Thursday, 10 October 2013

Opioid Need vs Opioid Misuse

Today's post from (see link below) is an interesting look at a current hot topic of conversation across the world and that is the increasing dependence on pain killing drugs. It talks specifically about opioids as analgesics. The US authorities especially are trying to clamp down on misuse of these drugs, thinking that the problem is driven more by criminal intentions than genuine medical need. However, people living with severe neuropathy have known for years that there are very few effective alternatives and very often opioids are the only things that can get their nerve pain under control. There's little doubt that doctors are prescribing opioids more widely than ever but that doesn't necessarily mean that they are being misdiagnosed, especially with conditions such as neuropathy. Opioid abuse is clearly a problem but the authorities have to be able to separate the genuine cases of need from those trying to make money out of other people's misery. This story will run and run.

Painkiller Addiction Worse Than Marijuana or Cocaine, Study Finds 
By Amir Khan, Everyday Health Staff Writer WEDNESDAY, August 28, 2013

Addiction to painkillers causes more deaths and illnesses around the world than illicit drugs, according to a new study, and the problem is growing.

Drugs you get from a dark alley may be safer than drugs you get in a doctor’s office, according to a new study published in the journal Lancet. Researchers from School of Population Health at the University of Queensland, Australia found that prescription painkillers contribute to more illnesses and deaths worldwide than marijuana, cocaine or heroin — and experts say the problem is particularly worrisome in the United States.

More than 15 million people around the world are addicted to opioid painkillers, such as Vicodin and OxyContin, compared to 13 million people who are addicted to marijuana, according to the study. Nicholas Kardaras, PhD, an addiction specialist and clinical assistant professor of health science at Stony Brook University in New York, said the findings are not surprising, as opioids are not only heavily addictive, but also very well marketed.

“Opiates have gotten much stronger over time and this creates more dependence,” Dr. Kardaras said. “In addition, pharmaceutical companies advertise these drugs heavily, and this creates a consumer market for powerful pain pills.”

Not only are prescription painkillers addictive, but they are also very deadly. Of the more than 78,000 people who died as a result of drug overdoses in 2010, 55 percent were due to painkiller overdoses, according to the study.

“Opiates are easy to overdose on,” Kardaras said. “When you take too many, your respiration slows down and your breathing stops. It’s very easy to reach that tipping point.”

Opioid addiction is rampant in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 12 million people use prescription painkillers for non-medical reasons in the United States, according to the CDC, and overdoses from them kill more than 14,000 people every year.

“Consumers have a very low pain threshold, so they opt for pain pills very quickly,” Kardaras said.

The problem is only getting worse. In 2009, more than 475,000 people were admitted to emergency rooms due to painkiller abuse — five times the number of people from just five years earlier.

“The question is whether we’re in more pain over that period,” Kardaras said. “But I really don’t think we are.”

But if Americans aren’t in more pain, what’s driving the increase in opiate addiction? Kardaras said it comes down to a lack of education.

 “In medical school, they devote one day out of 6 years of training to talking about opioid addiction,” he said. “Many doctors will prescribe pain pills and not speak to their clients about taking them responsibly.”

Fixing the problem begins in the doctor’s office, said Jorg Pahl, MD, an addiction specialist in Oklahoma City, Okla.

“It’s an issue of careful prescription of medications,” Dr. Pahl said. “Prescribing physicians need to be extra vigilant about evaluating patients for the possibility of drug addiction — for comorbid disorders including chronic pain, or history of addiction, depression, or anxiety disorders.”

In addition, Pahl said there needs to be more oversight around the prescriptions of these powerful drugs.

“Data from Prescription Monitoring Programs, the databases through which state governments collect data on who prescribes and where and when patients and prescriptions get filled, needs to be made available to prescribing physicians nationwide,” he said. “If a patient goes and gets a prescription filled in another state, I as the physician would want to know that. But I really have no way to under the current system.”
Finally, Kardaras said that keeping these drugs out of the reach of children can help cut down on the number of addicts as well.

“The gateway for a lot of young people into drug abuse is their parent’s medicine cabinet,” he said. “If a child is going to abuse drugs, they’re going to take what’s available and what they have access to, which is often painkillers.”

Unfortunately, Pahl said, the problem will likely get worse before it gets better.

“In decades past, doctors prescribed opioids mainly for cancer patients,” he said. “Now opioids are also commonly used for chronic non-cancer pain, especially chronic lower back pain. The U.S. has become overmedicated.”

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