Pharmaceutical opioids, dependency and addiction

The significant increase in the use of pharmaceutical opioids for the treatment of non-cancer pain and associated related increases in dependency and deaths has led to a lot of concern, particularly in the US.

The figures are alarming. Sales of opioid analgesics in the US increased fourfold between 1999 and 2010. In 2008 more than 14,000 deaths were related to the misuse of prescription medications, the vast majority prescription opioids.

While there is evidence that marketing of these drugs for use in non-chronic cancer pain was not as aggressive or untrammelled in Australia, recent statistics are worrying.

Researchers at the National Drug and Alcohol Research Centre found that, between 2002 and 2008, prescriptions for oxycodone increased by 152 per cent. Prescriptions were highest among older Australians. A second report from NDARC reveals that a total of 500 Australians aged 15-54 died due to accidental opioid overdoses in 2008 – the latest year for which final figures are available. Deaths in 2008 were predominantly due to opioids other than heroin (which include oxycodone and morphine). The largest recorded increase was among older Australians aged 45-54, with preliminary figures indicating deaths in that age group have increased by about 50 per cent since 2008.

Opioid dependence and fatal respiratory depression are serious and well known risks of opioid analgesics. Yet at the same time they are listed by the World Health Organisation (WHO) as essential medicines for the treatment of chronic pain.

With an ageing population we can expect their use to increase not decrease. In addition, there is no scientific consensus as to what the best course of action is. Some argue that the use of the drugs in non-chronic cancer pain in anything other than an end of life situation should be severely restricted as dependency is a very real risk even for patients without a history of substance use or mental illness. Others argue that there is no reliable large scale scientific evidence that tolerance is a typical result of opioid prescribing.

There is no doubt that we need a humane response to the management of chronic pain and not a knee jerk reaction, which dramatically restricts their use in the absence of reliable evidence of inevitable harm.

What all are agreed upon is that patients must be rigorously assessed for risk – which includes a previous of history of substance use or coexisting mental illness. As well patients prescribed opioids to treat chronic pain must be carefully monitored particularly with regard to dose and length of treatment.

At the same time, extremely promising programs are emerging which involves comprehensive approach to treating chronic pain encompassing mental, emotional, spiritual and physical functioning.

For some people, traditional pain management approaches and the use of pain medication have not worked. The goal of eliminating pain becomes seemingly impossible and unrealistic. There are well established pain treatment programs in US based on the recovery concept similar to addiction that have shown to be effective. The goal of pain recovery is to learn ways to accept and live in coexistence with pain.  It is individually managed, abstinence based, Twelve-step model, client empowered and solution oriented. It addresses family issues and long term support.

At South Pacific Private, we have been treating an increasing number of people with prescribed medication abuse, majority opiates, and many, as a result of chronic pain. While treating the addiction, we have found the recovery approach effective in addressing issues relating to chronic pain.

If you would like support regarding chronic pain and addiction to pain medication please contact us 24/7 on 1800 063 332 or email info@southpacificprivate.com.au.

You can also take our short online self-test to determine whether there might be a concern. Click to take the test here.