The headlines are everywhere. “The Killer Among Us.” “Inside a Killer Drug Epidemic.” “The Opioid Menace!”
Go behind the dramatic headlines and you will find that America does have a major problem with opiods. Opioids are a class of drugs related chemically to opium and include medications such as Hydrocodone (Vicodin), Oxycodone (OxyContin), Methadone and Fentanyl.
They are used for acute pain, such as that experienced after a traumatic injury or surgery but also used for chronic pain, which has lasted more than three months.
The use of opioids is wide-spread. Perhaps this is because as many as 1 in 5 American’s suffer from chronic pain. But still, the numbers are staggering.
In 2015, 26.2 percent, more than 1 in 4, of all Oregonians filled a prescription for a legally prescribed opioid drug. Since that time, the number of people receiving prescriptions has gone down to 20.8 percent, 1 in 5.
Wallowa County’s use is slightly below average, with 19.3 percent of the population filling opioid prescriptions in 2017. The rate in neighboring Union County was at 27.4 percent.
However the use of these pain medications has not been without cost. Opioid-involved deaths continue to increase in the United States.
Since 1999, the number of overdose deaths involving opioids has quadrupled. Currently 91 Americans die every day from an opioid overdose, according to the Centers for Disease Control. There are a number of other significant risks related to the use of opioids.
Patients taking prescription opioids can become addicted. Up to 1 out of 4 people receiving long-term opioid therapy in a primary care setting struggle with addiction, according to the Substance Abuse and Mental Health Services Administration. Other side effects include withdrawal when the medication is stopped, constipation, nausea, vomiting, dry mouth, sleepiness and dizziness, confusion and depression.
One of the biggest problems is increased sensitivity to pain when opioids are used for chronic pain. Chronic pain is not just about the body, it is also about the brain and the nervous system.
This is why opiates do not always work for treatment of chronic pain. If a person has pain that is due to a problem in the nervous system itself, such as the system having become hypersensitive, and we use opioids to block a pain signal down at the point of the original injury, it does not work.
Ultimately the pain signals increase, trying to get through the block, while at the same time the brain, due to the opiates, stops producing its natural pain killing chemicals. Thus there is more pain and less capacity to handle the pain, leading to an ever-growing need for opioids.
What is the answer? Treating the crisis involves a number of responses, the first involving prescribers themselves, who are now following new prescribing guidelines developed by the Centers for Disease Control.
The guidelines have 12 specific recommendations, the first being “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.” Other strategies include better education about opioids, increased monitoring of opioid use for those who have prescriptions, pain management contracts and an initial assessment of risk for addiction.
But one of the main strategies is the development of pain management programs such as the Center for Optimal Living, a program of Wallowa Valley Center for Wellness. Such programs work with primary care doctors to support and enhance the medical management of the pain.
They provide additional tools that aid in pain management. Some are psychological, such as mindfulness, while others involve physical conditioning, using tools such as yoga. In addition they offer patient education about such critical topics as nutrition. There are things all people can do. If you have chronic pain talk to your doctor about all your options. Participate in a pain management program.
When you are ready to stop using opioids, make sure you get rid of unused medicine properly, as these medicines are often sold illegally on the street.
Be aware of the signs of addiction in yourself and in those you love. Encourage friends you think may be addicted to talk to a doctor and seek help.
Kliewer is a licensed professional counselor and is head of the Center for Optimal Living in Enterprise.