As the opioid crisis in America unfolds with stories of addiction, overdoses, and unintended deaths, opioid medications continue to play an important role in certain medical situations. Matthew Merz, MD, a physical medicine and rehabilitation specialist at Mayfield Brain & Spine, answers eight basic questions about opioids and about when and how they can be effectively used.
1. Please define opioids. What drugs are included in this category?
Opioids or opiates are natural or synthetic derivatives of opium and are one type of narcotic substance. There are more than 600 individual opiates, most of which are for research or laboratory use only. Natural opiates include opium, morphine, and codeine. Other common synthetic or semi-synthetic opiates include heroin, methadone, hydrocodone, oxycodone, and fentanyl.
2. How do opioids work?
Opioids work by binding to opioid receptors in the brain and spinal cord. In so doing, they may suppress coughing, breathing, and feelings of pain.
3. Are all opioids addictive?
Potentially yes. Addiction depends on multiple factors, including medication potency, duration of use, genetic factors, and bio-psychosocial factors.
4. When are opioids appropriately prescribed and for what length of time?
Opioids are prescribed in multiple situations. They can be prescribed for:
- Severe and acute injuries, fractures, and pain following surgery. Prescriptions are usually for a relatively short duration, anywhere from a few days to a few weeks.
- Malignant pain, including metastatic cancer, which has spread from the original site to other parts of the body.
Controversy surrounds the use of opioids for chronic, nonmalignant pain that has failed all other treatments.
5. Does Mayfield have a policy regarding opioid prescriptions?
Yes. Mayfield’s policy is consistent with state and federal guidelines. These include: requiring a written prescription for no more than a 30-day supply, and careful monitoring of compliance, including periodic checks of the state pharmacy board report, urine toxicity screens, and pill counts. Mayfield often requires the patient to sign a single-provider, controlled substance contract.
6. What are alternatives for patients who suffer chronic pain?
- non-opiate medication
- exercise, both for the affected area as well as general cardiovascular fitness
- behavioral modification and psychological counseling
- use of other modalities, including TENS, ultrasound, heat, and cold
- use of other practitioners who provide therapies that include therapeutic massage, chiropractic care, and acupuncture
7. Can some patients with chronic pain safely take a continuous dose of an opioid medication?
Yes, with careful and frequent physician supervision, monitoring, and counseling.
8. What is your best advice for people who live with chronic pain?
- Realize there is no cure or permanent fix.
- The goals of treatment are modest improvement rather than complete relief and improvement and maintenance of function.
- The importance of exercise is paramount.