By Jo Ann Hummers on November 1, 2019
The Center for Disease Control recognizes some confusion about the safety of prescription opioids. They have written this piece in an effort to clarify the issues.
Prescription options can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer. In recent years, there has been a dramatic increase in the acceptance and use of prescription options for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.
When the prescription becomes the problem
• More than 191 million opioid prescriptions were dispensed to American patients in 2017—with wide variation across states.
• There is a wide variation of opioid prescription rates across states. Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii.
• Studies suggest that regional variation in use of prescription options cannot be explained by the underlying health status of the population.
The most common drugs involved in prescription opioid overdose deaths include:
• Oxycodone (such as OxyContin®)
• Hydrocodone (such as Vicodin®)3
To reverse this epidemic, we need to improve the way we treat pain. We must prevent abuse, addiction, and overdose before they start.
Addiction and Overdose
Anyone who takes prescription options can become addicted to them. In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction.,5,6 Once addicted, it can be hard to stop. In 2016, more than 11.5 million Americans reported misusing prescription options in the past year.
In addition to the serious risks of addiction, abuse, and overdose, the use of prescription options can have a number of side effects, even when taken as directed:
• Tolerance—meaning you might need to take more of the medication for the same pain relief
• Physical dependence—meaning you have symptoms of withdrawal when the medication is stopped
• Increased sensitivity to pain
• Nausea, vomiting, and dry mouth
• Sleepiness and dizziness
• Low levels of testosterone that can result in lower sex drive, energy, and strength
• Itching and sweating
Risk Factors for Prescription Opioid Abuse and Overdose
Risk factors for prescription opioid pain reliever abuse and overdose: obtaining overlapping prescriptions from multiple providers and pharmacies, taking high daily dosages of prescription opioid pain relievers, having mental illness or a history of alcohol or other substance abuse, living in rural areas and having low income. Research shows that some risk factors make people particularly vulnerable to prescription opioid abuse and overdose, including:
• Obtaining overlapping prescriptions from multiple providers and pharmacies.,8,9,10
• Taking high daily dosages of prescription pain relievers.,11,12,13
• Having mental illness or a history of alcohol or other substance abuse.
• Living in rural areas and having low income.
Inappropriate prescribing practices and opioid prescribing rates are substantially higher among Medicaid patients than among privately insured patients.
In one study based on 2010 data, 40% of Medicaid enrollees with prescriptions for pain relievers had at least one indicator of potentially inappropriate use or prescribing:
• overlapping prescriptions for pain relievers,
• overlapping pain reliever and benzodiazepine prescriptions,
• long-acting or extended release prescription pain relievers for acute pain, and
• high daily doses.
Taking too many prescription options can stop a person’s breathing—leading to death.
Prescription opioid overdose deaths also often involve benzodiazepines. Benzodiazepines are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. Examples include alprazolam (Xanax®), diazepam (Valium®), and lorazepam (Ativan®). Avoid taking benzodiazepines while taking prescription options whenever possible.
Jo Ann Hummers, EdD, is a Licensed Clinical Addictions Specialist. She has a private practice at the Nags Head Professional Center. Her work includes DWI assessments and treatment, smoking cessation sessions, and treatment for gambling and other addictions.
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