More Americans now die every year from drug overdoses than car accidents. And the majority of those overdoses involve prescription medications. In 2012 alone, health care providers wrote enough prescriptions for opioid pain medications to provide every American adult with a bottle of pills, the
White House noted in a recent statement.
These statistics — and frequent headlines about the United States’ opioid abuse “epidemic” — are alarming. But so is chronic pain, a debilitating affliction that, according to the National Institutes of Health (NIH), affects about one-third of the U.S. population.
For many chronic pain sufferers, prescription medications are the only way to manage pain and restore their quality of life. Prescriptions of opioids, a class of prescription pain-relievers that includes Vicodin (hydrocodone/acetaminophen), Percocet (oxycodone/acetaminophen) and Oxycontin (oxycodone) are particularly on the rise. According to the NIH, the number of prescriptions written for two opioids for pain treatment nearly tripled between 1991 and 2011.
“I think we’re in an era where health care providers are taking pain management more seriously, which is a good thing. I don’t think pain was assessed and managed properly in the past,” says
Rabia Atayee, PharmD, associate clinical professor in the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California, San Diego. “But on the flip side, this means more patients are getting opioids without fully understanding risks and benefits.”
Atayee specializes in pain management and works with patients at Moores Cancer Center at UC San Diego Health and Thornton Hospital. Her research is focused on evaluating how opioids are used in hospitals and developing strategies to manage opioid-induced side effects.
“Opioids can be polarizing — people tend to think these medications are either ‘the best’ or ‘horrible,’” Atayee says. “We want to dispel those myths and help people reach a middle ground when it comes to treating pain with opioids. Like any other mediation, opioids have their risks and concerns and of course shouldn’t always be used for everyone in pain, but we think these medications are beneficial and effective for certain people.”
Managing the medication
For chronic pain sufferers who would benefit from opioids, Atayee has some advice for decreasing risk during treatment. First, it is important to work with your provider to be sure you only take opioids while you are experiencing pain that can’t be treated as effectively any other way and while the benefits outweigh the risks, she says. Throughout treatment with opioids, it’s helpful to involve family members in understanding medications, to help prevent misuse and abuse. Then it’s essential to taper off of these medications with the help of your provider.
“The goal in prescribing opioids is that patients with pain will live and function better while on opioids than without opioids,” Atayee says. “Studies have shown that when opioids are taken exactly as prescribed they are generally safe to use, manage pain effectively, and rarely cause addiction.”
That’s the rub, though: 20 to 30 percent of patients prescribed opioids for chronic pain are misusing the medication, according to a study published April 2015 by the International Association for the Study of Pain. “Misuse” covers a wide range of behaviors — everything from sharing pills to taking more than is prescribed.
To prevent opioid misuse and abuse, Atayee and her colleagues are looking for new ways to help physicians set limits when it comes to prescribing opioids. They want to see more physicians prescribing only limited amounts of opioids to their patients, and then scheduling frequent follow-up visits to assess if the opioid is improving their quality of life.
“If prescribed and used correctly, opioids should help patients sleep better, work better, live better,” Atayee says. “What we don’t want to see is a patient whose function and quality of life decreases after starting an opioid.”
Unfortunately, opioid abuse extends beyond the doctor and patient. According to National Survey on Drug Use and Health, more than 50 percent of people who misuse or abuse opioids didn’t get it from a prescription. They got it from someone they knew and they didn’t have to pay for it.
“We reach a national crisis of abuse when opioids get into the hands of people who they are not intended for,” Atayee says. “That puts the responsibility on the person who is prescribed opioids to use them properly, not share them with others, and discard leftovers appropriately.”
Atayee explains that discarding leftover opioids properly could mean mixing unneeded pills with kitty litter, coffee grounds or bleach to make them unappetizing before discarding them. Alternatively, you can contact your sheriff’s department to learn about “prescription take back” programs in your area.
“According to the California Department of Public Health, there were more than 7,000 opioid-related deaths in California between 2008 and 2012,” Atayee says. “I believe most of those deaths could’ve been prevented.”
Care at UC San Diego Health
Center for Pain Medicine