Cutting back on opioids too much and too quickly

Are doctors cutting back on opioids too much and too quickly? – Healthy Debate – Author: Paul Taylor – Date: March 27, 2018

Question:

I suffer from a rare and very painful genetic disorder.

For a decade, my family physician has prescribed opioid drugs to me to ease the pain. But he recently retired and I had to find another doctor.

Well, any pain patient knows what’s coming next. There are very few doctors taking new pain patients and continuing their opioid therapy, no matter how well it has worked or for how long.  

Now my new doctor refuses to prescribe me the same dose of opioids to keep my pain in check.

He says if I’m not satisfied with the care he’s providing, I should find another doctor. I live in a rural Ontario community and that’s not easy.

My pain is intolerable. What am I supposed to do?

Answer:

You appear to be among the growing number of patients who’ve had their prescriptions inappropriately cut back in what some experts are calling an overreaction to the opioid epidemic.

Simply put, all the public attention on the misuse of opioids has made many family doctors reluctant to prescribe them even when they might benefit patients.

Opioids—including morphine, hydrocodone, oxycodone and fentanyl—are extremely effective for treating acute pain following surgery or a serious injury.

However, it’s also true that they can be problematic when taken for prolonged periods because many patients develop tolerance to opioids.

To make matters worse, it’s very common for patients to become physically dependent on opioids.

This is true of many medications, especially antidepressants, which have prevented some people from stopping the drug as they would like to.

If the drug is stopped abruptly, or the dose is reduced by even a little bit, patients can suffer extremely unpleasant withdrawal symptoms—including increased pain.

The increased pain isn’t from “withdrawal”, it’s the return of the pain that had been blocked by opioids for so long.

Reporters, researchers, the media, and almost everyone else is ignoring WHY opioids were prescribed in the first place.

“Opioids should not be considered a first-line therapy for chronic non-cancer pain,” says Jason Busse, the lead author of the guidelinesand an associate professor in the department of anesthesia at McMaster University in Hamilton.

This is no revelation to pain patients because I don’t know of any that expected or received opioids as the 1st  (or 2nd or 3rd or 4th…) treatment for their chronic pain.

Only with acute pain are opioids used immediately and without reservation, like gunshot wounds, burns, or horrific industrial accidents. It’s hard for me to believe,  but I see occasional reports of a reluctance to prescribe opioids even in cases like these.

That’s just sickening and craven, letting a victim of serious bodily harm writhe around in pain for hours and days and weeks in order to avoid potential (and unlikely, at least for acute pain) DEA trouble.

Instead, he says, physicians should initially try non-opioid medications and other treatments such as cognitive behavioral therapy and mindfulness training.

2 thoughts on “Cutting back on opioids too much and too quickly

  1. peter jasz

    ( RE: ” …Opioids—including morphine, hydrocodone, oxycodone and fentanyl—are extremely effective for treating acute pain following surgery or a serious injury.
    * However, it’s also true that they can be problematic when taken for prolonged periods because many patients develop tolerance to opioids.
    * To make matters worse, it’s very common for patients to become physically dependent on opioids.” )

    WTF ???

    *A) also EXTREMELY effective for (vicious) chronic pain -where nothing else is.
    *B) “problematic” Seriously ? (People speak of vicious, unrelenting suffering/death defying agony and you say/feel ‘opiates’ are problematic ??? Have you EVER taken note of the alarming/ damning side-effects of alternatives Gabapentin, NSAIDS, etc.) ?
    *C) “To make mattes worse” ???
    (you mean pain so bad you wish to kill yourself ‘twice’ -as in “to make matters worse” ?

    ” …“Opioids should not be considered a first-line therapy for chronic non-cancer pain,” says Jason Busse, the lead author of the guidelines and an associate professor in the department of anesthesia at McMaster University in Hamilton.”

    Jason is an (Associate) IDIOT. If pain becomes/remains severe/chronic OPIATES SHOULD BE the first/go to choice. It’s always young/ immature/naive ‘A-Holes’ like Jason that haven’t experienced such suffering that spew such garbage. And, as correctly stated/quoted below:

    ” ….This is no revelation to pain patients because I don’t know of any that expected or received opioids as the 1st (or 2nd or 3rd or 4th…) treatment for their chronic pain.”

    To think of the weeks/months/years I suffered since I had no clue what an opiate/opioid even was (was not prescribed prior) makes me sick to my stomach: The needless, endless anguish forever seared into my DNA, the pain so severe, visceral, unimaginable -unforgettable.
    And now let’s all run in fear/terror because of a near-benign, extremely effective, proven and safe (opiate) medication ?

    peter jasz
    ( P.S. It’s now 4:44 AM. I was awoken at 4:00 AM by, guess what ? (After a remarkably long/ untypical 4-hours “sleep”) I immediately took 50% (of prescribed meds)/and ran for a brand new ice-pack (strapped to my lumbar spine -that I’ve been using 24/7 the past EIGHT YEARS), paced around; ambulating/bobbing; watery-eyes starting to swell, cranked-up my (4-month new) Neuro-Mod -and began the oh-so-familiar countdown … .
    BUT, 35-minutes later (as I nearly finished writing this, the pain literally forced me to stop, stand, pace, ambulate as the remainder of ‘dose’ was taken. It’s now, 5:10 AM …
    Hell-on-Earth. Personified. )

    pj

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    1. Zyp Czyk Post author

      I’m so sorry you suffer like this. I have a taste of such a restless search and wait for relief when I’m awakened in the night by one of my intense headaches. Any pressure on my skull is agony, so I can’t lie down or even rest my head against the back of a seat. I wander through the house for hours waiting for my meds to work. I’m tremendously grateful to still have opioids, but they take almost 2 hours to start working somewhat for my headaches (a larger dose would undoubtedly work better, but you know that story). Toward morning, I finally collapse in a chair with exhaustion after I get a bit of relief, gently tipping my head back against the softest pillow I can find.

      This is certainly not the life we had expected – the daily dread of pain is a soul-crushing burden.

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