The opioid “quick fix” has become a MAJOR problem

15_261593-165kdeaths_flexslider_01_03041615_261593-abuse2mill_flexslider_02_030416

TGIF! It is the weekend! Although I will be studying for my “Alternative Diets” test all weekend, I’m just glad I get to do it in the comfort of my own home while leaning on a heating pad and having my comforts at arms reach!

You all know I have been having a rough pain week, and this corresponds well with the topic of this post today!

My dad and I have been discussing this topic for WEEKS, as this topic makes our blood BOIL, and I have been wanting to write this post for a while now. I have finally gotten the energy to do so. 

I want to discuss the opioid problem we are currently experiencing in Canada (and more so in the US) for the treatment of chronic pain. Did you know that 7 people die of opioid overdose every DAY in the US? Did you know that 1 person dies per day from a Fentanyl overdose every DAY in Canada? This is a MAJOR problem! Opioids are being prescribed MUCH too frequently and liberally, and most likely by doctors who do not have the experience or training to prescribe the drugs, or monitor their patients taking the drugs. 

NIHP2PChronicPain-Infographic

I have YEARS of experience taking opioids for pain, and now that I am no longer taking this type of medication to “manage” the pain, I am SO relieved. I can’t remember exactly, but I believe the first time I was prescribed opioids for my pain was 8 years ago in 2008 after I had surgery to fix my broken nose. I was prescribed Percocets by the surgeon for the pain. What did I discover when taking those percs for the nose and face pain after surgery? That it also relieved my back pain and fibro pain. What?! How amazing! Finally, some relief from my pain! So what did I do? I told my GP that it was helping my pain and asked if he could prescribe these for my fibro. He kind of hesitated, BUT he did end up prescribing them to me. After a few months of these prescriptions, he referred me to a chronic pain management clinic in Toronto where the doctors see you on a weekly, bi-weekly or monthly basis, dependant on your pain. I got into that clinic about 6 months later. Before you can even begin to receive treatment (whether injections and or pain meds) you are subjected to filling out 15 pages of medical details, and they go in depth about your risk for addiction and overdose. They then interview you for an hour to assess you psychologically. Apparently I passed those tested, because I began treatment right away. I have the most AMAZING chronic pain specialist at that clinic. She is honestly the ONLY doctor who I am currently seeing who I can truly trust, and believe is competent. I would say 9/10 of the doctors I have seen have been completely useless (no offence to any MD’s or specialists or naturopaths out there, this has just been MY experience, and maybe I just have bad luck). If you are ever looking for a chronic pain specialist in the Toronto area, let me know, and I will send you her contact details. 

8 years ago I began receiving injections for the pain and was prescribed a stronger opioid, oxycontin. My doctor would only provide me with 1-2 weeks worth of the opioid so that I could not take a bunch and overdose (although I wasn’t at risk for that, it’s a precaution they take), and was also required to provide a urine sample at every appointment. At every appointment, before seeing the doctor, I am to fill out forms with questions around my pain levels, the effectiveness and side effects from medications, and the effectiveness and side effects of the injections. I am then weighed (so that the proper dosing of injections can be given), have my blood pressure and oxygen levels taken, talk to the nurse, sign a form, then wait for the doctor to come in.

addiction

I was on the oxycontin for a while, having the dosage increased every few months, until it stopped working as well. At that point I was put on an even stronger medication. This cycle kept repeating itself until I eventually was on 36mg of hydromorphcontin per day, PLUS 12mg of dilaudid per day. If you google these medications, you will see that they are INCREDIBLY strong, some say stronger than cocaine. My doctor basically told me that if my mother took just one of those pills, she would have dropped dead of a heart attack because the dosage and type of medication were SO incredibly strong. During this time, I was also receiving massages, chiropractic adjustments, and seeing a psychologist, all to help manage the chronic pain. 

When was my pain at its worst? You guessed it – sitting at my computer for 8+ hours a day in my HR job, unable to take many breaks to stretch and walk around. In order to get through my days at work, I had to keep popping these pain meds. It wasn’t until I got into my law suit last year against my former employer, and finally settled the suit, that I was FINALLY able to wean off of the opioids. I have been opioid free now for over a year and it feels amazing. This is NO small feat. The withdrawal side effects from stopping opioids are INCREDIBLY strong, and the majority of people who try to come off of the meds don’t end up doing so, even when they WANT to. My doctor was monitoring me throughout the wean off, and she could not believe how well I was doing. She basically told me that NOBODY in her clinic tries to wean off of the meds like me, most just want to be on the medication for the rest of their lives. 

opiate-withdrawal-symptoms

opiate-withdrawal-timeline.png.pagespeed.ce.9zoZ2E-usH

Although I am no longer taking narcotics, am I still in pain? ABSOLUTELY! Have I found other treatment methods? YES! Am I high all of the time? NO! Am I handling life well without these medications? For the most part.

I am here to tell you that our society needs to STOP with the QUICK FIXES. A pill CANNOT fix your health problem, it only covers up the cause and treats the symptoms. While doing so, the medication is negatively affecting your body with the endless list of side effects, not to mention the lengthy list of potential long term side effects. I was SO constipated on these meds that I would have a bowel movement ONCE per week. Think of the toxins from my food that would keep recirculating through my blood, rather than being eliminated. That’s just the tip of the iceberg!

slide2

There are SO many alternative therapies to help manage pain, including but not limited to: physiotherapy, massage therapy, osteopathy, chiropractic, reflexology, hot tubs, psychologists, rest, not over-doing things, injections for pain, and we can’t forget, NUTRITION and STRESS MANAGEMENT! Are opioids safe and ok to be used for chronic pain? YES, I do believe they have their place, as part of a bigger treatment plan, however, I believe a pain specialist should be prescribing these medications, and NOT MD’s. Anyone taking opioids needs to be monitored VERY closely, and should do their best to keep the dosage down to as low as possible. 

vs-map-state-rx-rate-lg

I want to share an article around the opioid problem, written on June 14, 2016, just a few days ago:

People who take long-acting opioids for chronic pain are much more likely to die than those taking other medications, providing more evidence that the powerful narcotics should be used only as a last resort for ongoing pain.

It is well known that opioids such as oxycodone, morphine and fentanyl have risks. They can suppress the respiratory system, leading to accidental overdose, and they are also addictive.

But in this new study, researchers tried to determine whether those narcotic painkillers are also more likely to cause deaths not related to overdoses. They found that more than two-thirds of the deaths among those taking opioids were not caused by unintentional overdoses. About half were caused by cardiovascular problems.

This suggests that the existing approaches have underestimated the harms of long-acting opioids. These data would add even more urgency to reducing the use of opioids.

To do the study, which was published in the Journal of the American Medical Association, researchers studied data from thousands of patients in Tennessee who were either prescribed an opioid, an anticonvulsant used to treat chronic pain, or low-dose cyclic antidepressants, which can also be prescribed for pain. The researchers wanted to make sure that they were counting only people who died as a result of the medication, so they excluded people 75 and older, people with cancer or other life-threatening illnesses, those in end-of-life care and long-term-care residents. They also excluded people with a history of drug abuse.

Most people in the study were diagnosed with back pain, other musculoskeletal pain and abdominal pain.

After looking at the data, the researchers discovered that in the opioid group, there were 167 deaths per 10,000 person years (a measurement based on the number of people in the study and the total number of years of follow-up). In the control group, there were about 108 deaths per 10,000 person years.

The authors said the opioids may have caused or exacerbated breathing problems during sleep such as sleep apnea. Those breathing disruptions are linked to heart problems, which could explain why opioids are linked to a heightened risk of cardiovascular-related death.

The researchers note that, in some cases, opioids might be the right drug to use to treat pain. But over all they are being prescribed too liberally and exposing too many to risk.  What one can do is to use opioids as a last resort. The simple idea is to try other things first.

Some proponents of using opioids to treat long-term pain suggest that the drugs are safe if used cautiously and that the real problem are addicts who purposefully misuse the drugs.

This new research shows that isn’t the case. 

Canada is the world’s second-largest per capita consumer of opioids next to the United States. Many provinces have instituted drug-monitoring programs to crack down on people who fill prescriptions at multiple pharmacies, but researchers say much more needs to be done.

Earlier this year, the College of Family Physicians of Canada rejected a call by the Federation of Medical Regulatory Authorities of Canada to make a course on safe opioid prescribing mandatory for family doctors. Earlier this month, the College of Physicians and Surgeons of British Columbia adopted a mandatory opioid-prescribing standard that requires physicians to carefully assess a patient’s potential risk factors, review his or her other medications and start him or her on low doses. At the same time, the College of Physicians and Surgeons of Nova Scotia endorsed new guidelines from the U.S. Centers for Disease Control and Prevention that recommend against prescribing opioids for long-term chronic pain because of the risks.

As you can see, we have a LONG way to go in terms of dealing with this opioid problem. I am disgusted that the College rejected the suggestion to train family doctors on opioids, but happy to hear that BC and Nova Scotia are doing SOMETHING about it. Ontario, shame on you, get with the program! 

Well, I think I have said my peace about narcotics. Happy weekend all. Off to study!

Xoxo Lex

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s