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For many people living with chronic pain, opioid medications are a critical component to managing their pain and overall quality of life. However, the nationwide crackdown on opioids has put chronic pain sufferers in an impossible situation. The growing fear and stigma linked to opioid use have led to chronic pain patients being viewed as drug seekers and liars. We are viewed this way whether we take pain medications or not.
In an effort to curb opioid drug abuse and addiction, the Drug Enforcement Administration (DEA) relabeled pain medications as Schedule II drugs. Then the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians on prescribing medications for chronic pain. The guidelines are advisory, not mandatory, but are likely to be a powerful influence on physicians, insurers, and other government agencies.
State and federal officials are increasingly watching physicians who prescribe narcotics. Some doctors now refuse to prescribe opioid pain medications at all, the doctors that do require you to sign a pain contract. Pain treatment contracts typically include surprise pill counts, random drug tests, forbid the use of alcohol or illegal drugs, and you must keep your appointments.
Any violation of the agreement and you may be discharged from the doctor’s care and denied further treatment. You can sign one of these contracts, take narcotics long enough to develop a physical dependency, and be abruptly cut off your pain medication, and left going into withdrawal and feeling extremely ill. This is so wrong and yet it is happening again and again.
There is no denying there is an opiate addiction problem in this country.
I know at least 4 people who have overdosed on opiates. My own son was addicted to Oxycontin. He got it from a friend which led to him buying it from dealers. After losing his job because of his addiction he started using heroin because it was cheaper and more available. My son beat his addiction over 5 years ago but it was by no means easy.
Opioid Addiction 2016 Facts and Figures from the American Society of Addiction Medicine:
- Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014
- The overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 were four times those in 1999.
- In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills.
- Four in five new heroin users started out misusing prescription painkillers.
- 94% of respondents in a 2014 survey of people in treatment for opioid addiction said they chose to use heroin because prescription opioids were “far more expensive and harder to obtain.
The CDC claims that at least half of all opioid overdose deaths involve a prescription opioid. Yet data collected by the Substance Abuse and Mental Health Service Administration (SAMHSA) shows that the vast majority of opioid addiction starts on the street, not in the doctors office.
Addiction in pain patients is rare and occurs in less than 4% of patients treated with opioids. A review of 17 studies involving 88,235 patients with acute and chronic pain, the majority of whom were prescribed opioids for chronic noncancer pain, concluded that opioid use for chronic pain conditions is not associated with a major risk of developing a dependence. The patients who developed problems with opioid use had a prior history of substance abuse.
HealthRising.org published an article about a survey The National Pain Report recently released examining treatment effectiveness. According to the survey, opioids were far more effective for FM patients than the FDA approved fibromyalgia drugs. There were fewer side effects with opioids than the FDA approved drugs as well, and that FM patients were using them responsibly.
The difference between opioid addiction and physical dependence
Addiction is characterized by uncontrollable cravings, the inability to control drug use, and continuing use despite doing harm to oneself or others. Addiction is often called dependence which leads to confusion.
Physical dependence to opioids is normal and can occur without addiction. Physical dependence is the body’s adaptation to a particular drug. The body gets used to receiving regular doses of a certain medication. When the medication is abruptly stopped or the dosage is reduced too quickly, the person will experience withdrawal symptoms.
Opioid withdrawal is generally not dangerous. However, opioid withdrawal is very uncomfortable and distressing. If you find yourself being abruptly cut off of your pain medications, Palo Recovery has some great tips for detoxing from opiates.
Physical dependence and withdrawal symptoms occur with many medications, not just opioids.
The government’s war on opioids reinforces common misconceptions held by the general public about pain medication use and tends to create the impression that people who use pain medication are addicts -or mere steps away from full-blown addiction.
While controlling the abuse of opioids is necessary, the importance of decreasing drug abuse does not outweigh the needs of millions of people who suffer from chronic pain. Denying access to medication and treating chronic pain patients like criminals will not solve the problem. Ironically, there is evidence that restricting patient access to pain medicine could actually lead to more overdoses, not fewer.
I am allergic to opioids so I was prescribed Tramadol. But since tramadol has been reclassified as a controlled substance I can’t even get that anymore. What struggles are you facing trying to receive treatment for pain?