Pain and Addiction: The Opioid Epidemic
Author: Atlanta Addiction Recovery Center Editor
It’s hard to read any news feed or paper these days and not find an article on the growing opioid epidemic in the United States. It’s alarming and unsettling to see the faces of parents overdosing in a car with their kids in the backseat, or to see a pregnant woman injecting herself with a syringe.
The opioid epidemic does not discriminate. It’s even made the headlines with the deaths of entertainers such as Prince and Tom Petty due to fentanyl overdose. But there have also been other headlines of folks allegedly abusing opioids for pain. Take for instance Tiger Woods who was pulled over for erratic driving and was found to have two pain meds in his system, Vicodin and Dilaudid which were prescribed for pain.
Many researchers believe this is where the opioid epidemic started—the overprescribing of pain pills. So, where are we today and what do we do about the high percentage of population who legitimately suffer from pain?
Opioid Epidemic is Still Spreading
According to the Centers for Disease Control and Prevention (CDC), in the U.S., emergency room visits for opioid overdoses increased by about 30 percent between June 2016 and September 2017, indicating that the problem is not getting any better. “It does not respect state or county lines and is still increasing in every region in the United States,” Dr. Anne Schuchat, the acting director of the CDC, said in a statement.
The CDC reports that 64,000 people lost their lives to a drug overdose in 2016 – more than 20 times the number of Americans killed on 9/11, or 175 people each day. Of those, 42,249 were due to opioids.
Drug overdose is now the leading cause of death for Americans under the age of 50.
What are the Types of Opioids Being Abused?
Opioids are a class of drugs that act on the body’s opioid receptors, primarily those found in the brain, spinal cord, peripheral nervous system, and intestinal tract. There are several types of opioids: natural opioids include drugs such as heroin and morphine, which are derived from the resin of the opium poppy. Semi-synthetic opioids include prescription pain medications such as hydrocodone and oxycodone. Synthetic opioids include fentanyl and methadone.
The opioid addiction is mainly based on the following:
- Prescription opioids such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine and methadone, which are prescribed by doctors to treat moderate to severe pain.
- Fentanyl is a very potent synthetic opioid pain reliever. It is many times more powerful than other opioids and is approved for treating severe pain, typically advanced cancer pain. Illegally made and distributed, fentanyl has been on the rise in several states, and is a major culprit in overdose deaths. Fentanyl is 50 to 100 times stronger than morphine.
- Heroin is an illegal opioid. Heroin use has increased among all genders and socioeconomic groups – men and women across all age groups and income levels.
In the U.S., illegal drug manufacturers are making highly potent synthetic opioids with varying chemical compositions that can be deadly in minute amounts. Sold on the streets, the drugs often contain fentanyl or fentanyl-like compounds.
What are Some Signs of Opioid Overdose?
With the pervasiveness of the epidemic, you should know the signs of an overdose to help someone in the event. Signs of an overdose include:
- Awake, but unable to talk
- Limp posture
- Face is pale or clammy
- Blue fingernails and lips
- For lighter skinned people, the skin tone turns bluish purple; for darker skinned people, the skin tone turns grayish or ashen
- Slow, shallow or erratic breathing
- Pulse is slow and erratic, or there may be no pulse
- Choking sounds or a snore-like gurgling noise (sometimes called the “death-rattle”)
If you suspect someone is experiencing an overdose, call 911 immediately.
A person dies of opioid addiction every 20 minutes in the U.S.
Pain and Addiction
For those who are facing an opioid addiction, time is of the essence to get help. In many cases, the fear of chronic pain is what prevents an opioid addict from seeking help.
What is Pain?
Pain is an unpleasant sensory and emotional experience associated with actual tissue damage. But according to Dr. Stacy Seikel, pain is what a patient says it is. Regardless of the pathology, or if it’s a nerve root in somebody’s back, or it’s limbically-enhanced pain from childhood trauma, pain is a real experience for the individual.
Not all people who use pain prescriptions will become dependent but some will. If pain is resolved, patients can be tapered off slowly in a medically managed way. However, those who are hard-wired or have a genetic predisposition to become addicted may continue to think about or crave pills. In these cases, legitimate pain medication can be the first exposure to a drug that ultimately ends up in addiction.
How to Treat Pain
The brain of an addict likes the rapid onset and short duration of some opiates. Short-acting opiates work quickly to release dopamine and stimulates the reward system faster, thus the ‘high’ an individual feels and begins to crave. Slower drugs don’t have the reinforcing effect or the short duration. A slow-acting opioid-like Tramadol might be better for a person who has chronic pain and addiction.
Another option for patients who have chronic pain and addiction is a replacement of their opioid medication with buprenorphine or Suboxone. Buprenorphine can also prevent withdrawal symptoms, allowing patients to stabilize and facilitate their progression into non-opioid and non-pharmacologic forms of pain treatment.
How Do You Recover From an Opioid Addiction?
To ensure safety and to give patients the best chances of achieving long-term recovery, addiction treatment programs should be comprehensive, science-based and address the whole person.
Atlanta Addiction Recovery Center offers a comprehensive opioid addiction treatment program that includes:
- Medically supervised detox – Detox is an essential first step in the recovery process. Detox removes substances and toxins from the body, preparing patients physically and psychologically for the next phase of treatment. Medically supervised detox is strongly recommended for opiate withdrawal. Atlanta Addiction Recovery Center offers ambulatory detox which allows patients to return to the comfort of their own home or the home in the evenings while the staff is available to provide support 24/7.
- Expert medical management – Physicians who are board certified in addiction medicine are specifically trained to provide comprehensive care and disease management. They can diagnosis, detox, treat and support patients during opioid addiction recovery. Physicians should be supported by nurses and nurse practitioners, with experience or specialized training in addiction treatment or psychiatric care.
- Addiction centered counseling— Addiction-centered counseling helps patients develop the skills and structure to resist drug use, replace drug-using activities with constructive and rewarding sober activities, improve problem-solving abilities and restore interpersonal relationships.
- Spiritual Care – Through spiritual growth, patients set a better course for their lives and gain the fortitude to sustain their commitment to sobriety long after treatment ends.
- Family treatment – Addiction doesn’t just hurt individuals. It harms everyone it touches – loved ones most of all. Atlanta Addiction Recovery Center’s Family Program provides family members support, understanding, compassion and therapy to help mend relationships and tend to their own wounds.