Opioid drugs can be helpful after surgery or an injury, but when over time or used incorrectly the risks of opioids outweigh their benefits.
Prescription opioid drugs are killer these days. And that’s not adolescent slang for “good.”
More than 45,000 people died of drug poisoning in the United States in 2012. Yet 80 percent of those deaths were unintentional.
It’s not just street drugs. In fact, prescription opioids and benzodiazepines — frequently used to treat pain, anxiety, and insomnia — are the main culprits. With both drug classes, the body develops a tolerance and requires higher and higher dosages to have an effect. It’s easy to become physically and psychologically dependent, and, used for long enough, both classes are highly addictive.
What is an opioid?
Opioid drugs include hydrocodone (Vicodin), oxycodone (OxyContin), and codeine, while common benzodiazepines include alprazolam (Xanax), diazepam (Valium), and clonazepam (Klonopin).
Opioids are one of the oldest classes of pain medications. In the 1990s, U.S. medical policy toward the use of painkillers changed. Experts began prioritizing managing and reducing pain, and a growing consensus believed opioids could be effective in the management of short-term pain for many conditions.
As a result, laws regulating prescription painkillers were relaxed in numerous states. Painkiller sales exploded — quadrupling from 1999 to 2010 — while the overall number of people using them doubled.
Side effects of opioids
If the changes were intended to reduce pain, they may have had a more sinister effect. Painkillers are serious drugs that sedate and depress how your central nervous system controls your breathing muscles, and many people may not be adequately aware of the dangers they involve. Take enough of any opioid, and you’ll stop breathing.
As a result, painkillers are now killing. Tracking sales, painkiller-related deaths nearly quadrupled between 1999 and 2011. Today, 46 people die every day in the United States from opioid overdose. More people now die of prescription painkiller overdoses than from heroin and cocaine combined.
Women may be especially at risk. The risk of death from prescription painkiller overdose is increasing faster among women than men. Women are statistically more likely to have chronic and severe pain than men. Women are also more likely to receive a prescription for pain medicine, get stronger pain medicine, and take it for longer. That’s affecting their children, too, since women may take these drugs before they even know they’re pregnant. Opioid exposure during pregnancy can lead to fetal opioid withdrawal, called neonatal abstinence syndrome. Incidence of the syndrome grew by nearly 300 percent in the 2000s.
How to use, and not use, opioids
When used wisely, painkillers aren’t all bad. Painkillers can be helpful when recovering from major surgery or injury, while benzodiazepines can offer short-term help with anxiety or insomnia. But over time or used incorrectly, experts believe their risks outweigh the benefits. If you’re prescribed these powerful drugs, here are a few points to keep in mind:
- Never combine opioid painkillers (such as Vicodin) with benzodiazepines (like Ambien or Zanax). Both slow the heart and breathing and depress the nervous system while affecting brain function — a potentially lethal combo. Also avoid mixing either one with alcohol or antidepressants, which has the same effects; if you’re taking any of these drugs, it’s safest not to drink alcohol at all. In addition, plan to avoid driving, operating machinery, or performing any complex activity.
- Women who are planning to become pregnant should discuss medications they’re taking with their doctor.
- When it comes to painkillers, the best advice is to take as little as possible, for as short a period of time as possible—ideally, less than a month. Opioids and benzodiazepines become less effective with time because tolerance increases, but your risk of side effects, dependence, and addiction increases the longer they’re used. If a condition persists for more than 30 days, consider other pain management or mental health options.
If you’re affected by chronic health issues, there may be better ways to fight back than prescription medication.
First, it’s okay to reach for the ibuprofen, naproxen, or acetaminophen. Over-the-counter painkillers are safe and effective when used occasionally, even over extended periods. There are some caveats: avoid acetaminophen (Tylenol) if you drink alcohol regularly or have liver problems, since combining the two can lead to liver failure. Aspirin, too, can have unanticipated side effects. While you should generally feel safe trying these options, don’t take more than the maximum daily recommended dosages, and discuss any treatment plan with your doctor. You can also try using a pain relieving cream or ointment instead.
Exercise, diet, and other lifestyle changes can also have a significant impact on chronic conditions. Weight loss lessens knee pain, while back pain can be soothed with a consistent, gentle yoga practice. Massage and light exercise can improve fibromyalgia symptoms, and acupuncture helps with a range of chronic pain conditions, according to a 2012 review of 29 trials.
Before reaching for a prescription drug, consider the risks and benefits. If they do more harm than good, they may not be worth it. And isn’t the point to feel better?
April 24, 2018
Christopher Nystuen, MD, MBA