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Addiction and avoiding opioid dependence with pain medication alternatives: Part 2

Dr. Mackarey's Health & Exercise ForumADDICTION: Avoiding Opioid Dependence and Alternatives to Pain Medications

Part 2 of 2

(read Part 1 of this series at this link)

International Overdose Awareness Day, August 31, 2018

Special Feature “ Health & Exercise Forum” with Geisinger Commonwealth School of Medicine the 3rd Monday of every month!

Guest Columnist: Anthony Morada, MD2 

Anthony Morada, MD2

Anthony Morada, MD2

Anthony Morada, a second year medical student at Geisinger Commonwealth School of Medicine (GCSOM). Anthony Morada majored in Cell and Developmental Biology and minored in English at the University of California Santa Barbara. As a community advocate, Anthony has hosted a Metastatic Breast Cancer Symposium at GCSOM and will be hosting a free Hepatitis B Screening at GCSOM for the Steamtown Health Fair on September 22, 2018.

In 2017, Pennsylvania recorded the second highest increase in deaths from opioid overdose in the country.1 While this alarming measure included illegal opioids such as heroin, prescription painkillers consisted of more than 40% of all US opioid overdose deaths – calculating to more than 46 victims per day.2 Prescription painkillers like Methadone, Oxycodone, and Hydrocodone, are part of the opioid drug class because of the way they affect the pain receptors in the body. These pills are commonly prescribed by physicians to treat severe or persistent pain. While most patients appropriately use opioids to manage their pain, minimizing opioid use and seeing alternative forms of pain relief can help reduce the risk of opioid dependence and overdose.

Know The Risk Factors – Who is Most Vulnerable?       

Eliminating the need for opioids completely or using the lowest needed dose will reduce the chance of developing opioid addiction disorders. Research found that among patients prescribed opioids for chronic pain, approximately 10% of them will be diagnosed with an opioid use disorder.3 As the name describes, patients with an opioid use disorder rely on or are addicted to opioids, including prescription drugs and heroin. While not all patients will experience reliance on these drugs, researchers identified factors that may be associated with an increased risk of developing an opioid use disorder: the presence of another substance use disorders (including tobacco use disorders), a family history of substance use disorder, other mental health disorders (such as depression or posttraumatic stress disorders), a history of legal problems or incarceration, and individuals using opioids younger than 40 years of age.4,5 Therefore, patients meeting any of the previous criteria should be aware of the increased risk for developing opioid use disorder. Consequently, opioid addiction parallels the increased risk of death primarily due to the elevated rates of overdose and trauma.

 

Limit Exposure and Opportunity

Eliminating prescription opioids in the household can minimize the chance of family or friends from getting possession of opioids. Investigators found that prescription opioids were more often obtained from friends or relatives than from a clinician.6 Therefore, by removing unnecessary opioids, patients can reduce the amount of drugs in the community. Fortunately Pennsylvania’s Department of Drug and Alcohol Programs has a Drug Take-Back Box Program that allows individuals to safely dispose of their unused opioids at their local hospitals and pharmacies. While complete elimination may not be entirely reasonable, taking the minimum dose needed or alternative non-opioid pain relief can yield similar outcomes while decreasing the chance of adverse events.

In response to the epidemic, the Centers for Disease Control and Prevention (CDC) released prescription guidelines that recognize specific situations where a low dosage of opioids are appropriate such as: cancer treatment, palliative care, end-of-life care, and certain acute care situations. For long term pain management, the CDC recommends physical therapy for symptoms that are related to low back pain, osteoarthritis, fibromyalgia, or other chronic pain lasting longer than 90 days.7 Research has found that, treatment with opioids was not superior to nonopioid treatment for improving pain-related function over 12 months. The American Physical Therapy Association’s (APTA) launched a national public awareness campaign to encourage patients to #ChoosePT as a safer alternatives for long term pain relief.

 

Find Safer Alternatives for Pain Management

As a more permanent solution, physical therapy breaks the cycle of chronic pain while opioids temporarily masks symptoms and actually delays recovery. A physical therapist will partner with their patient to create a customized plan of care that addresses their painful movement faults. Physical therapists can treat symptoms through therapeutic exercise, hands-on techniques, and patient education on chronic pain management.8 Exercise therapy can be modified to include aerobic, aquatic, and resistance exercises that addresses musculoskeletal imbalances or poor conditioning causing pain. Impairment-specific exercise programs combined with patient education on pain mechanisms can help address fear associated with chronic pain symptoms. Physical therapists can also address proper posture, ergonomics, sleep positioning, and body mechanics to decrease overall daily stress on the body and improve functional capacity.9 Patients can be referred to other experts on behavioral and stress management techniques that promote overall health and wellness. The education process includes building a multidisciplinary team and setting patient-centered goals that are realistic for recovery without opioid use.

 

Use Resources

Victims of an opioid use disorder have a number of resources to help them manage their disease, and reduce the risk of recurrence and overdose. While self-diagnosing an opioid use disorder may prove difficult, there are a number of signs that may suggest a misuse of prescription drugs – these indications include: using more drugs than planned or for a longer period of time, unable to cut down the need for drugs, having a craving or strong desire to use, neglecting work or family, or any other symptoms that prevent the individual from previously normal activities.10 Individuals who are worried that they may have a problem with drugs are highly encouraged to talk to their primary care physician, or a mental health counselor. This way consultation and treatment programs can begin before the drug abuse gets out of hand. Normally, treatment of opioid use disorders involves 3 components: medicine, counseling, and support groups. Physicians can prescribe medicines that help patients reduce drug cravings and eliminate the high that comes from opioids. Addiction counseling helps patients come to terms with their addiction and helps them develop a life that does not involve drugs.

While support groups, like Narcotics Anonymous, provides a forum for those with the same conditions to share their experiences and advice with each other. In Scranton, there a few local resources aimed to help those with opioid and other substance use disorders. Some of the example organizations are the Greater Scranton Steamtown Area of Narcotics Anonymous and the Drug and Alcohol Treatment Service, Inc. in Scranton. The Pennsylvania Department of Drug and Alcohol Programs also supports a 24 hour hotline with a purpose to assist patients in finding treatment providers or funding for addiction treatments; this number can be reached at 1-800-662-HELP (4357). Alternatively, you can find this information on their website entitled PA Get Help Now at “apps.ddap.pa.gov/gethelpnow/” that will also help you find local care providers and pill take-back locations based on a zip code.

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Contributor: Kay Kovitprakornkul, BS, SPT

Next Week: Read Dr. Mackarey’s Health & Exercise Forum – every Monday. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquiries related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.