The government making it harder to get opioids is only half the battle. A greater understanding of what opioids are doing to our bodies is the only way forward.
The use of opioid drugs such as codeine has been a source of increasing concern within the community. In the past decade, opioid-related deaths have almost doubled from 591 in 2007 to more than 1,100 in 2016. This is a trend that is reflected internationally, with the United States experiencing record levels of opioid-related deaths year on year.
In response, many countries have chosen to ban the sale of over-the-counter opiates such as codeine. This is now the case in Australia as well, with Health Minister Greg Hunt introducing a blanket ban on all codeine products in 2018. Despite this, there remain risks with dependency on these drugs as a result of over-prescription and abuse.
When it comes to pain management, opioids are a quick but risky fix. Opioid use may be appropriate when experiencing acute pain, major trauma or after surgery. However, even in these cases they should only be used for a few weeks, depending on the severity of the acute injury.
The problem with prolonged opioid use is that they are often not effective for chronic pain conditions, particularly with long-term use over many months. This is an issue when you consider the many side effects and risks of opioid use. Use of opioid painkillers can result in dependency, nausea, constipation, dizziness, fatigue and depression. In the most extreme of cases, prolonged use may lead to poisoning, overdoses and even death. These risks increase significantly when it comes to more powerful opioids such as fentanyl.
While patients may experience benefit from opioid painkillers initially in the first few months, over time patients begin to develop a tolerance. The result of this is that they need to take an increasing amount of these painkillers to achieve the same effect. As time goes on, patients develop a dependency – meaning they cannot do without the opioids. When opioid painkillers are then stopped, patients may experience withdrawal symptoms. These symptoms range from restlessness, anxiety, mood swings and sweating, to increased pain perception, vomiting or abdominal pain. This can make it difficult to stop using opioids after a period of time and people may seek opioids in other forms. Observations studies show that long-term opioid use (of longer than six months) has uncertain benefits for pain levels, while definitely increasing harm for patients.
Overall, there are only a small number of cases in which opioid use is the most effective option… the risks largely outweigh any potential benefit.
Despite the well-known risks of these drugs, opioids continue to be prescribed at a high rate. While there has been a slight decrease in recent years, total prescriptions of oxycodone were at 2.5 million for 2016-2017, an increase of over a million in the past decade. Common chronic pain conditions such as arthritis, migraines, nerve damage and fibromyalgia are commonly cited reasons for requiring opioid painkillers.
Many people use opioids as a quick way to tide over quick bouts of pain as they continue their busy lifestyles, jobs and family life. However, the result of seeing opioids as a “quick” fix is that we are now faced with two problems: chronic pain syndrome as well as opioid dependency and addiction.
Chronic pain is a serious issue for Australians and it’s only going to get worse. One in five Australians are affected by chronic pain, with this number increasing to one in three for people over 65. As the Australian population gets older, so too will the level of chronic pain. This is why patients need to know now how else they can deal with chronic pain going into the future.
It is important for patients to be educated about the potential risks of using opioids. If time is spent with patients to provide a detailed explanation of the risks, some patients may want to seek alternative options. Other treatments such as physiotherapy, cognitive behavioural therapy, relaxation/breathing exercises and mindfulness techniques may be helpful.
If you have been taking opioids for more than two to four weeks, then you shouldn’t try to stop taking them abruptly due to potential withdrawal effects. Instead, the best course of action is to seek medical attention to come off medicines gradually. Discuss a pain treatment plan with your doctor that properly diagnoses the source of the pain and allows you to gradually lower your dependence on the drug. Some chronic conditions, such as back pain, can have several sources. It might be due to a misplaced disc, nerve problems or muscle issues. The treatment for the underlying condition is important. Knowing the reason for the pain can mean you have the appropriate long-term treatment.
Overall, there are only a small number of cases in which opioid use is the most effective option. When it comes to long-term or prolonged use, however, the risks largely outweigh any potential benefit. It is important that people have open and frank discussions with their doctors to make sure that their pain is being managed both adequately and safely.