Opioid Use

There is a shift happening in how pain is being managed. We had become quite comfortable with the use of prescribed opioid medications for pain in the past 20 years, but the simplistic approach of medication alone is now being questioned.

If you are currently taking opioid medication as prescribed and it is effective for managing your pain, you might be able to keep the dose where it is, but you should think about adding non-pharmacological pain management strategies to help you feel and function even better. This website is intended as a resource on that journey.

If you feel uncomfortable with how opioid medications affect you, or if you worry about addiction, we are finding out that people with pain can slowly reduce the opioid dose and, in some cases, get completely free of the medication without increasing pain. It appears that the use of these pain medications over longer periods of time may be suppressing our own natural pain killers. This is encouraging because it reminds us that our bodies and brains have an amazing capacity to heal, even from severe pain conditions.

What is the opioid crisis?
The growing number of overdoses and deaths caused by opioids, including fentanyl, is referred to as the “opioid crisis” and is recognized as a public health emergency.

Prescription opioid medications, the top four being fentanyl, hydromorphone, morphine and oxycodone, have been used to manage acute and chronic pain. While they can be effective for pain relief, these medications have adverse side effects and have a risk for dependence and addiction. The stigma attached to taking these medications has increased with the opioid crisis. To ensure safety, there have been changes to the opioid prescribing guidelines to decrease use of opioids, limit doses and reduce the simultaneous use of some other medications. Unfortunately, these harm reduction approaches have limited effect when prescription medications can be purchased illegally. Of even more concern is the illegal market with tainted products.

Prescription opioid medications are certainly safer than illicit drugs, but they can be misused too. The danger is that opinions against opioid prescribing could shift too far, too fast, and drive people with pain who can’t get their usual prescription medication to the more dangerous illicit products.

As people with pain and their healthcare providers, we need to take a thoughtful and compassionate approach to this crisis. We didn’t get here overnight, and this won’t be resolved quickly. If we keep open minds, we may come out of this with a better way of managing pain.
Even if the goal is to decrease the overall number of opioid prescriptions, it’s important that doctors don’t abruptly cut off patients who are on opioids. That can lead to unnecessary pain, withdrawal, or seeking illicit sources, even if the person was not addicted to opioids.

What is withdrawal?
When you use opioids for a long time, your body develops dependence, meaning that your body and brain is used to the medication being there and when it is stopped, the body reacts with flu-like symptoms and anxiety. It can be extremely uncomfortable, and our brains are wired to do almost anything to avoid these awful feelings.

What is addiction?
Addiction is when the use of the medication has negative consequences and the person continues to compulsively use it anyway. Only a small minority of people who use opioids for pain become addicted, but we still need to give those smaller numbers extra consideration because they are going to need more help to recover. They can benefit greatly from addiction treatment. There are also some alternative medications that help, like methadone and buprenorphine. These medications are used for both addiction and pain.

What are some alternatives to opioids?
Some examples of evidence-based, non-opioid interventions for pain are
• self-management,
• movement-based physical therapies,
• psychological treatments such as cognitive behavioural therapy,
• other medications, and
• medical marijuana.

There are still problems with access and coverage for many of the alternatives, and not all healthcare providers have the same level of expertise in pain management.

Mental health issues can increase your risk of opioid overdose death
Mental health issues are a better predictor of a person’s risk of overdose than being on high doses of opioids. Getting treatment for mental health conditions will have more of an impact on reducing risk for overdose than decreasing opioid dose alone.

Resources
Check out the resource list on this website for programs and services in Alberta and Canada to help with both pain management and addiction recovery. If you have suggestions for additional resources to help, send us a message.

References
Lopez, German (2018). Solving America’s painkiller paradox. Accessed on October 6, 2018

Sutton, Kathryn (2018). How the new opioid prescribing guidelines risk patient care. Accessed on October 6, 2018