According to the Centers for Disease Control and Prevention (CDC), 91 Americans die every day from an opioid overdose. In fact, overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths, the CDC affirms.
How opioids work
According to Shalu Gugnani, M.D., Behavioral Health Services Medical Director and Addictionologist at Northwest Community Healthcare (NCH), “Opioids act on various receptors throughout the body; and while they act on areas which help people alleviate pain, they also directly or indirectly trigger circuitry that give people a sense of pleasure or well-being that would normally be achieved by activities such as eating or sex.”
People can develop a tolerance to them, Dr. Gugnani adds.
“When the opioid is taken away, withdrawal symptoms develop, as the brain has adapted to receiving such high levels of the drug,” she says. “At this point, patients may experience intense cravings for the opioid, not just to feel pleasure, but simply to feel OK.”
Used to treat chronic pain, opioids are commonly dispensed, but taking the drugs for longer periods of time increases the risk of a substance use disorder, overdose and death.
“Just like diabetes, heart disease, cancer or other conditions, addiction is a chronic medical condition that requires long-term management,” Dr. Gugnani says. “Some individuals have a genetic predisposition to addiction, and others use a substance and their brain neurochemistry can be altered such that they need a substance.”
How to avoid opioid addiction
When appropriate, take non-narcotic pain medications such as acetaminophen, ibuprofen or naproxen.
In some cases physical therapy can reduce pain. NCH has physical rehabilitation therapists who can help with back and neck pain, arthritis, sports-related injuries and pre- and post-joint replacement surgery.
Exercise to reduce pain levels.
Cognitive behavioral therapy for chronic pain can be an effective approach. “The goal of cognitive behavioral therapy is to alter or reframe thinking patterns in response to pain and to decrease emotional stress,” explains Dr. Gugnani. “In turn, this can increase one’s tolerance of pain, and leads to improved functioning and quality of life.” She recommends mindfulness, acceptance and commitment therapy, and biofeedback, which have shown promise in managing chronic pain.
Follow the “fewer doses/fewer days” rule if you must take opioids. According to the CDC, “three days or less is often enough; more than seven days is rarely needed,” for a prescription. Ask your physician to prescribe the lowest effective dose possible of immediate-release opioids when starting, and reassess benefits and risks when considering increasing the dosage, the CDC recommends.
Dr. Gugnani says a comprehensive pain management program that employs medication, physical therapies and behavioral therapies is most effective in helping patients achieve their goals.