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Opioid-Abuse (3)

02 Nov

Opioids are a powerful class of drugs, but their use is coming under more and more scrutiny, mainly due to the high levels of prescription misuse, addiction and overdose. While finding alternatives to opioids is one component of this often complicated issue, determining what factors predispose people to abuse and addiction may be just as important.

Previous research into opioid abuse and addiction has revealed several factors that play into the development of opioid use disorder (such as a personal or family history of substance abuse,[1] psychological problems[2] or a history of abuse before adolescence[3][4]), but a new study has revealed a surprising new factor that has the ability to increase the risk of opioid addiction by a staggering 41%: pain levels.

Study Overview

The study, titled “Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample,” was published in July in the American Journal of Psychiatry.[5] The research was large scale, utilizing data of about 34,000 patients, which was obtained through the National Epidemiologic Survey on Alcohol and Related Conditions. The objective was to determine what relationship, if any, exists between moderate to severe pain and the likelihood of developing prescription opioid use disorder.

The study measured pain on a five-point scale based on how much it interfered with a patient’s daily life, and prescription opioid use disorder was determined through a structured interview. Both of these components were measured at baseline (between 2001 and 2002) and again three years later.

Key Findings

The study found that moderate to severe pain was significantly linked with opioid use disorder, both at the start and three years later. In fact, these individuals had a 41% increased risk of developing the disorder. This finding was independent of several demographic and clinical characteristics, including age, gender and anxiety and mood disorders.

The authors also found that despite women and older adults being more likely to report pain, it was men and younger adults who were more likely to experience opioid use disorder, lending more evidence to the theory that age and gender do, indeed, have an impact on the risk of developing opioid-related issues.

Implications for the Future

These finding not only point to the need for appropriate screening and monitoring for those on opioids – especially for those with more severe pain conditions – but they also demonstrate the need for effective interdisciplinary care from the onset. In a press release regarding the study, senior author Dr. Mark Olfson, a psychiatry professor at Columbia University Medical Center, said, “In light of the national opioid abuse epidemic, these new results underscore the importance of developing effective, multimodal approaches to managing common painful medical conditions.”[6]

Effectively treating painful conditions before they get to the moderate or severe stage has the ability to substantially lower the disconcerting trend of opioid abuse and addiction. Similarly, offering comprehensive alternatives to opioids no matter the pain level can effectively diminish reliance on these risky drugs. These steps, paired with close monitoring for signs of addiction among at-risk individuals, pill counts and drug testing for those on long-term opioid maintenance, may be able to reduce the number of those with opioid use disorder while simultaneously improving care for the chronic pain population as a whole.

Advanced Pain Management is committed to providing such a multidisciplinary, individualized approach, in addition to a safe, patient-centered medication management program. To learn more, call (888) 901-PAIN or download our in-depth guide to opioids and pain.

Download your free opioids and pain in-depth guide

[1] Michna, Edward, Edgar L. Ross, Wilfred L. Hynes, Srdjan S. Nedeljkovic, Sharonah Soumekh, David Janfaza, Diane Palombi, and Robert N. Jamison. "Predicting Aberrant Drug Behavior in Patients Treated for Chronic Pain: Importance of Abuse History." Journal of Pain and Symptom Management 28, no. 3 (September 2004): 250-58.

[2] Martins, S. S., M. C. Fenton, K. M. Keyes, C. Blanco, H. Zhu, and C. L. Storr. "Mood and Anxiety Disorders and Their Association with Non-medical Prescription Opioid Use and Prescription Opioid-use Disorder." Psychological Medicine 42, no. 06 (June 2012): 1261-272.

[3] Kendler, Kenneth S., Cynthia M. Bulik, Judy Silberg, John M. Hettema, John Myers, and Carol A. Prescott. "Childhood Sexual Abuse and Adult Psychiatric and Substance Use Disorders in Women." General Psychiatry 57, no. 10 (October 2000): 953-59.

[4] Naqavi, Mohammad Reza, Masood Mohammadi, Vahid Salari, and Nouzar Nakhaee. "The Relationship between Childhood Maltreatment and Opiate Dependency in Adolescence and Middle Age." Addiction & Health 3, no. 3-4 (2011): 92-98.

[5] Blanco, Carlos, Melanie M. Wall, Mayumi Okuda, Shuai Wang, Miren Iza, and Mark Olfson. “Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample.” American Journal of Psychiatry July 22, 2016.

[6] Columbia University Medical Center. “Significant Pain Increases the Risk of Opioid Addiction by 41 Percent: First Study to Make Direct Link Between Pain, Opioid Addiction Risk.” July 22, 2016. Accessed November 21, 2016. https://www.sciencedaily.com/releases/2016/07/160722092937.htm.

01 Nov

On July 13, Wisconsin’s Gov. Scott Walker, along with 45 of his fellow governors, took a major step in the fight against opioid abuse by signing the Compact to Fight Opioid Addiction, a promise to build on each state’s existing efforts in order to end the national opioid epidemic.

Overview of the Compact

The compact, developed and released by the National Governors Association, was a product of the association’s national meeting, where the governors agreed that collective action must be taken to end this public health and safety emergency.

A cornerstone of this compact is forming partnerships with healthcare providers to develop evidence-based opioid prescribing guidelines and ensure all providers have adequate training on pain management and opioid prescribing and addiction.

Mirroring Advanced Pain Management

This compact mirrors the current efforts of Advanced Pain Management, whose June “Time to Intervene” panel event brought together physicians, law enforcement and government officials in the fight against opioids. To address the crisis on an individual level, the company has been utilizing CDC-based opioid prescribing guidelines, along with prescription drug monitoring program (PDMP) data, to ensure the safety of their pain patients, who are oftentimes at a high risk for overdose or abuse. On a community level, their physicians are committed to educating providers and the public alike on the dangers of opioids, the current state of the national crisis and alternative treatment options.

Additional Points of the Compact

In addition to partnering with the healthcare community, the governors hope to address the epidemic by reducing health plan barriers in attaining comprehensive pain management services, as well as in obtaining addiction recovery services. Other ideas mentioned in the compact include strengthened PDMPs and Good Samaritan laws and increased access to the life-saving drug naloxone, all of which Wisconsin is already considering or has placed in action.

The governors will report on the steps their states have taken at the 2017 winter NGA meeting.

In a press release regarding the compact, Gov. Walker stated, “This is a national issue, and we all need to work together to get to the root of the problem so we can fight it.” Together, state and national officials, along with doctors, law enforcement and companies like Advanced Pain Management, may finally be able to stem the tide of this dangerous crisis.

Download your free opioids and pain in-depth guide

01 Nov

Tolerance, dependence, addiction – some risks of long-term opioid use are well-known and often talked about. But these aren’t the only negative effects that may arise. There are actually a plethora of common side effects and risks brought about by using these medications, and almost all patients taking opioids for chronic pain (96%) will experience at least one such side effect.[1]

So whether you’re currently on a long-term opioid regimen or simply weighing your pain management options, knowing all the risks of prolonged opioid use could save you some significant suffering down the road. Let our list of seven lesser-known opioid risks and side effects help guide your decision.

  1. Gastrointestinal issues. One of the most prevalent side effects of opioid usage is constipation. In fact, studies have shown that 40%-45% of those on opiate therapy suffer from it.[2] But it’s not the only gastrointestinal trouble caused by opioids; it’s only one of the symptoms categorized under the title “opioid-induced bowel dysfunction,” which also includes abdominal cramping, spasm and bloating, among others.[3] But constipation is often considered one of the worst, since it’s often unmanageable with OTC treatments like stool softeners and laxatives. 2 In addition to bowel-related disorders, opioids can also cause nausea in 25% of people.
  2. Sleep-related breathing problems. Abnormal breathing while asleep is a concerning issue for those on opioids, especially those on high doses. In fact, in a small study, 92% of patients on a dose of more than 200 morphine milligram equivalents (MME) a day experienced ataxic or irregular breathing, compared to 61% of people taking less than 200 mg and 5% of people not taking opioids.[4]
  3. Cardiovascular issues. Long-term opioid use, when compared with NSAIDs, has been shown in some studies to pose an increased risk for events such as myocardial infarction and heart failure.[2][5] This is especially true for those taking codeine for more than 180 days.
  4. Hyperalgesia. Opioid-induced hyperalgesia (OIH) is another possible outcome for patients on long-term opioid therapy. In cases of OIH, the patient actually becomes increasingly sensitive to pain. Although it’s not clear how prevalent OIH is, it can certainly cause some unwanted effects, including extreme acute pain after surgery and escalating opioid dosages.[6]
  5. Increased risk of fractures. Opioid use is associated with an increased risk of fractures, especially among the elderly population. The theory behind this is that opioids affect the central nervous system, causing such symptoms as dizziness and reduced alertness. [2][7] This, in turn, can result in falls. Elderly patients taking more than 50 MME a day have recently been found to be at double the risk of fracture among the elderly population, with a yearly fracture rate of 9.95%.[2]
  6. Hormone problems. Chronic opioid therapy can also have an impact on the endocrine system, causing hormone changes in both men and women. For men, this manifests as hypogonadism, which causes a decrease in the production of sex hormones, particularly testosterone, as well as erectile dysfunction, reduced libido, fatigue and even hot flashes.[8] In women, opioids can cause a decrease in the levels of estrogen in the body, in addition to low follicle-stimulating hormone and increased prolactin. Combined, these changes can lead to osteoporosis, inappropriate milk production and light or infrequent periods.[2]
  7. Depression. Patients on opioid therapy for long periods have an increased likelihood of developing depression. In one study, 38% of people on long-term opioids had at least moderate depression. [2][9] Furthermore, other opioid side effects, like intractable constipation, can lead to or worsen depression. [2]

Opioids can be a useful component in the treatment of pain, but they’re not the only option. If you’re experiencing side effects from long-term opioid treatment – or would like to find pain relief without the use of opioids – consider talking to a pain management specialist, who may be able to recommend other treatment options, including minimally invasive procedures.

Download your free opioids and pain in-depth guide

[1] Gregorian, Razmic S., Alexander Gasik, Winghan Jacqueline Kwong, Simon Voeller, and Shane Kavanagh. "Importance of Side Effects in Opioid Treatment: A Trade-Off Analysis With Patients and Physicians." The Journal of Pain 11, no. 11 (November 2010): 1095-108.

[2] Baldini, Angee, Michael Von Korff, and Elizabeth H. B. Lin. "A Review of Potential Adverse Effects of Long-Term Opioid Therapy." The Primary Care Companion For CNS Disorders 14, no. 3 (June 14, 2012).

[3] Panchal, S. J., P. Müller-Schwefe, and J. I. Wurzelmann. "Opioid-induced Bowel Dysfunction: Prevalence, Pathophysiology and Burden." International Journal of Clinical Practice 61, no. 7 (2007): 1181-187.

[4] Walker, James M., Robert J. Farney, Steven M. Rhondeau, Kathleen M. Boyle, Karen S. Valentine, Tom V. Cloward, and Kevin C. Shilling. "Chronic Opioid Use Is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing." Journal of Clinical Sleep Medicine 3, no. 5 (August 2007): 455-61.

[5] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[6] Lee, Marion, Sanford Silverman, Hans Hansen, Vikram Patel, and Laxmaiah Manchikanti. "A Comprehensive Review of Opioid-Induced Hyperalgesia." Pain Physician 14 (2011): 145-61.

[7] Li, L., S. Setoguchi, H. Cabral, and S. Jick. "Opioid Use for Noncancer Pain and Risk of Fracture in Adults: A Nested Case-Control Study Using the General Practice Research Database." American Journal of Epidemiology 178, no. 4 (August 15, 2013): 559-69.

[8] Smith, H. S., and J. A. Elliott. "Opioid-induced Androgen Deficiency (OPIAD)." Pain Physician 15, no. 3 (July 2012): ES145-156.

[9] Sullivan, Mark D., Michael Von Korff, Caleb Banta-Green, Joseph O. Merrill, and Kathleen Saunders. "Problems and Concerns of Patients Receiving Chronic Opioid Therapy for Chronic Non-cancer Pain." Pain 149, no. 2 (May 2010): 345-53.

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