Even Taking an Opioid Prescription Correctly Can Lead to Addiction
By Susan Gulstad, Vital Aging Network
An attentive, engaged audience listened intently as Anne Pylkas, MD, internist, and addiction specialist, issued an urgent call for action against the dangers of opioids. She spoke at the October VAN Forum, “Opioids: Friend or Foe?” Dr. Pylkas works at the Pain Management Clinic at HealthPartners.
Dr. Pylkas underscored the highly addictive nature of opioids, citing a University of Arkansas Medical Sciences review of 1.3 million patients who were prescribed opioids from 2006 to 2015:
- For a one-day prescription, a 6 percent risk of still using opioids a year later
- For a prescription longer than eight days, a 13 percent risk
- For a 30-day prescription, a 30 percent risk.
A snapshot of addiction
Addiction is a complex chronic disease of the brain that leads to brain dysfunction and behavioral changes. Brain functions such as motivation, memory and decision-making often become skewed and change behavior. The fear of painful withdrawal symptoms fuels the need for staying on a drug. A 2015 National Survey on Drug Use and Health reported 27.1 million illicit drug users in the U.S. Dr. Pylkas noted that 86 percent of heroin users started down the road to their addiction with opioid prescriptions.
Start of the opioid epidemic
The current opioid epidemic has its roots in a decision by OxyContin maker Purdue Pharma in the late 1990s to increase sales of the opioid by expanding its use. The company marketed the drug as being “virtually” non-addictive and providing 12 hours of pain relief, claiming it was safe to prescribe for relieving many kinds of pain. In reality, OxyContin provides only about eight hours of pain relief for many people. As Dr. Pylkas pointed out, pain can become worse during withdrawal, so patients often chose to take more opioid than prescribed or find other forms of pain relief, leading to abuse and addiction.
The staggering cost of the opioid-based epidemic can be reflected in human and financial terms. Since 1999, more than 200,000 Americans have died from overdoses. A 2013 study puts the total cost of the epidemic at $78.5 billion for health care and criminal justice costs and lost worker productivity
A realistic treatment approach
Dr. Pylkas talked about four components of treatment to break the cycle of addiction.
- Treat addiction correctly. Not all treatment choices work for everyone.
- Limit overdose deaths. Naloxone is an overdose rescue medication.
- Decrease opioid prescriptions. Prescribe fewer pills per prescription and prescribe opioids only for appropriate reasons.
- Treat chronic pain appropriately. Find the underlying cause. Try non-prescription treatments.