Our PAINDEMIC (Pain-epidemic)
With over 100 million Americans with chronic pain per the Institute of Medicine, it is no wonder we have a PAINDEMIC® on our hands! (1) Despite the barrage of technological advances, drugs, injections , and surgeries, more people continue to suffer with pain than those with diabetes, heart disease, and cancer combined. And as more strong painkillers are being used to suppress the painful symptoms, there has been a directly proportional rise in unintentional drug overdoses. (Graph 1) Many of these strong painkillers are called opioids, which are medications such as morphine, oxycodone, and hydrocodone. Unfortunately, these medications have the potential to cause significant respiratory depression and hence, death. The reality is that these medications cannot be received without a prescription; yet, there are over 250 million opioids still being prescribed every year in the United States with almost 50 people dying every day as a consequence. (2)
The Opioid Slippery Slope
It is a slippery slope for physicians to dish out a quick prescription for opioids especially when there is no strong evidence that they are effective for chronic, non-cancer pain. In addition, it is extraordinarily difficult to decipher who will become addicted, as most patients will be dependent on the medications (in other words, the body becomes accustomed to having the medications). Whether addicted or just dependent, it can make it extraordinarily difficult to quit when experiencing undesirable withdrawal, which can include extreme anxiety. Since physicians are still prescribing the medications and/or the patients are still insisting on the opioids, the snowball will continue to roll down hill. For this reason, the Drug Enforcement Administration (DEA) enforced a change in October 2014 as to how hydrocodone is prescribed—no more simple telephone calls. Nope, prescriptions must be handwritten and taken in person to the pharmacy.
GRAPH 1. Source: CDC (Cent. Dis. Control Prev.). 2011. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR 60:1487–92. OPR= opioid pain reliever.
Opioids—A Gateway to Heroin
As the difficulty in obtaining hydrocodone prescriptions may rise, so does the difficulty in affording prescribed medications with this country's inflated medical costs. Thus, it is no surprise that heroin (similar to other opioids) is on the rise as well. (Graph 2) It is cheaper on the black market and no prescription is needed. Interestingly, a national survey revealed that 4 out of 5 heroin users had used painkillers such as opioids before using heroin. (3) Although this could be due to several reasons; it should make physicians hesitate to write another prescription too quickly to a patient who may be vulnerable to its addictive or undeniably dangerous potential.
Treat the Cause of Pain, not just the Symptoms
And for anyone in pain, you must demand more conservative options before accepting or insisting on strong painkillers, such as opioids. To avoid being a statistic in this country's PAINDEMIC®, focus on potential contributors or causes versus masking the symptoms of pain. Your life just may count on it!
1. IOM (Institute of Medicine). 2011. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press.
2. CDC (Centers for Disease Control and Prevention). Vital Signs: Opioid Painkiller Prescribing. July 2014. http://www.cdc.gov/vitalsigns/opioid-prescribing/
3. Muhuri PK, Gfroerer JC, Davies MC. 2013. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Rev. Aug.: http://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm
4. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2001-2011. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-65, HHS Publication No. (SMA) 13-4772. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
5. Kolodny A et al. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Annu. Rev. Public Health. 2015. 36:559-74.