According to the Centers for Disease Control and Prevention (CDC), each day, 46 people die from an overdose of prescription painkillers in the U.S. Healthcare providers wrote 259 prescriptions for these drugs in 2012—enough for every American adult to have a bottle of pills.
The two are directly related. “An increase in painkiller prescribing is a key driver of the increase in prescription overdoses,” the CDC says, which is one of the reasons why they recently released new guidelines for prescribing opioids for chronic pain.
The new guidelines include recommendations for prescribing painkillers for chronic pain, excluding cancer, palliative, and end-of-life care. They’re meant to help healthcare providers to be sure they’re providing the most effective—and safest—treatments for their patients.
“The United States is currently experiencing an epidemic of prescription opioid overdose,” the CDC stated in a press release. “Increased prescribing and sale of opioids—a quadrupling since 1999—helped create and fuel this epidemic.”
“The United States is currently experiencing an epidemic of prescription opioid overdose,” the CDC stated in a press release. “Increased prescribing and sale of opioids—a quadrupling since 1999—helped create and fuel this epidemic.”
Women, in particular, are suffering.
Women Suffering from More Opioid Addictions
The CDC announced in January 2015 that more than a third of reproductive-aged women enrolled in Medicaid, and more than a quarter of those with private insurance, filled a prescription for an opioid pain medication each year from 2008 through 2012.
Many of these prescriptions are going to pregnant women, and the result is a rise in neonatal abstinence syndrome (NAS), a serious medical condition affects newborns exposed to addictive drugs while in the womb.
According to a 2016 report in the British Medical Journal by Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, estimates are that 14-22 percent of pregnant women receive an opioid prescription during their pregnancies.
Meanwhile, there has been a rise in opioid use disorders among pregnant women. Incidence of NAS has increased from 1.20 to 3.39 per 1,000 live births, between 2000 and 2009, and studies also indicate that opioid exposure can disrupt attachment between mom and baby, and cause cognitive impairments in children.
It’s not just pregnant women and their children that are at risk, however. A 2015 study showed that women, in general, are more likely than men to be introduced to opioids through a painkiller prescription. The proportion of women seeking treatment for opioid addiction has grown so much that today, the number of men and women receiving therapy in clinics for this addiction is about equal.
The CDC hopes that its new guidelines will help reduce opioid prescriptions, so that only those who really need them get them. They also believe the guidelines will encourage doctors work with patients to be sure a prescription doesn’t turn into an addiction.
The Food and Drug Administration (FDA) has stepped in to assist, requiring new boxed warnings on all opioid pain medications alerting doctors and patients to the risks of addiction and overdose.
What Are Opioid Prescription Painkillers?
If you’ve ever filled a prescription for Tylenol 3, OxyContin, or Vicodin, you’ve used an opioid prescription painkiller. Doctors typically prescribe them for use after surgery, dental procedures, or traumatic injuries, or at other times to help with severe pain or chronic pain. They are effective and relatively safe as long as their use is limited, but they carry a risk of misuse, abuse, and addiction.
Generic names for these drugs include:
- Oxycodone
- Hydrocodone
- Morphine
- Diphenoxylate
- Codeine
- Fentanyl
- Propoxyphene
- Hydromorphone
- Meperidine
- Methadone
Opioids are made from “opium,” which comes from the poppy plant, though many drugs today are made in the lab (synthetic). They work by reducing the intensity of pain signals reaching the brain. Depending on the dose, they can also potentially cause side effects like drowsiness, nausea, constipation, and mental confusion.
These drugs are blessings when it comes to recovering from difficult surgeries or other medical procedures, or when suffering from traumatic injuries. Those who struggle with chronic pain can suffer from lost work productivity, a limited ability to perform daily activities, and a reduced quality of life. For these individuals, prescription painkillers can feel like life savers.
The National Institute on Drug Abuse (NIDA) states that growing evidence suggests that those addicted to prescription opioids are shifting to heroin as prescription drugs become less available or harder to use.
But for others, opioids can present serious risks. The medications can change the part of the brain that controls emotions, resulting in extreme relaxation and a euphoric feeling. This can lead to wanting more and more, until the patient becomes addicted.
Some individuals may also become tolerant to the painkillers over time, at which point they may seek out other ways to experience the euphoria. The National Institute on Drug Abuse (NIDA) states that growing evidence suggests that those addicted to prescription opioids are shifting to heroin as prescription drugs become less available or harder to use.
Indeed, the number of heroin users in the U.S. nearly doubled between 2005 and 2012.
Who’s at Risk for Opioid Addiction?
Scientists know that some factors can increase risk of addition to opioid drugs. These include:
- Family history of addiction (to any substance)
- Prior addiction (to alcohol or any other substance)
- Childhood trauma
- Mental illness
- Prolonged use
A 2010 study reported that four factors together—age (younger than 65), depression, the use of psychotropic medications (like anti-depressants and anti-anxiety medications), and pain impairment—increased the risk of opioid dependence among patients taking prescription painkillers by eight-fold.
Women have additional risk factors. According to the American Society of Addiction Medicine, “Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men.” They added that women may also become dependent on prescription pain relievers more quickly than men.
According to the American Society of Addiction Medicine, “Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men.”
Dependence is slightly different than addiction. Someone who is dependent has a body that has gotten used to the drug, and experiences withdrawals when they try to stop using it. Someone who is addicted is compelled to seek out and use the drug to experience an even more intense “high,” or euphoria, even though they know it’s bad for their health.
Between 1999 and 2010, the number of deaths from prescription pain reliever overdoses in women increased more than 400 percent. From 2010 to 2013, female heroin overdoses increased from 0.4 to 1.2 per 100,000.
CDC Guidelines at a Glance
According to the CDC, between 1999 and 2014, more than 165,000 people died from overdose related to opioid pain medication in the U.S. In 2013, an estimated 1.9 million were abusing or dependent on prescription opioid medication.
As a result, the CDC created the new recommendations. Some of the key guidelines include the following:
- Choose other options when possible: Doctors should choose non-opioid medications and non-drug options when possible for patients with chronic pain. They should prescribe opioids only “if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”
- Evaluate risk: Before prescribing the drugs to patients, doctors should check medical history for things like a prior addiction, or current use of anti-anxiety drugs. They should avoid prescribing both opioids and anti-anxiety medications whenever possible, and should use urine drug testing before starting to be sure patients aren’t already taking other high-risk drugs.
- Set goals for treatment: Before starting therapy for chronic pain, clinicians should set goals with patients, which should include discontinuing the opioid therapy if benefits don’t outweigh risks.
- Talk about the risks: Doctors should inform patients about the risks associated with opioid therapy.
- Start slow: When first starting opioid therapy, doctors should prescribe fast-acting ones as opposed to extended-release/long-acting options. They should also choose the lowest effective dosage, and avoid increasing it to more than 90 MME per day. For acute pain, they should prescribe it for three days or less. According to the recommendations, “More than 7 days will rarely be needed.”
- Check back: Physicians should check back with their patients within one to four weeks of starting the prescription to make sure everything is okay, and to work with patients to taper off use of the drugs.
Optional Therapies May be More Effective
Meanwhile, other experts are calling for greater use of non-opioid painkillers and non-drug therapies, which carry a lower risk of addiction. Pain management expert Asokumar Buvanendran, M.D., professor of anesthesiology at Rush University Medical Center, says that to truly address the problem of opioid addiction, doctors must be made aware that there are safe and effective pain management alternatives.
He adds that though opioids are an important tool in treating pain when used appropriately, there are many other safe therapies that are as effective or even more effective that don’t carry the risk of dependence. These include:
- Non-narcotic medications (including some antidepressants, anticonvulsants, topical medications)
- Epidural injections
- Radiofrequency denervation
- Spinal cord stimulation
- Biofeedback
- Meditation
- Acupuncture
- Cognitive-behavior therapy
- Physical therapy
- A combination of some of the above
Buvanendran adds that insurance companies, as well, should be encouraged to cover these non-drug therapies, as their non-coverage is a major barrier to their wider use. Opioids are cheaper up-front, but considering the long-term costs of addiction, alternatives may prove to be more economical in the long run.
Of equal importance is working with patients to reach their goals. Most want to improve functioning in their daily lives—something that opioids can actually impair because of the side effects. A more comprehensive, multi-tiered approach to chronic pain, in particular, is often more effective than a pill.
The American Pain Society, for instance, stated in a press release that while they support the education of primary care physicians about pain and pain treatments, “chronic pain is a biopsychosocial condition that often requires integrated, multimodal and interdisciplinary treatment.”
Best Steps for Women
Since women are more likely to be prescribed painkillers, they need to be fully aware of the risks—particularly when they are of childbearing age.
Talk to your doctor to be sure you understand the goal of treatment. Find out if there are alternatives that may work just as well without the risks of dependency. Consider trying other alternatives at the same time, like meditation and acupuncture, which have shown in many studies to be very effective against chronic pain.
Finally, be aware of your own body. Take any prescription opioid medications as directed, and inform your doctor immediately of any troublesome symptoms. In the end, the best defense against dependency and addiction is your own attention to your pain.
Sources
“Opioid Painkiller Prescribing,” CDC, July 2014, /content/352/bmj.i19.
Monica Bawor, et al., “Sex differences in substance use, health, and social functioning among opioid users receiving methadone treatment: a multicenter cohort study,” Biology of Sex Differences, November 10, 2015; 6:21, /articles/10.1186/s13293-015-0038-6.
“FDA announces enhanced warnings for immediate-release opioid pain medications related to risks of misuse, abuse, addiction, overdose and death,” FDA News Release, March 22, 2016, /Psychiatry/Addictions/22039.
“Opioid Addiction: 2016 Facts & Figures,” American Society of Addiction Medicine, /article.aspx?articleid=2503508.
“Rush Anesthesiologist Pushes for Opioid Alternatives on CDC Expert Panel,” Rush University Medical Center, March 16, 2016, /articles/rush-anesthesiologist-pushes-for-opioid-alternatives-on-cdc-expert-panel.
Nora D. Volkow, M.D., “American’s Addiction to Opioids: Heroin and Prescription Drug Abuse,” NIDA, March 14, 2014, https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse.
“American Pain Society Endorses National Pain Strategy,” American Pain Society, [Press Release], March 18, 2016, /articles/american-pain-society-endorses-national-pain-strategy.
BMJ, “Concerns over prescribed opioid use among pregnant women: Expert cautions against the long term use of opioids during pregnancy to reduce associated harms including neonatal abstinence syndrome,” ScienceDaily, January 12, 2016, https://www.sciencedaily.com/releases/2016/01/160112214407.htm.
