Pain Management and Opioid Misuse
Opioids are strong pain relievers also referred to as narcotics. They are medications that might be administered by a doctor after an accident, major surgery, serious spot injuries or treatment for chronic pain from health conditions such as cancer and arthritis. It is not yet clear whether they are effectual in managing long term pain or not. Prescription opioids have the same chemical structure as endorphins that are produced by the body to manage pain naturally.
The drugs are obtained from the seed pod of poppy opium plant, but others are made in the lab and are called synthetic opioids while others are semi-synthetic, meaning that they are made from the opium plant. However, they both produce similar effects by stimulating the production of certain chemicals in the brain that inhibits pain. They also affect the brain’s reward center hence produce positive feelings.
Opioids generally make one relax. They usually come in the form of pills and mostly they are safe and can relieve pain when doctor’s instructions are followed. Nevertheless, they can lead to tolerance, dependence, and addiction. When you become dependent you experience withdrawal symptoms when not consuming the drug.
If one continues to use the drugs they risk addiction in which one takes the drug despite the negative effects. The effects worsen when they are misused. Misuse of opioids or any other medication, means not following the doctor’s instructions or you are not taking them for the intended purpose. Also, using another person’s medication is termed as misuse. Additionally, prescription opioids are the most abused drugs because of their euphoric effects.
Morphine was the first opioid medication discovered in 1803, however, many different opioids have since been obtained. In the US natural opioids, synthetic opioids, and semi-synthetic opioids are given to patients with acute pains whenever other medications such as ibuprofen and acetaminophen don’t work effectively. Moreover, some opioids are combined with other products that are specified for treating coughs and opioids addiction during recovery.
Forms of Opioids
Opioids medications are different, come in different forms, and differ in how they are consumed. Also, the length of use differs and they long they stay in the body. Some, one can swallow on their own while others are injectable and only administered by a healthcare professional. Immediate-release opioids begin working immediately after one consumes them, but the effects are short-lived. Extended-release opioids take time before they start working and the effects last longer.
Immediate-release opioids are used in relieving chronic pain, but extended-release opioids are used to manage the chronic pain when the earlier ones are not effective. When your doctor prescribes immediate-release opioids, he/she may also prescribe the extended-release opioids to help in managing the breakthrough pain like cancer pain.
The following are some examples of opioid-only products;
a) Buprenorphine
Buprenorphine is an extended-release opioid that comes in a sublingual tablet, injectable solution, and transdermal patch. The generic and brand- names solutions are only supposed to be injected by a healthcare professional. Buprenorphine brand-name products include Butrans- a transdermal patch, Belbuca- a buccal film, Buprenex- an injectable solution, and Probuphine- an intradermal implant.
It is used to manage chronic pain which requires 24/7 treatment. Because of its safe profile, it is used during opioid addiction treatment. Buprenorphine has a partial opioid agonist property that enables it to reduce the potential for misuse, euphoric effects, and physical dependence. When the appropriate doses are administered, Buprenorphine reduces the cravings for opioids and suppresses the opioid withdrawal symptoms.
b) Butorphanol
It is only available as a generic medication and comes in the nasal spray. Butorphanol is an immediate-release opioid which is typically given to ease moderate to severe pain. It is also available in an injectable solution that must be administered by a healthcare provider. Butorphanol is also used as anesthesia during surgery or during childbirth when the baby is expected in more than 4 hours.
Butorphanol can block the opioid receptors in the brain and can cause withdrawal symptoms to people who are dependent on opioids. Henceforth, individuals who have recently consumed high doses of opioids or have used opioids for a long period should not take the drug.
c) Tramadol
Tramadol comes in an extended-release oral capsule, extended-release oral tablet, and oral tablet. Brand name tramadol is inclusive of Conzip- an extended-release capsule and EnovaRx an external cream. The drug binds opioid receptors thus decreasing the body’s ability to experience pain.
The extended-release oral capsule and extended-release tablets are given to reduce chronic pain for patients who require long-term or continuous treatment. Once a person is prescribed tramadol, one can only get a maximum of 5 refills within a 6 month period. After one reaches the 6-month mark, their healthcare must give them a new prescription.
One should not stop taking the medication suddenly without recommendations from the doctor first. That can cause withdrawal symptoms such as anxiety, headache, nausea, insomnia, tremors, diarrhea, and sweating. Gradually reducing the amount you take over time prevents the withdrawal symptoms.
Besides the opioid only products, there opioid combinations of drugs that include;
• Aspirin/ caffeine/dihydrocodeine
• Hydrocodone/ibuprofen
• Acetaminophen/codeine
• Oxycodone/aspirin
• Oxycodone/naltrexone
• Tramadol/ acetaminophen
Factors to Consider when Using Opioids to Manage Pain
Although there are a quite a number of either opioid-only or combination of opioids, not all can be right for your pain relief. There are various factors to consider you and your doctor before settling on one, and they include;
1) The severity of the pain – some opioids are stronger than others, thus it will be best if your doctor evaluates the intensity of your pain. Immediate-release opioids are used on severe pain while extended-release opioids are given to manage severe pain that requires 24/7 treatment after others have failed to work.
2) Pain treatment history – it is vital to consider a patient’s pain treatment history since some opioids like fentanyl and methadone should only be given to patients who are used to taking opioids for pain management.
3) Drug interactions – some drugs produce harmful interactions when used together with opioids. Tell your doctor all medications that you are taking including the over-the-counter medications, herbs, and supplements.
4) Age – some opioids medications such as tramadol and codeine should not be prescribed to people who are 18years and below. Other factors such as obesity and lung complications are also considered.
Opioid Misuse
Prescriptions are effective in relieving pain and are safe when taken as per prescriptions and for a short period. However, they can be abused which is very dangerous. Opioids misuse includes misuse of prescriptions opioids like OxyContin and illegal drugs like heroin. Opioids are the leading drugs that causing death in the US.
Misuse of opioids includes;
• Consuming them without prescription from a doctor. One either purchases it illegally over the counter, steals it from a relative’s or friend’s medicine cabinet.
• Consuming another person’s prescription although you are taking it to manage pain is misuse. Human bodies are different, function differently, and react differently to drugs. Doctors administer drugs according to individuals, thus you should only use your own prescribed medications.
• Taking the opioids without following the doctor’s instructions or in different ways other than the way it supposed to be taken. A person may crush the powders to snort or dissolve them in water to either inject other than swallowing as advised. This tampers with the effects of the drug. Others take higher amounts hence overdosing as they chase the euphoric effects of opioids.
• Using the drug in other ways other than the intended way; to relieve pain. Most people usually take opioids to experience the high effect. Opioids produce euphoric effects that are characterized by feelings of self-worth, powerful, energy, and pleasure.
• Using opioids with other drugs such as alcohol. Specifically, mixing alcohol with opioids increases the risk of an overdose which is life-threatening. It can also critically lower the blood pressure or cause an irregular heartbeat. Any doctor or pharmacist tells patients what drugs to avoid when taking the opioids for one to be safe.
• Double doctoring – this implies the purchase of the drug from various doctors without telling any about the prescriptions you bought may be in the last 30 days. It is also known as ‘doctor shopping’ or Multiple Provider Episodes (MPEs) by professions.
Taking opioids in any of the above ways is considered as a misuse even if it does not have any negative consequences. However, most states regulate the distribution and possession of opioids. Prescription opioids are legal when prescribed by a licensed doctor and are taken by the patients whom they have been prescribed to.
In other countries such as the US, they are electrically monitored. Meaning, a patient can be tracked how often they purchase them. Illegal distribution and possession of opioids attract penalties which include fines, imprisonment, and sometimes a person can get both.
Dangers of Opioids Misuse
Whatever your motivation for misuse of opioids – whether you get it from your relative’s medicine cabinet, you consume to get high or you crush the pills in order to snort – misusing opioids can be extremely dangerous. If you are using a person’s medication, the doctor may not be able to examine and administer a drug that suits your needs. Although you may be having the same medical condition, drugs function differently and can trigger adverse side effects in you.
The following are some dangers of opioids misuse;
1. Health complications
Misusing or abusing opioids comes many health problems. Although it is common to find people misusing drugs, it is very unsafe. Opioids can cause constipation, nausea, confusion, anxiety, mood swings, slowed breathing, decreased heart rate and blood pressure, decrease in cognitive function, infertility, choking, and many other dangers.
In case of slowed breathing rate, one can suffer from a coma or die. Long term misuse of the drugs can damage the brain, kidney, and other body organs, reduce the immune level, increased sensitivity to pain, and other subsequent health conditions.
2. Overdose
Due to the euphoric effects, one can overdose the drug while chasing them. One wants to remain high and thus uses more and more of the drug producing life-threatening signs or death. Sometimes it can be hard to notice when somebody is very high or going through an opioid overdose. If you are having difficulty in telling whether you or your loved one is overdosing check the following symptoms;
• Constricted pupils and Pinpoint pupils or the center circle in the eyes are very small.
• Making sounds such as gurgling or snoring sounds and choking.
• Not responding to touch or voice.
• Clammy, pale, or grey skin.
• Blue or purple lips and fingernails.
• Slowed breathing, irregular, or one has stopped breathing.
The most essential thing to do if you suspect a person is experiencing an overdose is to call 911 so that they can get immediate medical attention. However, as you await the doctor you can help them by checking and opening the airways and giving them one breathe in every 5 seconds. Additionally, if you have naloxone inject 1ml of the solution into their muscle as you keep on giving them breaths.
It can also be administered as a nasal spray. Naloxone temporarily inhibits opioids from attaching to the opioid receptors in the brain, thus preventing any effects. Since it only functions temporarily; multiple doses may be required in case of a strong opioid. Although in many states naloxone is legal, it can be difficult to get it due to the stigma surrounding its use and abuse.
Any person who uses opioids whether legally or illegally should have naloxone and know how to use it. The solution is not made for individuals with drug abuse disorders. Overdosing can happen to anyone, anytime, anywhere, and unintentionally. Do not let stigma around naloxone put you or your loved one at a risk for overdose or death.
Sadly, some bystanders in case of overdose fail to ask for help through 911 because they are afraid that they may be arrested for drug-related crimes. Due to this, 40 states and the districts of Columbia adopted the ‘Good Samaritan’ or ‘911 drug immunity’ regulations that offer legal protection to people who call 911 in case of an overdose. The scope of the law varies with states; hence one should familiarize themselves with their state’s laws.
Factors that Affect the Risk of an Overdose
There are factors that increase the risk of an overdose such as when one is using the drugs for the first time, you have other health conditions like liver disease or you are dehydrated, using opioids with other substances, and if the drug is stronger than the one you are used to. Opioids have different strengths and the time they are active in the body is different too. The following are some factors that can affect the risk of an overdose;
• The kind of formulation – there are short-acting and long-acting prescription opioids. For instance, methadone, when taken orally, can stay in the body for more than 24 hours and this increases the risk of an overdose. On the other hand, short-acting opioids like fentanyl stay in the body for a few minutes, and it has less risk of an overdose.
• Tampering – this involves crashing the tablets and snorting or dissolving in water and injecting into the blood veins. This increases the potency of the opioids making them act faster.
• Method of consumption – the faster the delivery method to the body, the more intense the effects and the greater the risk of an overdose. Quick methods include injections that deliver the opioids directly to the bloodstream. However, taking opioids in whichever way can cause an overdose.
• Combining with other drugs; legal or illegal- using opioids with other substance s such as alcohol and benzos, which are sedatives, can increase the risk of an overdose.
• Tolerance – people who have developed tolerance to prescription opioids; they have stopped experiencing effects after the consumption of the usual quantities they used to. They end up taking more and more for them to feel the effects. This increases their risk of an overdose.
• Purity – drugs that are man-made in the labs sometimes are not pure and may contain harmful additives that increase the risks of an overdose.
3. Addiction
Opioids are strong addictive drugs and any person who uses them in the right way or misuses them can become addicted. Addiction is the best-known effects of the misuse of drugs, and it’s surprising that some people become addicted without even noticing. Misusing opioids such using another person’s prescriptions increases the risk of addiction.
Researchers have found out that taking opioids longer than the doctor advises puts one at risk of long-term use of the drugs and thus addiction. Other factors that may influence addiction are genes, environment, and health condition of a person. External factors such as unemployment, poverty, age, tobacco use, history of severe depression, and stressful situations.
Signs of opioid addiction include;
a. Strong cravings for the drug.
b. Taking more than the prescribed dose
c. The urge to stop misusing but you are not able to – a feeling of powerless.
d. Behaving irresponsibly e.g. stealing in order to get the money to purchase the opioids.
e. Mood swings, irritability, and depression.
4. Physical dependence
One becomes physically dependent on the opioids and cannot function unless they consume them. A person who is dependent on the drugs may experience withdrawal symptoms when not taking the opioids such as;
• Sleeping problems, muscle pains, and stomach pain.
• Diarrhea and vomiting,
• Strong cravings, cold flashes, and goosebumps.
• Uncontrollable leg movements and bone pains.
• Nausea, cold sweat, and agitation.
• Shaking and anxiety.
Withdrawal symptoms can be very uncomfortable, one major reason that makes quitting the misuse of opioids hard. However, during recovery medications are given to ease the withdrawal symptoms. Such medicines include Iofexidine, non-opioid and are FDA approved drugs.
Other medicines are buprenorphine and methadone that work by binding with the opioid receptors in the brain just as the opioid one is addicted to. They mimic the effects of the drug and thus reduce cravings and withdrawal symptoms. However, other drugs block the opioid receptors and prevent the drug from producing any effects. They include naltrexone.
Behavioral therapies are also given to help modify the patient’s behaviors toward opioids use. They also assist in improving one’s moods and having a positive attitude during the treatment plan. The specialists teach addicts on various healthy life skills and how to overcome the cravings.
Some behavioral therapies given are cognitive behavioral therapy which changes the person’s opioid use expectations and behaviors and helps in managing stress and multidimensional family therapy that is generally applied to teenagers with substance use problems and deals with family’s and personal influence on drug use. The behavioral therapies are more effective when combined with medications.
5. Legal problems
Taking another person’s medicine misusing medication is prohibited by the law. Moreover, the chances of engaging in criminal activities are high when you are misusing drugs. If caught in the possession or distributing you attract fines, jail terms, and suspension from school if you are a student.
Safe Use of Opioids
Consuming opioids even for a short period can cause overdose, dependence, and addiction. The following are some ideas that can help you to use opioids safely without risking;
I. Tell your doctor about any history of drug abuse.
II. Follow the doctor’s instructions. Take the exact quantity, do not crash, chew or dissolve in liquids.
III. Ask the doctor about the drugs you should avoid while on the opioid medication.
IV. Ask the doctor about the warning signs of opioid addiction so that you can watch them.
Conclusion
Prescription opioids are effective in managing moderate to severe pain; however, others are used to treat diarrhea and coughing. There are various opioids that can treat acute and chronic pain and some are more specific. Talk to the doctor since there are various considerations to be made in order to administer the appropriate opioid for you.
People misuse prescription opioids in various ways such as not following the doctor’s instructions, taking another person’s dosage, consuming it to get high, and many others. Misuse can lead to overdose, dependence, and addiction.