Prescription opioid abuse is one of the fastest-growing problems in the United States, even surpassing heroin addiction in recent years. Because of this, opioid abuse has garnered a lot of attention. Experts have now developed strategies to help patients using prescription opioids avoid addiction, methods to help addicted people get off prescription opioids, and opioid-free alternatives for pain management.
Physicians are beginning to put strategies in place to reduce the risk of prescription opioid abuse, tolerance, dependence, and addiction.
For example, Pain Doctor’s parent company, Pain Doctor, has a 12-Step Compliance Checklist for Long-Term Opioid Therapy. This checklist includes checking the patient history and family history, both of which can indicate whether an individual is at a higher risk of opioid abuse or addiction. The checklist also includes referral for additional evaluation when needed (such as psychological evaluation for depression) and regular urine drug screening. Also, the physician and patient work together to document pain levels, how well the patient responded to opioid therapy, risks and benefits, and pain-management goals.
The World Health Organization (WHO) has also developed a way to curb prescription opioid abuse. The WHO Pain Relief Ladder, which has also been adopted by the Department of Veteran Affairs (VA), provides established steps to take before prescribing strong opioid painkillers to cancer patients in pain. The first step is the administration of non-opioid painkillers, like aspirin. If the pain persists, mild opioids, such as codeine, should be prescribed. The third and last step is the prescription or administration of stronger opioids, such as morphine.
WHO also suggests administering pain medications “by the clock” rather than “on demand.” In other words, painkillers should be taken every three to six hours. This is to help people regulate opioid intake and avoid the trap of popping another pill whenever they experience pain.
Increasing research on recovery from opioid abuse is leading to more effective ways to help addicts quit.
The drug buprenorphine has shown a lot of promise at helping opioid addicts. One study found that treating patients with opioid addictions by providing buprenorphine while they’re hospitalized was effective, even if the reason they came to the hospital had nothing to do with opioids. The buprenorphine was provided in a tapered dose and provided along with a referral to a primary care office-based buprenorphine treatment program.
Another study found that buprenorphine maintenance treatment over an extended period was more successful than a single, tapering dose of buprenorphine. The maintenance dose was stable for six weeks, followed by three weeks of a tapered dose. For the entire period, the patients were given support by physician and nurses, as well as drug counseling.
One study has also been attempting to find ways to lessen the number of opioid overdose deaths. An increasing number of communities are initiating opioid overdose prevention programs (OOPPs). Patients at risk for opioid overdose are given kits containing naloxone, which rapidly reverses the effects of opioids, along with training on recognition, prevention, and risk factors for overdose. More studies are needed to evaluate the overall impact of OOPPs, but initial studies suggest that they may be a viable way to reduce the number of fatal overdoses.
Mindfulness training has also shown promise for opioid addicts. The Mindfulness-Oriented Recovery Enhancement (MORE) program teaches participants how to appreciate the small joys of everyday life. For example, they’re taught to meditate on the beauty of a bouquet of flowers, and then they’re encouraged to apply those same appreciative meditative techniques to other aspects of their lives.
Addicts have often become almost numb or dull to the pleasures of life, which fuels their need to take opioids to feel happiness. However, EEGs done on the participants showed an increase in brain activity after the MORE program, suggesting that the techniques taught during the program can help addicts learn to feel joy in life and reduce cravings for opioids.
Another study provided additional hope for the skewed pleasure and reward reactions of addicts. Researchers found that the longer addicts went without opioids, the closer to normal their reactions to pleasurable stimuli became. This suggests that eventually, opioid addicts should experience “physiological re-regulation” of stimuli responses.
One of the best ways to avoid opioid abuse altogether is to use alternatives to opioids to manage pain.
Some of these alternatives may be medications. For instance, attempt to control pain with medications like aspirin or acetaminophen before considering an opioid prescription with your doctor. Another possible alternative to opioids is a new injection called liposomal bupivacaine.
During a study, it was found that an injection of liposomal bupivacaine may be just as successful as a traditional nerve block after knee surgery. Additionally, nerve blocks can cause weakness, making it difficult for patients to start walking around immediately following surgery. Liposomal bupivacaine controlled the pain just as well, but without the side effect of weakness.
There are also lots of natural alternatives to opioids. A healthy diet can help, for example. A physician can also suggest supplements, such as glucosamine chondroitin or omega-3 fatty acids, that may help. Hot and cold application can reduce pain, too. Stress relief can also have a big impact, so anything that reduces stress – from yoga to meditation to massage – can reduce pain. Other alternatives to opioids include losing weight and exercise, especially if a source of chronic pain is related to being overweight. Arthritic knees, for instance, might feel significantly better after losing weight.
A few more surprising ways to reduce pain without opioids include:
- Getting enough sleep
- Falling in love
- Listening to music
These alternatives to opioids may not work as effectively as medications. However, when used in conjunction with non-opioid medications and other natural pain-relief methods, it may be possible to achieve the same amount of pain relief without the risk of serious side effects or addiction.
How do you control your pain?
Image by renee. via Flickr