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How to Safely Use Opioids to Manage Pain

In the United States, nearly 50 million adults suffer from chronic pain — a life-altering condition marked by inflammation, fatigue, depression and reduced flexibility. One of the most common forms of treatment, opioids, can be highly addictive and are often misused. To reduce the chance of long-term abuse, there are preventive measures every person must take.

Factors to Consider

A doctor is an excellent resource for setting pain management goals and assessing medications. It’s important to have an open dialogue about the necessity and potential side effects of using an opioid. There are multiple factors both parties should consider:

  • Dosage: A higher dosage doesn’t guarantee long-term pain reduction. In fact, taking more than 50 morphine milligram equivalents (MME) per day, doubles the risk of a potential overdose. Ingesting more than the suggested amount may also lead to expensive and avoidable health complications as well as death.
  • Drug Interactions: Mixing opioids with other drugs or alcohol can cause nausea, drowsiness, fainting, respiratory depression or toxicity, which may lead to a coma. The U.S. Food and Drug Administration recommends that doctors refrain from prescribing opioids to patients who already use substances that suppress the central nervous system.
  • Patient’s History: Prior to prescribing any drug, a doctor should have a clear understanding of the patient’s medical and family history. Mental illness, including substance and alcohol abuse, can significantly increase one’s risk of developing an addiction. Patients should also divulge previous conditions that may impact their ability to safely maintain an opioid regimen.
  • Purpose of Opioids: Talk to your doctor about why an opioid is being prescribed. What type will be used? What are the possible side effects? Due to their habit-forming nature, closely follow instructions regarding dosage and long or short-term usage.
  • Second Opinion: After receiving an opioid treatment plan, don’t be afraid to ask for a second opinion. Another doctor may suggest an alternative that has lower risks but produces similar results.

Commonly Prescribed Opioids

Before starting an opioid program, it’s imperative to discuss the different types and dangers associated with each. Frequently prescribed opioids include:

  • Codeine – A narcotic that alleviates modern to severe pain, that can also depress breathing and increase drowsiness. When combined with other medications, codeine is a viable cough suppressant and is often ingested as capsules, tablets or liquid.
  • Fentanyl – A synthetic opioid used to treat pain due to a medical procedure (i.e. surgery) or ongoing illness like cancer. Fentanyl is 50 to 100 times stronger than morphine and can be prescribed as a shot, patch or lozenge.
  • Hydrocodone – A semisynthetic opioid used to treat severe, around-the-clock pain. It’s not recommended for those seeking relief on an as-needed basis. A popular form of hydrocodone is the drug Vicodin, which also contains acetaminophen.
  • Morphine – An opioid used to treat acute or chronic pain. When abused, morphine can lead to life-threatening conditions such as kidney failure, low blood pressure and respiratory issues. It may be prescribed in a liquid, tablet or capsule form.
  • Oxycodone – A drug often combined with aspirin, acetaminophen or ibuprofen to treat moderate to severe pain. Individuals who misuse oxycodone may experience headaches, nausea, seizures or heart failure. Notable variations of the drug include Percocet, OxyContin, Roxicet and Percodan.

Opioid Alternatives

The approach to chronic pain is predicated on history and type. Therefore, non-opioid treatments, including therapy, are also available. Common alternatives are:

  • Acetaminophen
  • Anticonvulsants
  • Antidepressants
  • Counseling/psychiatric assistance
  • Implantable nerve stimulators
  • Local anesthetic nerve blocks
  • NSAIDS (nonsteroidal anti-inflammatory drugs)
  • Physical therapy
  • Surgery
  • TENS (Transcutaneous electrical nerve stimulators)
  • Topical medications

If a patient does not want to be prescribed opioids of any kind, they can fill out a Nonopioid Directive form.

About the author: Dr. William Beecroft M.D., D.L.F.A.P.A. is a medical director of behavioral health at Blue Cross Blue Shield of Michigan.

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Photo credit: Charles Wollertz

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