War on Opioids

In midst of raging epidemic, health care industry has tighter rein on medication

By Barbara Pierce


We’ve seen a staggering increase in opiate painkiller abuse over the past decade.

New York, like many states, is suffering the consequences of an opioid epidemic. Every day on the news, we hear horror stories of young people dying, small children sadly neglected, and families ripped apart. Most of us know someone seriously affected by opiate abuse.

Opioids are a class of drugs that include the synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. They are chemically similar to heroin.

Pain is the No. 1 one reason people see a doctor or go to the emergency room. Opioids are often used to treat pain because they work so well.

Opioids can stop the body from processing pain on many levels, from the skin to the brain. Because they work throughout the body, they are extremely effective for multiple types of pain.

But they are highly addictive: the more people take them, the more they crave them. This can lead to addiction, or continuing to take opioids despite negative consequences. Scientists have not yet been able to develop opioids that reduce pain without producing addicting effects.

The risks of opioid use are well established. Research has found that taking opioids for more than a few days increases your risk of long-term use, which increases your risk of addiction.

Research also finds that about one in four patients on opioids for extended periods will at some point use them in ways other than as intended, with as many as 10 percent developing addiction.

The longer someone takes opioids, the more they may need to take to get the same effect. This is called building tolerance. Having a high tolerance doesn’t always mean you’ll become addicted. But taking higher doses of opioids increases the risk for both addiction and overdose.

Many who become addicted have turned to heroin as a “more affordable” alternative once their doctor stops prescribing and buying pills on the street becomes too costly. This is especially true of those who receive an opioid prescription as a teenager.

ED doctor weighs in

Kirby Black, emergency department medical director at Oneida Healthcare, explained how the emergency department handles this issue.

Q.: You see many patients in pain. What do you prescribe for pain?

A.: “The vast majority of patients we see in the emergency department have a complaint that involves pain,” he said. “There are many modalities to deal with pain. In the emergency department, these are mostly going to involve medications.”

“In all situations, opiates are the last resort for pain,” he explained. “These medications are typically reserved for acute severe pain.

“There is no perfect pain medication. All pain medications have side effects or toxicity issues that need to be considered.”

Other medications may be just as effective for acute pain, even after surgery. The general alternatives are Tylenol, ibuprofen or naproxen.

Some of these drugs, like Tylenol or ibuprofen, don’t require a prescription. People may think that prescription drugs work better for acute pain, but that’s often not the case.

“In the emergency department, I also often use lidocaine patches as well. And there are other options for topical preparations available, including several over-the-counter medications,” he said.

Q.: What is the health community doing to curb opioid dependency?

A.: “There are many steps which the health community is taking to curb opioid dependency,” said Black. “Opioid prescriptions are monitored much more closely than any other prescription. Each state has a database that tracks narcotic prescriptions so physicians and pharmacists can be aware of potential dependency issues.

“Over the past few years, there has been increased awareness of the epidemic which also includes mandatory education that is required by almost all states with license renewal,” he added. “We at Oneida Healthcare are taking steps to track and review the rate of prescriptions, as well as providing education and encouraging the use of non-opioid medications when possible.”

Q.: What do you think about using naloxone to reverse an opioid overdose?

A.: Naloxone is a lifesaving medication that reverses the effects of narcotics when given right away, Black explained. “I have used it many times in the emergency department, and it is used often by paramedics to save the life of someone who has overdosed. I also prescribe naloxone for patients to have around if they overdose. Even if it is not used on them, it may benefit another person.”

Dealing safely with pain

Things you can do if you’re prescribed an opioid:

— Ask if there are ways besides opioids to relieve your pain.

— Make sure your health care provider knows about all other medications you are taking.

— Let your health care provider know if you or others in your family have had any problems with addiction, such as with alcohol, prescription medications, or illicit drugs.

— Ask about the risks of taking an opioid.

— Ask how to take the opioid and how long you should take it.

— Never use alcohol when taking an opioid.

— Store opioids in a safe place out of sight and out of reach of children, preferably in a locked cabinet.

— Dispose of leftover prescription medicine quickly and properly.

Source: National Institutes of Health