COVID-19 aside, the landscape of family practice has changed dramatically in the last few years, especially as it pertains to prescribing medication for patients with chronic pain. The CDC reports that starting in 2006, the total number of opioid prescriptions dispensed continued to rise until it peaked in 2012 at “more than 255 million and a prescribing rate of 81.3 prescriptions per 100 persons.”

Since then the opioid prescribing rate has declined, falling to the lowest level in 13 years by 2018. That was still, by any measure, a large number, coming in at more than 168 million total opioid prescriptions.

Research was consistently proving that quite often, the cons of prescribing strong, addictive pain medications were much higher than the pros.

As the reality and fallout from these prescribing habits continue to be revealed, many family practices are opting to cut down or completely stop treating chronic pain with opioid pain medication.


CHRONIC PAIN MANAGEMENT FAQS


Other Options For Pain Management

This has been tough for patients who relied on these types of medications for years, and who, in the majority of cases, have taken their medications exactly as prescribed. It is often equally difficult for many practitioners who believed this to be a good and helpful component of a comprehensive family or internal medicine practice.

Some doctors will help their patients with a slow taper where the provider prescribes lower and lower doses of the opiate at each visit. Depending on the amount of pain medication a patient is on, and how long they’ve been on it, this may be a very protracted, but safe, solution.

Some people have access to switching to a pain management practice. This of course, depends on insurance, out of pocket costs, and availability of this specialty in the patient’s area. Often people are being switched from short-acting pain medication to long-acting opioids such as methadone or Suboxone.

A patient may be switched to methadone for its ability to stay in the system for at least 24 hours, making dosing only once a day. For people who are using methadone as a treatment for addiction, a daily visit to the methadone clinic is generally the rule. As methadone itself is a long acting opioid, it will cause withdrawal if stopped abruptly.

Long-Term Use of Suboxone and Buprenorphine Products

Other patients who are being transitioned off pain medications are being prescribed one of the several available buprenorphine products. Suboxone, Subutex, and Zubsolv are just a few. These products are actually partial opioid agonists, that is, they may cause some mild euphoria, but much less than short acting pain medications like oxycodone and hydrocodone and their ‘family’, heroin, fentanyl, tramadol, etc. Buprenorphine products such as Suboxone can also last at least 24 hours, again, eliminating the need for dosing every several hours with a short acting medication.

Switching from a short-acting pain medication to a buprenorphine product is fairly simple to do, however, you must find a doctor who has acquired the prescribing credentials, as this is a highly controlled medication.

Patients will often ask, “Well isn’t it just substituting one addictive drug for another when you go from say, Percocet to Suboxone?”

Danger of Suboxone Withdrawal

Medications containing buprenorphine will result in physical dependence when used regularly for a period of time. If a person stops taking Suboxone, he/she will experience opioid withdrawal symptoms, and they may last for an extended period of time.

What About Stopping Pain Medications Altogether?

Other people consider this an opportunity to see what life might be like without being on pain medication at all:

  • The freedom of never worrying about losing a prescription or the medication itself
  • Of not having to plan vacations or travel (remember when we could travel?) around a doctor’s appointment
  • Enduring the judgmental looks from the new or substitute pharmacist
  • Risking one more visit to the doctor and another potential exposure to COVID-19
  • Trying to get a shy bladder going in the clinic
  • Finding out if one’s pain is actually that much better being on these drugs

This growing recognition about the overuse and relative ineffectiveness of using opioids for chronic pain management has brought people from around the country to our clinic. At the Coleman Institute for Addiction Medicine, we offer an Accelerated Opiate Detox (AOD), a safe and comfortable form of rapid detox, to help people get off their pain meds by compressing and addressing their withdrawal symptoms. Depending on the amount of pain medication a person is using, our out-patient detox program will generally last from three to five days.

A cornerstone of the Coleman Method is our use of long-acting naltrexone in the form of a two-month implant at the completion of the detox. Naltrexone occupies the opiate receptors, essentially eliminating physical cravings for opioids and eliminating withdrawal. As naltrexone is a pure blocker, or antagonist, it does not produce dependence or tolerance, and therefore no withdrawal when it is stopped, or when the implant completely dissolves.

You can find more information on our Naltrexone Therapy FAQ page.

Over the past 12 years working at the Coleman Institute, I’ve treated thousands of patients who are dependent on opioid pain medication. They are often quite nervous about how they are going to feel when they have no more opiate medication—after all, they were put on it for pain in the first place. Remarkably, when queried in the months following our rapid detox procedure, our patients almost invariably describe pain levels that are manageable by simply using over-the-counter (OTC) medications or mind-body techniques such as yoga and mindfulness based programs.

It is frightening for a person to consider stopping a medication they’ve depended on for years. If you would like to learn more about The Coleman method, please give our office a call at 877-77-3389. Until then, stay safe!

Joan Shepherd, FNP


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