Written by Samar Arshad and Edited by Gouri Ajith
Opioids – pain alleviators, or fatal drugs in disguise? For many centuries, opioids have been regarded as one of the most effective pain medications used in the medical setting. In essence, opioids are considered a standard form of biomedical care, utilized in most parts of the world to manage acute to chronic levels of pain [1]. Generally, the term “opioids” refers to opiate receptors on cells of the nervous system throughout the brain and body, and the various compounds that bind to them [2]. Once a receptor and opioid compound have bound to one another, pain relief is instant. [3] However, in addition to alleviating pain, opioids also produce euphoric feelings that many regard as being the dark side of such an essential form of medication. These side effects are a significant portion of the current discourse on how opioids are involved in addiction and drug abuse. Also relevant is how those in the biomedical sphere can help patients alleviate their chronic pain without the use of this double-edged sword.
When a person is no longer utilizing opioids simply for pain relief, the following can ensue: opioid tolerance, opioid dependence, and opioid addiction [4]. Specifically, brain abnormalities occur when one has abused opioids to the point of dependence – the body cannot function without the perpetual feeling of euphoria that opioids induce, and thus “demands” this feeling at all times. Opioid use becomes even more problematic when one uses it without having any significant pain – it is in this circumstance that opioids solely activate reward processes in the brain, further motivating one to use them for pleasure rather than for prescription purposes. As the brain becomes tolerant of such harsh compounds, the opioid user falls into the dark hole of addiction.
While many may choose to utilize opioids for pain relief, there is a high risk of addiction for any person who uses them. Fortunately, there are alternatives to using opioids, as it has been found that people dealing with chronic pain – who would traditionally benefit from the use of opioids to relieve their pain – can permanently taper off pain medication use thorough alternative interventions such as meditation or psychological counseling [5]. However, very few people have access to such alternative measures, and as a result must rely solely on opioids to relieve their chronic pain. Due to the lack of accessibility to alternative interventions, there has been close to a 345 percent increase in opioid-related deaths within the last 16 years. Some legislature has been passed to drastically restrict the amount of pain medication doctors can prescribe, but it has only forced patients to reduce their use of the drug with minimal support and guidance from healthcare professionals on how to do it safely and successfully [5].
Aiming to taper opioids to reduce patients’ fatal dependency on them, an opioids researcher at Minneapolis Veterans Affairs Health Care System found that as opioid doses are gradually reduced, most patients end up with mitigated pain and a better quality of life [5]. However, it is notable that the studies that found this association stressed multidisciplinary care, as well as close follow-up of patients throughout their journey. As such, it is evident that the involvement of attentive and caring healthcare providers is crucial to the process of opioid tapering, and leads to better health outcomes for patients in the end. Unfortunately, many chronic pain patients in the U.S. who are addicted to opioids may not have health insurance or access to proper healthcare facilities, thus greatly inhibiting their ability to receive quality care and support.
At the end of the day, pain is pain – however, with the support of doctors, pharmacists, and even mental health professionals, opioid dependency can be addressed and treated [5]. While many may think otherwise, mental health professionals can help opioid-addicted patients by proposing alternative methods for dealing with pain, such as setting personal goals and thereby working with patients’ cognitive capacities to look within themselves and work to move beyond their addictions [5]. Additionally, the wide range of healthcare providers should advocate for alternative methods of dealing with pain that do not involve the risk of enslavement to opioids. Following in the footsteps of the National Pain Strategy, a program started by Stanford University’s Division of Pain Medicine, it will be important for current and future medical professionals to regard opioid addiction as a true public health crisis that cannot be resolved by simply developing treatments [6]. In order to alleviate the epidemic and improve people’s health outcomes as a whole, patients need to be educated on the appropriate uses of opioids as well as have an interdisciplinary medical support system that helps guide them in dealing with their pain without resorting to these small but deadly drugs [6].
References:
- Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Experimental and Clinical Psychopharmacology, 5: 405-416.
- National Institute on Drug Abuse. “Opioids.” NIDA, www.drugabuse.gov/drugs-abuse/opioids.
- “The National Alliance of Advocates for Buprenorphine Treatment.” How Do Opioids Work in the Brain?, www.naabt.org/faq_answers.cfm?ID=6.
- Kosten, Thomas, R., Tony, G., P., (2002). “The neurobiology of opioid dependence: implications for treatment”. Science & practice perspectives, 1:13-20.
- Wallis, Claudia. “How to Help Pain Patients Cut Back on Opioids.” Scientific American, 1 Oct. 2018, www.scientificamerican.com/article/how-to-help-pain-patients-cut-back-on-opioids/#googDisableSync.