Unfortunately, it happens all the time. Patients are prescribed narcotic painkillers for legitimate reasons and then, become addicted to them. Most of the time, the doctors who are prescribing the medicines are good physicians who mean well. They are just trying to relieve pain in order to help their patients, but the very prescription that is given to relieve pain can often turn into a lifetime of misery. Historically, no data has been available on just how often this happens, but a recent study provides some frightening answers.
The study looked at over one million patients who were given a new prescription for opiate pain medications and then followed them to see how many were still taking opiates 12 months later. They excluded any patients who had received an opiate prescription in the prior 6 months - so the one million excluded any chronic pain patients who may have already been addicted. The study also excluded any patients with cancer.
What they found was very scary for patients who were prescribed opiates for more than one day. The study found that if the patient was prescribed opiates for only one day there was a low chance these patients would turn progress to long-term use, but, if the patient was given a script for just 10 days, there was a 1 in 5 chance (20%) that the patient would still be taking them 1 year later. The results are astounding. Consuming a prescription of opiates for only 10 days leads to chronic use for over 20% of the patients. It was even worse if the patients were given a script for 30 days. If patients received opiate scripts totaling 30 days of narcotics, the likelihood that they would still be taking opiates 12 months later was up to 30%. The implications for physicians and patients are clear - avoid these drugs as much as possible.
I frequently get asked by patients who are in recovery how they should handle situations like kidney stones, broken bones, or surgery where they will likely want or need some form of opiate pain medicine. Unfortunately, we frequently see patients who come to us for detoxification off of opiates. They were in recovery but then developed a medical condition that required pain medicines. We all need to be extremely careful.
Here are some brief suggestions:
- Have the physician use regular doses of the same meds that they would normally use during any procedure and immediately post-op.
- Ask the doctor how long the average person needs to stay on opiate medicines for this condition, and how quickly can people stop taking the opiates.
- Use non-opiate pain relieving methods - ice, NSAID’s (non-steroidal, anti-inflammatory drugs), Tylenol, etc., as first line. Only use the opiates if these other methods are insufficient to relieve the pain.
- When you do require opiates for pain, go home with an average dose for no more than one week.
- Have someone else hold the medicines and dispense them as needed – with no intention to make you suffer – just put an extra step in between wanting the medicine and taking the medicine.
- Continue weekly visits with the physician who is prescribing the medicines until opiates are no longer needed.
When these suggestions are followed, it is easier to avoid a return, or even a start, towards opiate dependence or addiction. The current opioid epidemic has made it clear that it is very important for physicians to prescribe as few of these drugs as possible and for patients to take as few of these drugs as possible.