Just a few day ago, sitting across from one of my therapy patients, a former opioid addict now 10 years in to recovery, I was reminded, in the midst of all of the bad news about the opioid overdose epidemic, that if the same level of determination that fuels an addict’s pathological pursuit of opioids can easily be channeled in to recovering from the devastating impact of addiction, a life can easily be transformed – and even the sickest of addicts can easily be restored to health. This patient, that experienced a severe sports-related back injury in his early 20s and underwent two surgeries to repair the damage, was handed handfuls of prescriptions for opioids to hunt his seemingly unending pain after surgery. He tried them all – Vicodin, Norco, Fentanyl and Darvocet – and when they failed, he began supplementing them along with Oxycontin he bought on the street. After mixing opioids along with downers, he overdosed, Simply two days prior to his scheduled qualifying exams for graduate school.
Having survived the overdose, along with recovery or death as his remaining choices, he seized control over his life, seeking out treatment along with a medicine known as suboxone for his opioid addiction. Various other healthy and balanced behaviors and choices followed, including a couple stints in inpatient rehab, treatment by a psychiatrist, involvement in self-assistance groups and outpatient therapy. Recovery has actually not been easy, and he continues to job at it, however the payoff has actually been well worth the struggle. Now, a decade later, along with a doctoral degree, a stable job, a wife he loves and plans to start a family, no one would certainly ever guess that he is a former painkiller addict.
In the addiction community, several would certainly say that he “hit rock bottom” prior to he was able to change. however we know so even more now about the risks of opioid treatments for pain and the potential for fatal overdose. Waiting for a loved one to hit bottom, we risk missing a opportunity to save a life. As knowledgeable consumers of medicine in the Digital Era, we have actually the power to make safer and more informed choices about pain treatment, and we can easily recognize the signs of a strategy of pain management that is headed towards addiction and destructive consequences in a loved one.
Addiction Medicine: a Tough Pill to Swallow, for Some
The staggering statistics are all over the media. Drug overdoses are claiming more lives than auto accidents, along with opioids as the main driver of the climbing death toll. The Centers for Disease Control and Prevention estimate that 78 individuals die every day from an opioid overdose, an unprecedented toll in the history of the health impact of drug abuse. along with proper treatment, however, several recover from opioid addiction. along with as much public awareness that has actually produced about the potential for opioid addiction and overdose, the rates of treatment initiation and recovery must increase dramatically, if this short article is put to use by consumers of medical care.
Research studies have actually found medication-assisted treatments for opioid addiction, such as suboxone and methadone, to be highly effective in helping individuals recover from addiction and preventing overdose deaths. There are several reasons these medication-assisted treatments are underutilized, including limited availability of the medicines and trained prescribers. Perhaps just as problematic is the skepticism that patients and health care providers have actually about the use of these medicines in treating addiction. Concerns about replacing one addiction along with one more are all too common, and usually stem from misunderstandings about how these medicines work.
Medicines like suboxone and methadone eliminate the vicious cycle of using increasing doses of opioids and then going in to withdrawal when they wear off, a cycle that fuels escalating use of opioids to defeat the terrible discomfort in withdrawal. The desperation to stay clear of withdrawal can easily then contribute to excessive use, overdose and even criminal activities in the pursuit of more of the drug. Medicines that are used to treat opioid addiction stop the cycle of highs and withdrawals by providing a constant dose of a replacement drug that acts on the same area of the brain. This restores the stability of the addict’s brain chemistry, relieves cravings and helps the person become functional again, and to be productive and have actually meaningful relationships.
If Your Doctor Prescribes Opioids, Ask Why
While once considered a secondary concern in medicine, the tip that pain could be believed of as a “fifth vital sign” to stay clear of undertreating it emerged over a decade ago, prior to the surge in painkiller prescriptions. Curbing inappropriate and excessive use of opioid treatment while avoiding jeopardizing opioid therapy for people that clearly need it is a balancing act that will certainly keep on to challenge physicians.
As scientific data concerning chronic pain treatment has actually accumulated, the benefits of opioids when prescribed for pain that extends beyond three months have actually been called in to question. What’s more, the repeated use of opioids has actually been found to worsen pain in a sizable group of patients, a condition known as “hyperalgesia.” This can easily develop a vicious cycle in which the pain sufferer takes larger doses of opioids to try and eliminate a pain condition that was itself worsened by opioids in the initial place. As the pain steadily intensifies in response to escalating doses of opioids, the risk of addiction and overdose worsens.
More critically, because opioids likewise affect the respiratory centers in the brain, which regulate breathing, at too high a dose, or when combined along with Various other sedatives, respiratory depression and death can easily occur. This is now the too-often heard story of a fatal overdose.
New guidelines for opioid prescribers that are treating chronic pain, released in March by the Centers for Disease Control, recommend consideration of alternative treatments to opioids very than starting along with opioids as a “go-to” pain management strategy. As these guidelines are being implemented, we are not powerless versus the devastating disease of opioid addiction. If a doctor prescribes opioids for your pain management, ensure you ask questions about the risks – and alternative treatments.
If you have actually a history of addiction, even if unrelated to controlled substances, or if you suffer from a mental health condition like depression, you are more vulnerable to becoming addicted to opioids. Adolescents likewise have actually an increased risk. however even those that are not at especially high risk can easily produce an opioid addiction; no one is immune. As an informed patient, you can easily ask your doctor to try non-opioid pain treatment strategies initial and see how they job prior to considering a strategy of care that could include opioid medications.
As the fight versus opioid addiction continues in this nation, spreading awareness of an opioid antidote that is now available for reversing an overdose is critical. The treatment is easy to use, available as an injection in to the muscle or a spray in to the nose that can easily and ought to be carried by people that are taking opioids and by their family members. It’s called naloxone, and while a victim of an overdose most likely won’t have the ability to administer it, a bystander can, quickly restoring the victim’s ability to breathe within 2 to 5 minutes.
Recovery from both chronic pain and addiction can easily be achieved through a combination of behavioral therapies and effective medicines. Studies support the use of non-medicinal approaches including psychotherapy, exercise, biofeedback and complementary medicine such as yoga, meditation and acupuncture, to treat certain types of pain. In addition, non-opioid medications may likewise be useful and can easily include nonsteroidal anti-inflammatory drugs, anticonvulsants and certain antidepressants.
Addictive behavior can easily be recognized as a progressive loss of control over drug use, and can easily be reflected in behaviors such as “doctor shopping,” or seeking multiple prescriptions for opioids from different doctors, difficulty functioning in important life areas such as at job or in important relationships, and escalating use of opioids despite the devastating impacts, both physical and psychological. If you or a person you are close to is suffering from these signs and symptoms, seeking a prompt evaluation by an addiction treatment professional is a good place to start.
Addiction is not a simple problem along with a simple solution. My colleagues and I at UCLA Integrated Substance Abuse Programs are conducting ongoing research to much better understand and treat this devastating illness. several have actually tragically lost the fight, yet I have actually worked along with and heard powerful stories from those that not only survived, however have actually produced rewarding and meaningful lives in the aftermath of their battle along with this disease. It is true: Physicians have actually an essential role in ending the opioid overdose epidemic, by shifting their prescribing practices to stay clear of unnecessary and excessive use of opioids in pain management. just as true, however, is the fact that we can easily be empowered by all that we have actually learned about pain control, opioid abuse and addiction, and have actually the courage to face the pain along with alternative and safe methods of treatment, or recognize when a loved one needs help. There is assistance available, and it works.
Suzette Glasner-Edwards, Ph.D., is an associate professor at UCLA Department of Psychiatry and author of “The Addiction Recovery Skills Workbook.”