelines provide for chronic pain patients?

The CDC has defined chronic pain as pain that typically lasts more than three months or past the time of normal tissue healing. Using this definition, the CDC published a list of 12 recommendations they believe will help guide medical practitioners in the future when prescribing painkillers to chronic pain patients.

There are three main principals that resonant through the new guidelines:

1. Non-opioid therapy is always preferred for chronic pain patients with an exception that includes active cancer, palliative, and end-of-life care.
2. If opioids are deemed necessary after other methods, the lowest effective possible dosage should be prescribed to reduce risks, such as addiction and overdose.
3. Providers should be cautious about prescribing opioids and always monitor patients closely for any signs of trouble.

Other recommendations include discussing the risks and benefits of opioid therapy with patients, conducting a drug test to assess prescribed medications, and reviewing patient’s history of controlled substances using state prescription drug monitoring programs.

All of this boils down to one thing: the CDC does not believe that opioids should be more regulated, considering the high risk of misuse, abuse, and addiction.

This fact is emphasized by the lack of evidence that supports the efficacy of long-term opioid treatments for chronic pain, as most research is focused on short-term benefits. The CDC believes the current painkiller epidemic is primarily fueled by physicians treating chronic pain with painkillers, without focusing on other alternative treatment options first. The purpose of these new guidelines is to assist doctors in helping their patients. In the words of Debra Houry, MD, and director of the CDC’s National Center for Injury Prevention and Control:

“This guideline will help equip them [doctors] with the knowledge and guidance needed to talk with their patients about how to manage pain in the safest, most effective manner.”

What kind of research backs up these guidelines?

These guidelines were created with input from numerous different sources, such as primary care professional societies, subject matter experts, and state agencies. The CDC also reviewed scientific literature and existing evidence-based guidelines to finely hone and establish a new general practice of opioid prescriptions.

Data from 2012 indicates that health care providers wrote prescriptions for 259 million patients in the form of opioid pain medications, which is “enough for every adult in the United States to have a bottle of pills.” This is a startling statistic as some opioids can be as addictive as heroin, which is why research has shown that some patients turn to heroin after they have run out of their prescriptions.

Between 1999 and 2014, more than 165,000 people in the U.S. died of overdosing on opioids and the Drug Abuse Warning Network estimated over 420,000 emergency departments visits related to abuse of these narcotics. This is on top of a recent study that shows that having a history of taking an opioid pain medication greatly increases the risk for developing a dependency on these drugs.

How does it affect chronic pain patients?

These guidelines are just that: non-binding suggestions that physicians should keep in mind when prescribing opioids to patients.

While these recommendations do not have the force of law behind them, it is quite possible that some states will construct laws out of these suggestions. Furthermore, some medical practitioners will pay deference to the CDC and will change their own practices to fall more closely in line with the CDC’s suggestions.

This could have potential ramifications for those who need opioids to effectively manage their pain condition and, in that way, create new barriers to relief. This could include doctors being more reluctant of prescribing opioids. It could also mean that new patients will have to go through multiple other non-opioid treatments before an opiate option is considered.

However, not everyone believes these guidelines will make a difference. According to Dr. Una McCann, professor of psychiatry at Johns Hopkins Medicine:

“Unfortunately, I’m not sure that the people who are prescribing these medications long-term are going to heed the pretty practical advice that’s provided by the Centers for Disease Control and Prevention.”

What do you think? Are these new guidelines too restrictive or are the new CDC opioid guidelines on the right track? Will you or someone you know be affected by these new recommendations?

By Ted Swing, Ph.D

Medications are one of the most common treatments for pain. Their effectiveness for immediate pain is well-established and they can be effective for treating chronic pain as well. One of the most widely used types of pain medications are opioids, such as morphine or oxycodone. Studies have found that these medications can be effective in treating chronic pain, with an average pain relief of about 30%. Their side effects and risks require close medical supervision to use these medications safely. In addition to the more widely recognized dangers such as increased risk of accidents, addiction and even death, these medications can have a less widely recognized side effect: opioid induced hyperalgesia.

Opioid induced hyperalgesia

The primary effect of opioids is to stimulate specific brain receptors that alleviate pain. This is why these medications have long been used for treating pain. However, doctors and researchers have found that, in some cases, opioids actually have the opposite effect — that is, taking opioids increases the pain that a person feels. Sensations, such as being stuck by a needle, that normally cause mild pain may instead cause extreme pain. The patient may begin to experience new pain or sensitivity in different parts of the body. In some cases the severity of their previous chronic pain conditions also increases. This phenomenon, where taking opioids causes increased sensitivity to pain, is known as opioid induced hyperalgesia (OIH). OIH is well demonstrated in animal studies. Numerous studies have found that mice and rats experience greater sensitivity to pain for several hours after the effects of an opioid have worn off. Some studies in humans also find that higher doses of opioids during a surgery are associated with greater post-operative pain after those opioids have worn off.

It also appears that OIH can occur while a person is still taking opioids. Though the incidence of OIH is unknown, many doctors believe it is more common than was previously realized. OIH may be especially likely for those taking high doses taken for a long time. One study followed 23 patients experiencing severe pain (8/10 on average) despite taking very high doses of opioids. These patients were weaned off their opioids over the course of weeks. The researchers found that these patients’ pain decreased to an average of about 3/10 after stopping their opioids, with 21 of the 23 patients experiencing reduced pain.

Why does opioid induced hyperalgesia occur?

Opioid induced hyperalgesia occurs as a result of changes in the brain and spinal nerves as the body adapts to the effects of opioids. Several neural systems that normally regulate the perception of pain may become overactive in response to the pain relieving effects of opioids, which block normal pain perception. The overactivity of these neural systems can block out or even exceed the pain relieving effect of the drug. This increased pain can last as long as the opioid dose is maintained.

What can be done for opioid induced hyperalgesia?

Only your provider can determine if you have opioid induced hyperalgesia, as several other conditions may have similar symptoms. In many cases when a patient is experiencing OIH, reducing or even eliminating opioids can produce a substantial reduction in pain. In other cases, switching to a different opioid may be effective in reversing OIH and restoring pain relief.

When used responsibly under proper supervision, opioids can be an effective treatment for many types of chronic pain. It is critical to take opioids and other medications as directed by their prescriber. However, in addition to the well known risks, patients and health care providers must be alert to the possibility of opioid induced hyperalgesia. If a low or moderate dose of opioid therapy is producing partial relief of pain, this may represent the full potential benefit of the opioid therapy. Increasing the dose to a high level may not only fail to increase pain relief but in some cases can actually lead to more pain.

Ted Swing has more than 11 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

Increasing opioid prescription rates have escalated the number of people abusing the drug. And while the majority people taking the pills don’t abuse them, the epidemic and its implications are shaping the national drug abuse conversation.

Frighteningly, some measures intended to curb the disturbing trend have only turned the most vulnerable opioid abusers onto heroin.

Painkiller prescriptions jumped by 173% from 1991 to 2013, federal officials say.

The number of opioid prescriptions reached 207 million in 2013, up from 76 million in 1991, according to the National Institute on Drug Abuse (NIDA). About two million people in the U.S. live with an opioid addiction. Meanwhile, despite burgeoning efforts to save lives, the number of people dying from overdose has more than quadrupled since 1999.

As a result of these changing times, more U.S. adults now express greater concern over opioid abuse than over heroin use, according to a survey from Harvard School of Public Health. The poll found that 51% of those surveyed worried that opioids posed a threat to their communities while only 45% said the same of heroin.

Nearly 80% of those surveyed said the problem had stayed the same or grown worse over the past five years. Harvard professor Robert J. Blendon tells ScienceDaily:

“For much of the public, the issue of prescription painkiller abuse is not just a remote concern; it’s a problem they see in their personal lives.”

That’s because nearly 40% of those polled said they knew someone personally who has recently abused prescription pills. Some people blame rising opioid prescription rates for the problem, with excess supply often moving into the hands of drug abusers who never needed the pills for a medical purpose. Others blame the ease of buying the pills illegally.

Opioid abuse and heroin use are closely linked, worrying policymakers and concerned citizens.

Part of the problem with opioid abuse is not the high risks of the pills themselves, but their tendency to lead those who become addicted to harder drugs like heroin. In fact, many people now use the drugs simultaneously, according to research from the Washington University School of Medicine.

Although the drugs are linked, many people who become addicted to opioids convince themselves their situation is less dire than it is. Researcher Theodore J. Cicero tells ScienceDaily:

“People used to tell us quite often, ‘At least I’m not using heroin,’ when we asked about their drug abuse…But in many years, many have come to ignore that aversion because heroin is cheaper and accessible and because they’ve seen friends and neighbors use heroin.”

In fact, heroin use is on the rise, as is pain pill abuse, fueled in part by rising opioid prescription rates, researchers say. White men face the highest risk of abusing both drugs in combination, according to research from Penn State.

Penn State researcher Shannon Monnat attributes the rise to a “domino effect of addiction” that started in the 1980s and 90s when rising opioid prescription rates caused more people to become addicted, reports ScienceDaily.

And Monnat says the measures to prevent people from abusing the medications, such as making the pills difficult to crush, along with various prescription monitoring programs, haven’t slowed the rates of addiction. Instead, people turned to heroin, which is cheaper and easier to buy.

Efforts to make opioids more difficult to access and abuse have not lessened addiction rates, but turned people to heroin, experts say.

This problematic trend is not very common, but Monnat says the number of people addicted to both opioids and heroin or heroin only is increasing faster than the people who are addicted to painkillers only. She adds:

“You don’t eliminate the addiction simply by eliminating access to the drug…People who are addicted to the morphine substance will find a substitute.”

To stem this worrisome development, Brandeis University scholars recommend lowering the overall opioid prescription rates while increasing access for medical help overcoming addiction. Their research showed that recreational use of opioids was not the problem. Instead, an increasing number of people receiving the pills for medical use are succumbing to addiction, resulting in skyrocketing overdose rates.

Since 1997, the number of people in the U.S. who have entered treatment for painkiller addiction has soared by 900%, researchers say.

Those taking the pills for chronic pain have an especially high risk for addiction, the researchers said, because of the long-lasting nature of their health condition. Opioid painkiller manufacturers have encouraged this trend, even though medical research casts doubt on its efficacy. Study author Dr. Andrew Kolodny tells ScienceDaily:

“We need to prevent new cases of opioid addiction and we need to expand access to treatment for the millions of Americans who are already addicted…Without better access to addiction treatment, overdose deaths will remain high and heroin will keep flooding in.”

Prescription drug monitoring programs offer hope in the effort to prevent opioid overdose deaths.

States are largely responsible for implementing their own programs to combat this rising problem, and they’re looking to each other to see which ones work. In Florida, a prescription drug monitoring program resulted in a 25% drop in deaths related to oxycodone.

The success was likely due to the increased ability of health care providers to search a database and monitor patients’ access to prescriptions, according to researchers at the University of Florida. Study author Chris Delcher tells ScienceDaily:

“Forty-nine states have prescription drug monitoring programs of some kind, but this is the first study to demonstrate that one of these programs significantly reduced oxycodone-related deaths.”

Oxycodone is one of the most commonly abused painkillers, and exponentially rising rates had Florida officials worried. From 2007 to 2010, the rate of related deaths leapt by 118%. Starting in 2010, the number started to decline after implementing tamper-resistant pills, heightened law enforcement efforts, and the shut down of medical clinics that existed essentially to peddle opioids.

Despite all these efforts, the Florida researchers attribute about 25% of that decline to their prescription monitoring program that acts as a centralized database to track who is taking which pills, making it easy for health care providers to oversee their patients.

Do you think changing opioid prescription rates would affect the number of people dying from overdose or becoming addicted to heroin?