Last week, Tiger Woods was pulled over for driving under the influence…of opioid medications. He is not an IV drug user and he was not drunk behind the wheel. Instead, his judgement was clouded, at least in part, by very strong pain medications. His picture was plastered over every major news outlet, and for better or worse, he is becoming today’s face for an epidemic.
A 2016 Washington Post/Kaiser Family Foundation survey found that 1 in 3 patients who took opioids for at least two months reported feeling addicted or dependent on the drugs. In addition, patients taking opioids prior to surgery have greater post-surgical pain, and face a higher risk of pneumonia, over-sedation and even death. It is not uncommon to have post-surgical patients report they felt symptoms of “withdrawal” after they stopped taking their pain medications only a few weeks following surgery.
According to the U.S. Department of Health and Human Services, more people died from drug overdoses in 2014 than in any year on record, and the majority of drug overdose deaths (more than six out of ten) involved an opioid. Since 1999, the rate of overdose deaths involving opioids (including prescription pain relievers and heroin) nearly quadrupled. On an average day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate nonmedical use of prescription opioids, and 78 people die from an opioid-related overdose. According to the CDC, in 2015 alone, more than 22,000 people died from prescription opioid overdoses, and countless more have had their lives influenced by dependence.
How did we get here?
In 1996, the American Pain Society coined the concept of “pain as the 5thvital sign”. This came over a decade after a letter to the New England Journal of Medicine stated that “the development of addiction is rare in medical patients with no history of addiction.” In the early 90s, narcotic prescriptions increased by 2-3 million each year, and by 1996, that figure jumped to 8 million. Purdue Pharma (maker of OxyContin) released an advertising campaign in 1998 called “I Got My Life Back.” It followed six people who suffered from chronic pain and were treated with OxyContin. In this video, they stated about OxyContin “They don’t wear out; they go on working; they do not have serious medical side effects….So, these drugs, which I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain.”
A year after this video campaign was distributed, over 11 million opioid prescriptions were distributed. In 2007, the Purdue Pharma and three of its executives were charged with misbranding OxyContin and downplaying the possibility of addiction. Three executives pleaded guilty, and the company settled with the U.S. government for $635 million.
In March 2016, CDC Director Tom Frieden wrote in the New England Journal of Medicine that data about long-term use of prescription opioids is lacking. But, he wrote, “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently.” Several more studies have shown that use of opioids for chronic pain may actually worsen pain and functioning, possibly by increasing pain perception.
Where are we today?
Now nearly 2 decades since the medical push for little or no pain, we have an opioid industry that is 2ndworldwide to cancer medications in profitability for big pharmaceutical companies. 80% of the world’s narcotics are consumed through prescriptions in the US, which represents only 5% of the world’s population [Nation In Pain]. According to IMS Health, Vicodin and non-branded hydrocodone combination painkillers are the most commonly prescribed drugs in the US.
While effective for controlling severe pain, we now recognize that opioid medications are best utilized in short duration and with a defined course. They are notthe optimal treatment for chronic pain conditions. Chronic pain from arthritis should not be managed with opioid medications, especially as patients await joint replacement to treat these conditions. Additionally, the duration of use following surgery should be limited and controlled to help avoid the known tolerance and addiction effects of these medications. Under careful supervision and with appropriate indications, these can be very effective medications for patient care.
To highlight the potential dangers of opioids, the American Academy of Orthopedic Surgeons (AAOS) created a campaign to educate providers and patients. Their message: “Painkillers are easy to get into. Hard to escape.”
If you or a loved one is struggling with pain medications, contact your physician to discuss safe alternatives before it is too late.
