Prescription Opioid Medicines
Did you know?
Opioid misuse and addiction is a serious national crisis. Americans use more than 80% of all the opioids prescribed in the world. Many of those are in our medicine cabinets- left over from a previous prescription (See Table). The CDC estimates that the “economic burden” of prescription opioid misuse in the US is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
- Risk of chronic opioid use increases after 3 days. The risk of chronic opioid use increases with each additional day of medication starting with the third day, with the sharpest increase after the fifth and 31st day on therapy and a second prescription or refill CDC 2017). If you’re prescribed an opioid, the best approach is to try the lowest possible dose, in the smallest quantity and only for as long as necessary. Generally, opioids should be prescribed for acute pain for 3 days or less and more than 7 days is rarely necessary.
- Opioids can be unsafe at any dose. Opioids can be dangerous at any dose even when prescribed by your doctor and taken responsibly. Opioids can also cause unpleasant side effects such as drowsiness, constipation, as well as respiratory depression (slowed or shallow breathing) that can lead to overdose-related death. After taking opioids for even a short period of time, e.g. 3-5 days, some individuals can become physically dependent and experience withdrawal symptoms when stopping the medication. (Veterans Health Administration: Safe and Responsible use of opioids-patient guide)
- Opioid overdoses have increased up to 70%. From July 2016 to September 2017 overdoses increased up to 70% in some areas of the US (CDC Vital Signs 2017). An opioid overdose can cause you to stop breathing. Certain factors increase risk of overdose, including combining opioids with alcohol or other drugs, a high daily dosage, age greater than 65, and certain medical conditions like sleep apnea, reduced kidney or liver function.
- It is very easy to become addicted to opioids. Our bodies naturally release endorphins to induce pleasure and relieve pain. Opioids create artificial “endorphins” in the brain and nervous system. After a few days on opioids, the body gradually stops making its own endorphins and eventually the same dose of opioids stops triggering the good feelings and pain relief. If you stop taking the opioids you may experience symptoms of withdrawal, e.g., worsening of pain, nausea, anxiety, depression and restlessness. Staying on the opioids, even after the pain is gone, is the only way to feel good and avoid these symptoms.
- An opioid use disorder (OUD) can develop after repeated use of opioids. An opioid use disorder is a chronic brain disease that develops from repeated use of opioids. Up to 40% of patients on long-term opioid therapy (over 90 days) have an opioid use disorder. In its moderate to severe form it is known as addiction and the risk of death from overdose is up to 20X greater than in the general population. The American Psychiatric Association defines an OUD as having 2 of 11 criteria in a 12 month period, e.g., need for increasing amounts to achieve same effect, symptoms of withdrawal if stop taking, etc.
- Article in WEBMD: Pain killers: seven warning signs of addiction
- There are many non-opioid options for acute pain, e.g., post-op pain. Opioids have been shown to be effective for very short-term (3–5 days) treatment of severe acute pain (e.g., invasive surgery or significant trauma). However, non-opioid drugs such as Ibuprofen have also been found to be effective without the same risks. In three studies of post-surgical pain, Ibuprofen 400 mg was more effective in reducing pain than oxycodone 5 mg and there was no difference in pain reduction between ibuprofen and ibuprofen + oxycodone (an opioid). (Veterans Administration Acute Pain Provider Guide, 2017) Pre-operative education about risks of opioid use was found to reduce the use of opioids post-op by more than 50% (Hill 2018).
- American Society of Anesthesiologists: Treating post op pain with non-opioids, e.g. NSAIDS like Ibuprofen
- CDC Opioids for acute pain: what you need to know
- CDC Non opioid treatments for chronic pain
- 70% of opioids used for non-medical purposes are from friends and family. Nearly 16.7 million people used prescription drugs for a nonmedical purpose in the past year; 70% obtained their pills from family and friends, including stealing from a home medicine cabinet.
- Appropriate disposal of unused medications is a critical component of curbing opioid crisis. If you have unused prescription opioids at the end of your treatment, find your community drug take-back program or your pharmacy mail-back program, or flush them down the toilet following guidance from the Food and Drug Administration (www.fda.gov/Drugs/ResourcesForYou). Do not store them in your medicine cabinet.
- Naloxone is a safe and easy to use drug that can reverse an opioid overdose.
- The US Surgeon General issued a public health advisory recommendation for individuals at risk for OUD, urging their family and friends keep naloxone on hand and know how to use it.
- In many states, a pharmacist can dispense naloxone without a prescription if there is a statewide “standing order” in place. That means if certain criteria are met, the pharmacist is authorized to provide the drug.
- You can save a life by knowing the signs and symptoms of an opioid overdose. The signs of an opioid overdose include small, constricted “pinpoint pupils,” loss of consciousness, slow- shallow breathing, pale, blue or cold skin. If you are not sure, call 911 anyway. Administer Naloxone if available. CDC Preventing an opioid overdose-Know the signs
- There are many resources to help someone with an opioid addiction.
- Find a local treatment: Find a physician, health center for treatment of an opioid use disorder
- Article: How to Help an Addicted Friend or Relative
- American Society of Addictive Medicine: Opioid Addiction Treatment: A guide for patients, families and friends
- Tapering your opioids to get off of them: Mayo Clinic Tapering off opioids: When and how and Hospital for Special Surgery-patient guide and CDC: Tapering opioids for chronic pain
- Centers for Disease Control (CDC) videos
- Change the Conversation About Opioid Use Disorders discusses the connection between the chemistry of the brain and opioid addiction.
- Even When Prescribed by a Doctor raises awareness about prescription opioids among the general public, including risks of opioids, talking with your doctor about your concerns and working together to make informed decisions about pain management.
- National Safety Council videos:
- Alternatives to opioid pain management, covers the risk of opioids and research on alternatives to opioids for pain management. (30 minutes)
- Beyond prescription drug over opioid statistic (3 minutes) Story of Louie Micele, a student and football player that died of an overdose following addiction from prescription overdose for sports injury.
- Signs and Symptoms of opioid overdose (1 minute)
- Foundation for a Drug-Free World video: The Truth About Prescription Drug Abuse Former users focuses on the dangers of taking prescription drugs for non-medicinal purposes, including addiction and other adverse reactions.
- Chicago Recovery Alliance video: Using Injectable Naloxone to reverse opioid overdose (13 minutes) Graphic depiction of real drug overdoses with instructions for use of Naloxone, an injectable drug to reverse opioid overdoses.
- New York City Department of Health and Mental Hygiene video: Prevent an overdose, save a life Patients describe their overdose and instructions on how to administer naloxone.
Premier healthcare alliance – Opioid resources
- Premier has been actively involved in responding to the US opioid epidemic since spring of 2017, with a focus on safer pain management and opioid prescribing. A summary of Premier capabilities follows; details can be found on the Premier Safety Institute® website section on Premier resources.
- Legislative front: engaged with White House Opioid Task Force and led lobbying efforts that resulted in passage the Opioid Overdose Prevention and Safety Act on 10/24/18 into law to advance treatment, recovery and prevention
- Thought leadership: participation on national panels, summits, advisory committees, and federal task force to address this issue, e.g., Healthcare Leadership Council and National Quality Forum, and develop white papers, playbooks, guidelines, etc
- Premier’s CEO, Susan DeVore signed the Leidos CEO pledge to end opioid use disorder/addiction on behalf of Premier and its Associates.
- Care Redesign-Collaborative: Pilot study as part of our CMS funded HIIN on Safer Post-operative Pain Management to reduce opioid harm in collaboration with American Society of Anesthesiologists
- GPO Safer Pain Management Product Portfolio: annotated searchable repository of GPO pain management contracts, suppliers, and programs
- Data Analytics: Premier member Data Optimization reports—powered by QualityAdvisor™– on Opioid use and Opioid-associated Overdoses in the emergency department
- Clinical surveillance tools: TheraDoc™ provides utilization analytics and real-time alerts on high risk drugs, including opioids
- Research/publications: on opioid misuse, adverse events, associated costs,
- Education: webinars, blogs, journal publications