One patient was a legal secretary for one of the US’s biggest corporate lawyers.
Another was a suburban mother in New Jersey who died in her sleep. Then there was the internationally recognized photographer who had an exhibition at the Louvre Museum in Paris.
None of these were the type of person who usually comes to mind when most people think about opioid abuse. Far removed from a figure hunched in a corner of an abandoned building or someone furtively purchasing heroin in a city alley, these people (and countless others) all had one thing in common: they developed crippling addictions to the opioid prescription painkiller Oxycontin.
Their stories are discussed in “Empire of Pain: The Secret History of the Sackler Dynasty” by Patrick Radden Keefe. An investigative journalist and staff writer for the New Yorker, Keefe’s book takes a detailed look at the business practices of the Sackler family and their company, Purdue Pharma.
Purdue is the manufacturer of Oxycontin.
A Prescription Turned Gateway Drug
Designed to treat serious and chronic pain, Oxycontin was often prescribed in powerful, long-lasting doses. In turn, this caused many users to engage in prescription painkiller abuse … even if they used the drug under their physician’s directions.
Tragically, many people who developed a dependence on Oxycontin later moved to street opioids such as heroin when their prescriptions ran out.
Many experts blame overprescription for the current opioid epidemic. Keefe’s book details pharmacies who filed thousands of prescriptions for Oxycontin. Additionally, many patients received prescriptions for exceptionally powerful forms of the drug, which resulted in accidental overdoses and increased dependency.
Nobody would deny that there is a legitimate role for painkillers, however powerful, in medicine. Recovery from surgery can be difficult, and chronic diseases such as cancer can be excruciating for patients in late stages of the disease. Even relatively minor procedures such has having your wisdom teeth removed or knee surgery can be painful enough for a physician to prescribe painkillers.
However, a number of recent studies from the University of Michigan (UM) may show opioid painkillers may actually not be needed in some cases where they’ve been prescribed.
Non-Opioid Painkillers May Be As Effective As Opioids In Pain Control
In the first study, UM researchers examined over 22,000 patients from 70 hospitals who had all undergone common surgeries. When the surgeries were complete, 86% of the patients in the study had received a prescription for an opioid painkiller.
Meanwhile, the remaining 14% had non-opioid prescriptions.
Three months after the patients in the study had undergone their operations, the researchers conduced a poll asking them about their pain during the first week after leaving the hospital, if they were satisfied with their care, if they had any regrets about their surgery and so on.
Surprisingly, the UM researchers found very few differences in the survey responses between the two groups. Both reported the same percentages of ER visits and other complications after their respective surgeries. Most notable of all? There was no difference in the percentage of patients from each group who needed emergency care for pain.
Indeed, the patients who received the non-opioid prescriptions reported having no pain during their first week after their surgeries.
In a UM press release, Ryan Howard, MD, the study’s main author said while opioids had been a regular part of post-surgery care for years, their well-known risk for abuse needed to be taken into consideration. “Perhaps it’s time to make them the exception, not the rule,” he said.
Granted, the study’s subjects hadn’t undergone major surgeries, nor were any of them dealing with chronic pain from injuries or disease. Another UM study from earlier in 2021 shows a drug used to treat opioid addiction may also provide people dealing with intense pain a less addictive option.
Naltrexone: From Medication-Assisted Treatment To Pain Management
Chronic pain’s no joke. The CDC estimates 50 million Americans live with chronic pain. Worse, 8% live with what the CDC calls “high-impact” chronic pain.
The costs are heavy: as you can imagine, chronic pain has considerable impact on daily activities. Naturally, it contributes to anxiety and depressive disorders. Worst of all, chronic pain’s also a risk factor for opioid dependence. When it’s treated with prescriptions which also have a high potential for abuse, you can see how easy it is to fall into addiction.
Fortunately, there’s a way out – many people being treated for an opioid use disorder receive medication-assisted treatment, a process where they receive medicines which help them deal with cravings and withdrawal symptoms. One of those medications is naltrexone, which blocks the euphoric effects – the high – of opioid and alcohol use.
Interestingly, naltrexone may also be a pain reliever in small doses. Although it’s not approved by the FDA for pain management, studies seem to show naltrexone seems to have some pain reducing qualities. Researchers from UM’s School of Dentistry found low doses of the drug were able to treat oral and chronic pain. According to the researchers, naltrexone seems to affect the nerve pathways the body uses to reduce pain.
“Low-dose naltrexone begins to address the cause of pain and not just mask it, which allows us to better target diseases causing chronic pain, as well as potentially consider pain control outside of opioid use,” said Elizabeth Hatfield, DDS, lead author and lecturer at UM’s school of dentistry in a press release.
It’s a hopeful development for anyone dealing with chronic pain … and yet concerned about the potential for addiction.
“Our heroin patients come from the five best neighborhoods.”
That’s a quote from Robert Martin, who was director of substance abuse services at Carolinas Medical Center in Charlotte, N.C. in 2013. Now a consultant in the treatment industry, Martin was speaking to USA Today in the wake of a study published by the center.
In the study, Carolinas Medical researchers looked at the ZIP codes of patients who were in the center’s detox facility. Interested in seeing where heroin users first used the drug, the researchers were shocked to discover many of their detoxing patients came from Charlotte’s wealthiest neighborhoods.
Many of them had found the same route discussed earlier in this article: when the patients found prescription opioids too difficult to get, they turned to heroin.
Aside from proving addiction doesn’t discriminate on the basis of race, class or gender, it’s an illustration of addiction’s nature. While almost nobody deliberately seeks out to become addicted, opioids can be so powerful it’s easy to fall into the trap.
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