First, what are opioids?
Opioids, sometimes referred to as narcotics, are a class of drugs naturally found in the opium poppy plant. Opioids work in the brain to produce various effects, including pain relief. Prescription opioids, such as OxyContin and Vicodin, are used to block pain signals between the brain and body. They act on opioid receptors found in the dorsal horn of the spinal cord, the brain stem, thalamus, and the cortex. While opioids serve many pain-relieving effects, they can also promote feelings of happiness and relaxation or cause people to feel “high”, which contributes to the addictive potential of the drugs.
The clinical challenge
With growing numbers of opioid overdoses and an increase in chronic pain prevalence, it is imperative that physicians be able to distinguish among individuals who:
-would use opioids for pain management, without developing problems with misuse
-those who would use them to alleviate pain but then become addicted
-and those who desire a prescription for an opioid because of an underlying substance use disorder
Tolerance, dependence, and addiction
To understand the opioid epidemic, we should first discuss the distinctions between tolerance, dependance, and addiction. Tolerance occurs when an individual no longer feels the same amount of pain relief by the same dose of drug. This individual may then seek to increase their dosage in order to experience the same pain relief. On the other hand, when an individual develops dependence, a physiological adaptive state occurs. In individuals with dependence, neurons function normally only when the drug is present. Along with physical dependence, individuals experience psychological dependence. This type of dependence is typically associated with cravings for the drug, which may last for months or years. This craving is a key symptom associated with opioid use disorder, commonly known as addiction. While dependence is an adaptive physiological state, addiction is a dysfunctional behavior. Individuals with addiction are known to engage in compulsive drug seeking and use behavior. Individuals experiencing withdrawal from addiction may present with sweating, dehydration, anxiety, cold flashes with goosebumps and severe cravings. Overall, while there are clear distinctions between these states, it can be very difficult to identify these populations separately because behaviorally, they may look very similar. Being that pain is a subjective experience, defining addiction issues associated with prescription drugs has proven to be tremendously complicated.
What this means for chronic pain patients
The opioid epidemic has had many implications for chronic pain patients, one of the most significant being the fracture in the doctor-patient relationship. Since doctors have to monitor patients’ opioid intake and perform drug screenings, patients may feel distrusted. In addition, the opioid epidemic has created an unwarranted stigma for individuals with chronic pain. This stigma not only impacts chronic pain patients mentally, but also affects the process of pain management. More specifically, 42% of chronic pain patients admitted that this stigma impacted how they communicate with their doctor regarding their pain, and 34% stated that they had to stop taking opioids because their doctor would no longer prescribe them. These are only a few of the challenges chronic pain patients face due to the opioid epidemic. Now more than ever, it is imperative for physicians and patients alike to be educated on the use of opioids.
Commentaires