What Everyone Should Know About Opioids
http://www.refinery29.com/2017/05/154770/what-are-opiate-drugs
In the past 15 years or so, deaths related to heroin and prescription opioids have quadrupled in the U.S., according to the CDC. And opioid addiction is becoming an increasingly widespread issue, especially among young women. So how did we get here?
“The first thing you have to understand [is that] our opioid crisis is not a drug abuse problem — it’s not a problem of people taking dangerous drugs because it feels good and they’re accidentally harming themselves… The opioid crisis is an epidemic of opioid addiction,” says Andrew Kolodny, MD, co-director of opioid policy research collaboration at Brandeis University and a medical advisor for the recently released HBO documentary Warning: This Drug May Kill You.
However, when we talk about the opioid crisis as if it’s a drug abuse or misuse problem, Dr. Kolodny says, “that suggests that there are a lot of people behaving badly and [our issue is figuring out] how we stop them from behaving badly — and that isn’t the case.”
Ahead, we talked to Dr. Kolodny about what these drugs really are, why we’re facing this crisis now, and how we can help those most severely affected get the treatment they need.
Let’s start with the basics: What are opioid drugs?
“Opioids are drugs that come from opium. Some of the more commonly prescribed opioids are drugs like hydrocodone and oxycodone, which literally come from opium — you need opium to make them. Hydrocodone is in Vicodin and oxycodone is in Percocet and Oxycontin.
“They are both what we would term ‘semi-synthetic’ opioids because you start with something natural and you treat it chemically to create a more potent version of opium. Heroin is also a semi-synthetic opioid.
“Many people don’t realize — including many of the doctors who prescribe opioids — that the effects of drugs like oxycodone and hydrocodone are indistinguishable from the effects produced by drugs like heroin. So if you’ve ever been curious about what heroin feels like, if you’ve had a Vicodin, that’s basically the same thing.”
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When taken on a daily basis long-term, opioids are really lousy drugs.
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We hear so much about misuse of opioids — so what are opioid drugs supposed to be used for?
“These are very important medicines for easing suffering at the end of life. They’re also very useful when used on a short-term basis for severe acute pain, after major surgery or a serious accident, for example.
“Unfortunately, the bulk of the prescribing of opioids in the U.S. is not for end-of-life care or a couple of days after surgery — it’s for common conditions where opioids may be more likely to harm the patient than help them. In fact, we have about 10-12 million Americans who are on opioids for chronic pain. They’re taking them every day. They take a drug like Oxycontin…every day, morning and night, for months or years. We have so many people on daily opioids that drug companies that can now make money off of drugs to treat the side effects of opioids, such as constipation.
“When taken on a daily basis long-term, opioids are really lousy drugs. One reason is that they’re addictive … But also, opioids have some unique characteristics: You very quickly develop a tolerance to the pain-relieving effects, meaning you’ll need higher and higher doses in order to continue getting to get pain relief. And the other effect is what we call ‘physiological dependence,’ which means that if you try to stop taking the drug after taking it on a regular basis, you feel very sick — not just a flu-like illness, but you can also feel very severe anxiety and agonizing pain as a symptom of opioid withdrawal.
“So the other problem with taking them long-term [besides addiction] is that evidence tells us they don’t work — they can become ineffective and make pain worse.”
These drugs have been around for decades — why are we seeing the epidemic now?
“Beginning around 20 years ago, the medical community decided to prescribe [opioids] much more aggressively. The prescribing of opioids quadrupled from around 1999 to 2012. As prescribing starts to go up rapidly, it leads to this parallel increase in addiction and overdose deaths. In other words, the epidemic has been caused by doctors overprescribing opioids, and they really overexposed the U.S. population to prescription opioids.
“What led to the change in culture of prescribing? Starting in the late ’90s with the release of oxycontin by Purdue Pharma, that launched a multifaceted campaign designed to increase opioid prescribing. When they were putting Oxycontin on the market, which is extended-release oxycodone, [drugs like that were mostly] used in palliative care settings.
“Purdue wouldn’t have been able to have much financial success had it only been used in palliative care — patients at the end of their lives with cancer pain is not a common condition, and the patients won’t be under medicine for very long. They needed to see it prescribed for common, especially chronic problems.
“So the campaign they launched was focused on getting the medical community more comfortable with opioids as a class of drug. Purdue would ultimately get into trouble in 2007 for some of the specific ways they marketed Oxycontin as less addictive [than other opioids]. But what they never really got in trouble for (which was much more damaging) was to mislead the medical community about the safety and effectiveness of using opioids on a long-term basis.
“As part of the campaign, doctors started to hear that they were allowing patients to suffer needlessly because we were under-prescribing opioids. We would start hearing that the risk of addiction had been overblown, that legitimate pain patients very rarely get addicted. A statistic that was used was that ‘much less than 1%’ of our patients will get addicted. We started hearing that, for just about any complaint of pain, opioids are ‘the safest and most effective option.’
“We didn’t just hear it from the drug companies — doctors would have been smart enough to be skeptical of marketing from a drug company — but the marketing was really, in many ways, disguised as education. The medical community began hearing from pain specialists eminent in the field all of these messages, we start hearing it from professional societies, state medical boards… From just about every direction we began hearing that, ‘If you’re an enlightened, caring doctor, you’ll be different form those stingy, puritanical doctors of the past that let people suffer.’
“As we responded to this brilliant campaign and as opioid prescribing took off, it led to a public health catastrophe.”
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As we responded to this brilliant campaign and as opioid prescribing took off, it led to a public health catastrophe.
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What is the ideal treatment plan for opioid addiction?
“Most people with opioid addiction don’t do well with abstinence-based approaches, meaning going for detox or going to a rehab for 30 days and then coming home. That doesn’t work for many people and, in fact, when you come back from detox, rehab, or jail and your tolerance has gone back to normal, people are at a very high risk for an overdose death.
“There’s also a drug called Vivitrol, which is a monthly injection of naltrexone (an opioid blocker). Even though that’s a medicine, that’s really more of an abstinence-based approach.
“So the first-line treatment for opioid addiction is a medicine called burpenorphine (or Suboxone). In some cases methadone maintenance is a good option, especially for patients with a more severe addiction who need the structure of visiting a methadone maintenance clinic on a daily basis.
“Unfortunately there’s not adequate access to buprenorphine. There are many restrictions and rules that limit the ability of doctors to treat people with this medicine, which is pretty crazy because buprenorphine is much safer than drugs like Oxycontin. For the more dangerous opioids that are causing addiction and people are overdosing on, there are very few restrictions. Yet for the medicine used to treat opioid addiction, we have too many restrictions.”
Why is the use of buprenorphine sometimes considered “controversial” ?
“Among experts, there is no controversy about using buprenorphine. But there is a strong stigma and bias against these treatments, including very concerning statements by HHS Secretary Tom Price a few days ago. But there are many people who are making the mistake of thinking [treatment with buprenorphine] is substituting one opioid drug for another.
“I’ve treated patients with opioid addiction by prescribing them buprenorphine for many years. I didn’t have too much success getting them off buprenorphine — it’s very hard to come off without relapsing — but while my patients are on it, I’ve watched them lead very productive lives. They get married, have babies, graduate college, hold good jobs — you would never know looking at them that they were on a drug. They would tell you they felt perfectly normal.
“It’s certainly not a cure, and it would be nice if we had other options. It’s certainly always better if someone can manage a chronic illness without taking a medicine… but it’s similar to diabetes. For type 2 diabetes, if someone can really control their diet and lose weight and exercise regularly, they can get off their insulin and just be on oral hypoglycemics. And if they do a really good job, they can even get off the oral medicine. That’s definitely better than being on insulin or pills, which have side effects.
“But a lot of people can’t do it. And if you insist on it — if we told people, ‘You can only have your insulin for six months and then you have to be better,’ we’d be in a really bad place. We’d see a lot of people going blind or losing limbs from untreated diabetes. That’s kind of where we are with opioid addiction, because not enough people are accessing the treatments that are effective.”
Filed under: General Problems
I’m glad that you agree with me,hopefully every one else looks at things the way that we do.
I hope life isn’t a big joke, because I don’t get it, Jack handey. How could be possible after the opiate was approved to use for chronic pain on a safe way then now is addictive ??? . How come who ever bringing up the opiates years back don’t look at this situation to find a better solution for chronic pain but of course and like always ” money is always first and guilt falls on patient, who believe and give the trust to a doctor and the treatments”. Now hey we go again, now the solution we have to believe to our desperate and chronic pain is not to look how definite on kill the pain and why the pain is there. Now next option is ” Medical Marihuana”. Marihuana is Marihuana , something like Marihuana had been and still a drug addictive mostly among young but maybe cheaper than opiates since if it withing the reach of young people it should not cost much. The Medical insurance, treatments and medicines have reached to the point of the very prohibitive to obtain and somewhat unsafe . I think the Medical Laws should be review those laws to protect patients and fix of a broken medical field system. My comment is in order to provide some hope for an earlier, more secure solution and for better potential on bring relief to the needy.
Your ideology is based upon ,believing,what the government is spewing is true,,,The government always lies,they never tell the truth,,,its about money ,and locking up Chronic physical pain human being in mass mental warehouses,,to fill up the pockets of so-called ,”addiction,” ,shrinks,,They have done this before,,Eugenic,,Pennhurst,,sanatoriums back after the civil war,,,,Again All done by the ,”’educated ones,”’ that allowed their education to drive them into arrogant,ignorant , psychopaths,,jmo,,maryw
I have had chronic, severe pain since I was a child and I am currently 67. Through the years, I have tried every modality one can think of with no help whatsoever. Six and 1/2 years ago, I went on opioids and they work wonderfully and have given me a quality of life back that I could only dream of. They work and they work well. Kolodny is just plain wrong and has a conflict of interest as he is head of a so-called addiction clinic. I’ve not had to increase my dose over these 6 and 1/2 years either and still have excellent relief.
”Our Doctors don’t prescribe heroin,,,he is a extremist,,,,,,with no knowledge of the factual effects of our medicine on us,,,like I said,,,give me a heroin addict to tell me what herion does,,,not a inhumane psychopath who he himself has NEVER had CPP,,,or has never ever tried our medicines,,for physical pain long term,ever!!!!just used rats soo far,,,ohhh and prison inmates,,,What comes out of his mouth is just academic,,,not,,,real world AT ALLL!! ,,mary
It makes me sick when people who havn’t a clue, claim that opiate meds dont work over time for chronic pain. That’s absolutely not true, and I will bet-that if you told a person that hydrocodone has the same effect as herioin,they would laugh in their face. These people have no authority when it comes to what works or not; we do. And if chronic pain can’t be managed effectively with anything else-so what ? opiates are safe. Tylenol will kill the liver, Ibuprofen, the kidneys. Exercise, and eating right doesnt cure chronic-illness..
To Dorlee,,,your comment explains the problem,,What Doctors are/were doing ,,out of fear from our dea/government,,,Doctors were labeling all of us drug addicts,,drug seeking behaviour,blah blah,,because your rite,,what klondyn did was use the same symptoms/communication we give our Doctors,,ie WE KNOW WHAT MEDICINE WORKS FOR OUR BODIES,,,WE KNOW HOW MUCH WORKS,,,it is our body after all,and us CPP’S have experience long term physical pain and experience has taught us exactly what we need,,,But klondyn used it to his advantage by stating ,”if we ask for say Oxycodone at 60 mill a day to function,,because we have been dealing w/this for 15 +++ freaking years,,,HE/KLONDYN LABELED THAT ,”DRUG SEEKING BEHAVIOURS,” TO FILL UP HIS PENNHURSTS INSTITUTION W./CPP HUMAN BEING,,,,HIS CREEPY/TORTUREOUS IDEOLOGY LITERALLY TOSSED US BACK TO THE DARK AGES WHERE THE CRIPPLE,DEFORMED ,PHYSICALLY ILL GOT INSTITUTIONALIZED,,FILLING UP ”SANITARIUMS” BY THE THOUSANDS,,,jUST LIKE DR..CHEEK STATES!!!!! it about money for some shrinks,,,not about HUMANE effective medical care.
As u know,,what this does to a CPP,,,WHEN drug seeking behaviour or addict is written on their record,,,,THEY WILL NEVER SEE EFFECTIVE PAIN MEDICINE AGAIN!!!.i LITERALLY HAVE THIS F-EN NURSE DOWN AS WEST ALLIS,,WHO HAS BEEN TRYING FOR A DECADE TO GET ME KICKED OUT W/LIES,,,,CLAIMING TO MY DOCTOR/PHARMACIST I WAS FILLING SCRIPTS ON DAY 30,,AND SHE CLAIM 4 TIMES DAY 29,,,A LIE ON THE DAY 29,,,WHAT WAS HAPPENING AS ALL PHARMACIST DO,,,IS WHEN THEY HAD TIME,,,THEY WOULD FILL THE SCRIPTS FOR THE NEXT DAY,,,ENTERING THEM INTO THE COMPUTERS,,,WELL THIS BITCH,,,,TOLD MY DOC BY LOOKING AT THE P.D.M.P ,,,SAW THE SCRIPT WAS ENTER’D INTO THE SYSTEM ON DAY 29,,,,,NOT THAT I PICKED IT UP ON DAY 29,,,,WE HAD TO GET EVERY CANCELLED F-ING CHECK,,,TO PROVE SHE WAS LIEING,..,,,,WE DID EXACTLY THAT,,,,WAS SHE FIRED,,,,NOPE,,,PISST OFF,,,,BUT NOT FIRED,,,,,,,i got my ass chewed out by my doctor,,,until he look thru my receipts,,,,no apology nothing!!!!But what she did,,she could of gotten me in trouble,,,my pharmacist,,and my doctor,,,,yet,”they”’ don’t fire her!!!!!maryw,,,,
So the little pipsqueak Kolodny has no problem using opioids (methadone, buprenorphine) for those who are addicted to opioids and became addicted to opioids by PURPOSELY ABUSING THEM in the first place while denying opioids to those who are in legitimate pain and use them RESPONSIBLY. Opioids are a class of medications approved for treating physical pain yet the medical community should deny these medications to those with legitimate physical pain who take them responsibly while giving them to those who PURPOSELY ABUSED them. That’s the very definition of a hypocrite. Seriously, this is the most ass-backwards situation I think I’ve ever heard of.
(Note: I have no problem with recovering addicts using a safer alternative to keep their cravings down. That is between them and their doctor. I respect their privacy. What I do have a problem with is the pure hypocrisy behind this approach – deny those in legitimate pain while giving them to those who started purposely abusing them in the first place).
Kolodny makes his living on addiction. He has a vested interest in blaming opioids. I bet he also owns stock in the pharmaceutical companies that make Suboxone and Naloxone. As with all conventional treatments, they “treat” the problem by just switching drugs. Meanwhile, there is a REAL cause and a REAL cure for addiction. It just doesn’t keep people addicted to another drug. All conventional doctors like Kolodny are simply PMP’s ( an acronym I’ve coined which means “patent medicine pushers”. Like the quack in the wagon with his elixers back in the 1800’s. My program for addiction works, and cures. Hopefully someday I’ll be able to do it again on a grander scale. Meanwhile, people can learn about it and even do it themselves. See the short clip here: https://youtu.be/YvG5Vv5rW5A
All the wonderful things he stated that addicts can do to lead normal lives while taking buprenorphine sounds a little like what chronic pain patients are able to do with their lives while taking opioids. And as far as his statement about telling diabetic patients that they can only have their insulin for 6 months and then they have to be better “would be a really bad place to be” sounds like what is happening to us pain patients as our meds are being reduced and taken away. Very one sided article and I cannot believe people believe what he says. Ask a pain patient if long term use helps them. Quit trying to scare the average Joe into believing all the hype you are putting out. Stay with your ideas on addiction and leave the chronic pain patients to their specialists. You must still be making money from the addiction clinics that are only working 10-15 percent of the time.
Gary ,,,excellent point,,,these MEDICINES,, dont talk,,don’t feel,,,People do,,,,your point is perfect,,,along w/your statement,,”is it better to leave them in unrelenting physical pain,,NO,,, of course not for no NORMAL HUMAN BEING WOULD WANT TO LIVE LIFE IN FORCED PHYSICAL PAIN,, it is not NORMAL,,IT GOES AGAINST EVERYTHING THAT MAKES US human,,,to force us into physical pain,,when a simple effective MEDICINE,,, will lessen that physical pain,,As adults in a so-called free country,,,thee amount of physical pain we are TO endure,,should of never ever been put in the hand of a government entity/employee!!!MARYW
I would take issue with some of this article.The verdict really is not in at this time,if long term use of an Opiod such as hydrocodone continues to effectively control pain in chronic conditions.I am close to someone who has been prescribed this med for close to seven years for degenerative disc and spinal conditions.My friend has been on the same dose,40 milligrams daily,the past four years.Although somewhat of a tolerance occurs,my friend tells me,and I have observed, that this dosage makes a crucial difference in his functionality.With his med he can function well enough to walk a little,sit up and read,socialize,etc.Although he can do so only for short periods of time,he tells me even that short time is important to him.
I also take issue with the issue of addiction.Medical dependency and addiction,are not the same.My friend at times is able to take three instead of four,thirty mil.instead of fourty,and does so without any cravings or negative effects other than spending a little longer in bed.He has never abused or misused his meds.It is my understanding that even specialists can not clearly define addiction as all cases are not equal,all people differ.The United Nations office on drug control has stated in past reports that 90% of people who use a drug,the majority,are not harmed by it,and about 10% develope a problem with their substance.William Bennett,the former director of national drug control policy,has stated that non -addicted users still comprise the vast bulk of our drug involved population.I personally like to use alcohol as an example.Alcohol,a drug,when used sensibly,does not harm someone’s life.The percentage of hard core alcoholics,seems to me,would be maybe the same ten percent as the United Nations office on drug control equation concerning other drugs.
If physical dependency occurs in those using meds for pain,would it be better to leave them in constant pain without relief,just so it can be said they are not dependent? Drugs can kill.They also ,if not abused,can benefit.Its not the drug that determines that,it is the individual.
Gary, if it helps, my dad took 5 mg oxycodone four times a day to control his pain for over 30 years. They’d only increase it by 2.5 to 5 more mgs for a few weeks after each of his surgeries. He never had a problem with it no longer working. Also, I’ve taken the same amount of tramadol for over 12 years. Knock on wood, it hasn’t quit working for me. It truly annoys me because people like me and my dad (and there are hundreds of thousands, millions, who’ve been functioning to the best of their ability and stable on long-term opioid therapy) aren’t even considered when they state that opioid therapy isn’t “effective” for chronic pain.
Personally, I don’t believe “tolerance” is a major issue with chronic pain patients who use opioid therapy for years. I believe the majority of “tolerance” we see is in those who purposely abuse opioids, as they quickly build a tolerance to the “high.” In those with chronic pain who end up needing stronger medication every few years, I believe their medical condition has gotten worse, therefore, requiring stronger medication to reduce their pain, which has increased because their condition has deteriorated. (Just my opinion. 100% agree with your post by the way. I just wanted to add what I’ve personally witnessed by having a disabled parent who suffered severe chronic pain since I was a child).
I believe NOTHING this idiot saids,,,now give me a documentary from a actual herion user or past user,,and they have also tried legally opiates,,,,thats the persons i would listen to and believe!!!!! THIS GUY i SWEAR,,IF I EVER WON A LOTTERY I WOULD SUE THE LIFE OUT OF HIM,,FOR TORTURE ,GENOCIDE AND ASK FOR THE DEATH PENALTY FOR ALL THE CPP’S HE HAS WILLFULLY KILLED W/HIS PENNHURST,EUGENICS MENTALITY,,,,ALL; HE WANTS IS INSTITUTION FILLED UP W/ FALSELY ,”LABELLED,”,,,,,,SO-CALLED ADDICTS,,,HIS LOGIC IS THAT OF HITLERS,,,HE STATES HOW TERRIBLE THESE MEDICINES ARE,,YET MILLION HAD LIVED NORMAL LIVES BECAUSE THEY OFFER’D LESSEN PHYSICAL PAIN,,,,IT is EXACTLY LIKE KILL-EN OF THE JEWS BECAUSE HITLER SAID THEY WERE ALL BAD,,,BUT NEVER OFFERING ANY JEWISH PEOPLE ,, the HUMANE rite,,TO DEFEND THEIR WAY OF LIVE,who they are,,,THERE WAS A HOLACOST BECAUSE HITLER SAID TO ,”KILL THE JEWS,”’JUST LIKE KLONDYN IS SAYING KILL THEE OPIATES/DOCTORS AND HUMAN BEINGS WHO USE THEM RESPONSIBLY FOR PHYSICAL PAIN W/NO ACTUAL FACTUAL EXPERIENCE BEHIND HIS STATEMENT,,,HES A SHRINK,,,,NOT A CHEMIST,NOT A HEROIN USER,,.,AND NEVER IN HIS LIFE HAS HE SUFFER’D IN LONG TERM PHYSICAL PAIN,,,,YET IDIOTS BLINDLY FOLLOW THE ORDERS TO KILL THE OPIATES,KILL THE DOCTORS KILL THE MEDICALLY ILL W/PAINFUL MEDICAL CONDITIONS,,,,,HE IS PSYCHOPATH,,HE HAS NO KNOWLEDGE OF ENDURING LONG TERM PHYSICAL PAIN,,,,YET BLINDLY PEOPLE FOLLOW HIM,,,EVEN THOU HE HAS THE ONE WILLFULLY KILLING THE MEDICALLY ILL W/HIS ARROGANCE COMBINED W/IGNORANCE!!!!!WHY WOULD ANYONE W/ 1/2 A BRAIN FOLLOW A MURDERER???!!!!maryw