Opioids and our community

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Arthritis and opioid use?

When you have rheumatoid arthritis your immune system, which normally fights infection, attacks the lining of your joints. This makes your joints swollen, stiff and painful. The small joints of your hands and feet are usually affected first. There is currently no cure for rheumatoid arthritis at present, so the treatments aim to relieve the pain and stiffness and improve your ability to move.

The pain of Rheumatoid Arthritis is severe and constant for some people. People take certain drugs to reduce inflammation prednisone, but due to the side effects may choose to rely on opioids, which include narcotic pain relievers like morphine, oxycodone, fentanyl and buprenorphine.

Opioids are powerful pain‐relieving substances that range in strength from relatively mild, such as codeine, to strong, such as morphine. They can be taken in pill form, injection or patch placed on the skin.

Unfortunately, opioids cause patients to become biologically dependent on them over time. Some rheumatoid arthritis patients may consistently take opioids (escalating in their dosing) for years or decades. This can have a significant impact patients’ digestive system and their ability to have regular bowel movements.

For some patients, dietary changes and over-the-counter laxatives may not alleviate motility problems. These patients should ask their doctor about other therapeutic options to aid this serious health condition.

CJ position on opioids

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We need more robust studies to help us understand when and if the use of long-term opioid medications can be helpful and how best to counteract the side effects, including constipation and dependency. We also need to uncover more details about the risk of neonatal opioid withdrawal syndrome (NOWS), which occurs after a baby has been exposed to these drugs while in the womb.

Physicians need to be better educated about the diagnosis and treatment of patients suffering with chronic pain and how OIC affects patients’ lives. This can change through better communication between the patient and physician.

Thankfully, there are treatments to quell the severity of these negative side effects caused by opioids. They are called gastrointestinal (GI) motility drugs. While these treatments are fairly new, the hope is that collectively, we can seek to expand access to an incredibly important and innovative medication. It is important to support coverage of GI motility drugs by pharmaceutical and therapeutic committees nationwide.

Prescription opioid abuse is real

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Pain is a message that damage is occurring to the body and we need to take action. The physiology of acute pain is tissue damage and the resolution of the pain is associated with healing of the injury.

Over the years, the medical profession has accumulated an array of therapeutic tools to combat chronic pain, but a cure still eludes us. Opioid medications constitute one such tool. In 1997, the American Academy of Pain Medicine, in acknowledgement of the severity of the suffering of patients with chronic pain as well as our inability to provide patients with acceptable solutions to their pain, issued a consensus paper endorsing the use of opioid medications for the treatment of chronic noncancerous pain.

The Academy acknowledged that one of the problems with long-term use of opioids was addiction. In response, the medical profession began making the distinction between addiction and dependence. Addiction was defined as a craving for opioids with the intention of getting “high” as associated with drug-seeking behavior. Dependence occurred when an opioid medication was prescribed for medical reasons.

Since then, the sales of prescription opioid medications measured in grams skyrocketed. Between 1997 and 2007, sales rose by 866% for oxycodone, 525% for fentanyl, 280% for hydrocodone and 222% for morphine. As reported in Pain Physician in July 2012, “Gram for gram, people in the United States now consume more narcotic medication than any other nation worldwide.” The report goes on to document that over 90% of patients taking opioid pain medications were prescribed these medications for the treatment of chronic pain.

The consequences of this explosion in the use of prescription narcotic medication for chronic pain have been horrific. In 2011, approximately 17,000 drug overdose deaths involved prescription opioid medications, and according to the CDC, “In 2007 there were more opioid analgesic deaths than overdoses involving heroin and cocaine combined.”

Chronic pain is not a “thing” but one manifestation of a complex physiologic process that frequently impacts many functions in the body, including the gastrointestinal, psychological, endocrinal systems, and sleep. Treatment of individuals requires that we take a whole person perspective in our diagnosis and treatment, which requires a multidisciplinary approach.

More Americans now die every year from drug overdoses than in motor vehicle crashes and the majority of those overdoses involve prescription medications. Health care providers wrote 259 million prescriptions for opioid pain medications in 2012 – enough for every American adult to have a bottle of pills.

Opioids are a class of prescription pain medications that includes hydrocodone, oxycodone, morphine, and methadone. Heroin belongs to the same class of drugs, and four in five heroin users started out by misusing prescription opioid pain medications. In 2010, the President released his first National Drug Control Strategy, which emphasized the need for action to address opioid use disorders and overdose, while ensuring that individuals with pain receive safe, effective treatment.