Headlines declaring that life expectancy in the U.S. has declined for the first time since 1993 because of deaths from opioids are the latest red-flag warning that, as a nation and individually, we need to change both our approach to managing pain with opioids and how we address illicit drug use.
The Centers for Disease Control and Prevention reports that between 2015 and 2016, there was a 28 percent increase in fatal opioid overdoses! In 2016, more than 63,000 Americans died of drug overdose—and 42,249 of those deaths involved opioids. Those drugs are now killing more folks than guns or breast cancer!
To focus the country's health care providers and YOU on the problem, the Food and Drug Administration asked the National Academies of Sciences, Engineering and Medicine to develop a plan to curb the epidemic. Their report, "Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use," is out, as are additional publications, Congressional testimonies and journal editorials based on the findings. They offer guidance that the country and each one of YOU should pay careful attention to.
WHAT YOU NEED
TO KNOW AND DO
If you or a loved one is dealing with acute, chronic or surgery-related pain, it's important to understand the risks and benefits of using opioids and to learn about the full range of pain-management alternatives that are available. A new study shows that 60 percent of opioid overdose deaths involve people who suffer from chronic pain.
The Benefits: Severe pain interferes with healing, quality of life and overall health and well-being. Opioids can eliminate severe pain and allow you to heal or participate in activities (such as physical therapy) that will help you banish the source of pain.
The Risks: Unless pain medicines are administered within a pain-management plan that targets tapering off the drugs as you heal and feel better, it is possible to become addicted even at low doses. (Management of chronic pain associated with end of life is another matter; hospice targets comfort for whatever time remains.)
The Smart Steps:
1. If opioids are the right medication for your pain control, ask your physician to refer you to a pain-management specialist who will guide you through your medication regimen and protect you from addiction.
2. Be conscientious about physical therapy, changing diet to decrease pain/inflammation, adding stress management and other at-home activities when prescribed. It may seem counterintuitive that the strain (and sometimes pain) of physical therapy, along with diet and meditation, can ease chronic pain, but it can!
3. Ask your doctor about taking non-opioid analgesics, including ibuprofen and prescription NSAIDs like celecoxib (Celebrex) and indomethacin (Indocin). A recent study in JAMA found that for "patients presenting to the ED [emergency department] with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics." That matters because it's reported that nearly 19 percent of people leave EDs with an opioid prescription—and even short-term use can trigger dependence. We suggest that even for persistent pain, some NSAIDs are more or less equivalent in effectiveness to low-dose opioids.
4. Explore medical massage to ease distress. Consider acupuncture; pain-management group therapy; gentle stretching; water therapy; and tai chi or yoga (if the doc says they're OK).
WHAT THE GOVERNMENT NEEDS TO DO
1. Make sure pain-management therapies that do NOT rely on drugs are covered by insurance. These days, insurance companies are more likely to cover an oxycodone prescription than acupuncture treatments.
2. Adopt a wide-ranging public health perspective that targets both prescription pain-medication abuse and heroin/fentanyl abuse. And institute evidence-based guidelines for allowing opioid prescriptions. One study found that post-surgery, 43 percent of opioid prescriptions were not necessary for patients' well-being.
3. Make sure that an overdose medication, such as naloxone, is widely available to EMTs, health care facilities, etc.
Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into "The Dr. Oz Show" or visit sharecare.com.
(c) 2018 Michael Roizen, M.D., and Mehmet Oz, M.D.