Opioids: Prescribe with Care

In the past several years, opioid misuse and abuse has become an increasing problem in our society. Recently, the death of music icon, Prince, was attributed to an accidental overdose of Fentanyl, a powerful synthetic opiate used to treat chronic pain. This problem is not limited to high-profile celebrities –– according to the Centers for Disease Control and Prevention (CDC), roughly 78 Americans die every day from opioid overdose. In fact, the rate of deaths in the U.S. due to opioid overdose has increased by approximately 200 percent since the year 2000.

Currently, prescription medications are at the root of more than half of the recorded U.S. deaths involving opioid overdoses, and sales of these medications have been steadily rising. This is not surprising, considering pain is a primary symptom of many health problems.

One of the major draws to opioids as means of treating chronic pain is that they have no ceiling effect, unlike over-the-counter (OTC) pain relievers and anti-inflammatory medications. This means that higher dosages of opiates continue to provide increased pain relief with, seemingly, no upper limit. While an excessively high dosage of these medications shouldn’t be prescribed, when dealing with severe, chronic pain, accidental overdoses can and do happen.

Opiates can cause respiratory depression (hypoventilation), slowing a person’s breathing. This worsens when opioids are used in combination with other medications or alcohol. The body can also become tolerant (habituated) to the pain relief that opiates are generally prescribed to provide, but not to the opiate’s negative side effects such as cognitive and psychological dullness, constipation, and testosterone suppression. Furthermore, if opiates aren’t taken as prescribed, they can also become addictive — often contributing to the potential of an overdose.

Given the prevalence of opioid misuse and abuse, it is more important than ever for health care providers to consider alternative pain management solutions and use caution when prescribing opiates. A variety of pain treatments are available and can be considered prior to prescribing opioid medications. New treatments are also continually being developed, providing doctors with an increasing array of promising options. To determine the best approach, it is essential to first identify the true source of the patient’s discomfort and then select the treatment that most effectively balances risk with long-term relief.

In less severe cases that can be managed with exercises and strengthening, physical therapy, chiropractic therapy, transcutaneous electrical nerve stimulation (TENS) machines, massage, counseling and/or any combination thereof; chronic pain can be significantly reduced without the use of opiates. For more severe pain, including those caused by injuries to the spine or nerves, there are specific diagnostic and/or therapeutic steroid injections that may greatly help in directing the treatment, and also in reducing medications. Additionally, minimally invasive procedures like radiofrequency ablation (RFA) — which uses heat to reduce nerve sensitivity and interrupt pain signals — have helped with long-term results for chronic, facet-related pain in the neck or lower back. Other non-opiate options also include implantable technologies.

If, after a thorough evaluation, prescribing opioids proves to be an appropriate resource for pain management, then forming an open and honest line of communication with the patient is key. Patients should be kept informed of the risks of taking opioids and clearly instructed on the appropriate dosage for their condition. Before prescribing a higher dosage, a patient’s current and long-term needs should be carefully assessed to ensure prescriptions are not increased unnecessarily. Additionally, patients should be informed of the dangers of the prescription pain medications falling into the hands of those who may seek them. Patients should be encouraged to keep a careful eye on their medications, advised to store them in a lock box, and warned against sharing them with others.

While the severity and frequency of problems related to prescription opioids are on the rise, and many factors that contribute to this situation are beyond the prescribing doctor’s control, it is both the responsibility of medical professionals and their patients to do everything in their power to prevent opioid misuse, abuse, and overdose.

About Dr. Kamyar Assil

Kamyar Assil, M.D. is an expert in pain management with more than two decades of experience. He received a Bachelor of Science with honors in psychobiology from the University of California, Los Angeles (UCLA) and a medical degree from the University of Southern California (USC) Keck School of Medicine. Dr. Assil was one of the first fellowship-trained pain specialists in the Ventura County region, with formal training in pain management from State University of New York Health Science Center in Brooklyn, NY. He also completed a clinical fellowship and advanced training in interventional pain management at the Manhattan Center for Pain Management at Saint Luke’s-Roosevelt Hospital in New York City, NY.

A sought-after practitioner with specializations in interventional pain management, Dr. Assil focuses on targeting the source of pain –– treating pain problems acute to chronic, from severe spine and peripheral pain pathologies, headaches, neck pain and nerve damage to herniated disks and lower back pain. A Qualified Medical Examiner (QME), Dr. Assil also practices as medical consultant in legal cases and as an expert witness for interventional medicine and pain management. He also serves as a senior instructor of the Spine Interventional Society (SIS) and as a visiting clinical professor at USC Medical School’s Department of Anesthesiology’s division of pain medicine.

References

  1. 1. https://www.cdc.gov/drugoverdose/epidemic/index.html
  2. 2. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
  3. 3. https://www.cdc.gov/drugoverdose/data/overdose.html