The Opioid Crisis and Pain Relief Alternatives

5 Important Statistics on Opioid Use and Abuse

1. Drug overdoses killed more Americans in 2016 than guns or car accidents. 1 out of 50 causes of death are drug-related.
2. Over 97 million Americans took prescription painkillers in 2015.
3. The amount of opioids prescribed yearly in the U.S. is enough for every American to be medicated for three full weeks.
4. 8-12% of people with chronic pain who are prescribed opioids develop an opioid use disorder.
5. Opioid death rates have doubled from 2010 to 2016. Over 115 people a day die from opioid overdose. That’s over 42,000 people a year in the U.S.

Ready to learn more about the Opioid Crisis and Alternatives? Browse by topic:

• What is an opioid? What’s the difference between opioids and narcotics?
• Examples of Opioids
• The Negative Effects of Opioid Use
• Where are overdose deaths most common? Who is affected?
• How does opioid addiction cause death?
• Opioids and Heroin Addiction: A Timeline
• How does prescription drug use lead to heroin use?
• Why do doctors prescribe opioids?
• The Importance of Alternatives to Opioids
• Pain Relief Alternatives to Opioids
• You can help fight the opioid crisis…
• If you or someone you know struggles with opioid use…

What is an opioid? What’s the difference between opioids and narcotics?

Opioids are chemicals that interact with the opioid receptors in your nerve cells. They can be natural, created from the opium of poppy plants, or synthetic, created using chemicals in a lab. The term opiates is sometimes used to refer specifically to natural forms. Opioids reduce pain, but they also cause a feeling of euphoria, a “high”, which is why they can be misused.

Narcotics refer to drugs that relieve pain. Opioids fall under this category, but the term is not used in the medical field as often now, due to its association with illegal drugs.

Examples of Opioids

• Codeine
• Methadone
• Hydrocodone (Vicodin, Norco)
• Morphine
• Oxycodone (Oxycontin, Percocet)
• Hydromorphone (Dilaudid)
• Fentanyl (Duragesic)
• Heroin

The Negative Effects of Opioid Use

Opioid misuse has a variety of negative consequences including:

• Diminished school performance
• Poor mental health
• Deteriorating relationships
• Job loss
• Increase in sickness and death (resulting from car accidents, poisoning, violence, and other accidents)
• Overdose Death

Injectable drug use has even more consequences including:

• The risks mentioned above
• Increased risk for HIV, viral hepatitis, endocarditis, and other blood diseases
• Increased risk for MRSA, Staph, and other bacterial infections
• Increased risk for Hepatitis C

Where are overdose deaths most common? Who is affected?

Currently, New England, the Rust Belt, and the Appalachian regions have the highest concentration of overdose deaths, but there is significant variation in deaths across the United States. Over 2 million people in the U.S. have an opioid use disorder, that’s nearly the population of New Mexico.

Misuse and overdose has hit the Caucasian population the hardest, but this is starting to change. The crisis affects our entire nation, costing $504 billion a year in 2015 according to the Surgeon General.

How does opioid addiction cause death?

The drug’s chemicals attach to opioid receptors in the brain which causes a variety of effects. In addition to the pain relief and a high, the chemicals also cause drowsiness and a lower breathing rate. This depression of important areas in the brain can cause breathing, heart rate, and body temperature regulation to stop, leading to death. Most of the 42,000 overdose deaths a year are unintentional.

Opioids and Heroin Addiction: A Timeline

The History: 1860s-1970s

1860s: Morphine is used to treat pain during the Civil War and soldiers become addicted to it.
1898: Heroin is first produced commercially by the Bayer Company. It is believed to be less addictive than morphine, so it’s given to people with morphine addictions.
1914: The Harrison Narcotics Act requires doctors write prescriptions for narcotics (like opioids).
1924: The Anti-Heroin Act bans producing and selling it in the U.S.
1970: The Controlled Substances Act groups drugs according to likelihood of abuse, Schedule I having the most potential. Heroin is considered a Schedule I drug, while morphine, fentanyl, oxycodone are Schedule II drugs, and vicodin is eventually categorized here as well.

The Current Crisis: 1980s-Today

1980: The New England Journal of Medicine publishes "Addiction Rare in Patients Treated with Narcotics". It becomes widely cited as proof that narcotics are a safe, acceptable treatment for chronic pain, although it was not a medical study and only looked at a small, specific population.
1995: OxyContin is released as a safer pill option by Purdue Pharma.
2007: Purdue Pharma pleads guilty when the government charges them with misleading advertising, including claims that OxyContin is safer and less addictive than other opioids. The company and executives plead guilty and pay $634.5 million in fines.
2015: The DEA conducts the biggest prescription drug bust in its history. “Operation Pilluted” focused on healthcare providers who dispensed large amounts of opioids. It led to 280 arrests.
2016: CDC guidelines are published regarding chronic pain and prescription opioids. They recommend alternative medications, exercise, and other ways to reduce pain as the first line of treatment.
2017: The opioid crisis was declared a public health emergency.

How does prescription drug use lead to heroin use?

The Facts

4-6% of people who misuse prescription (Rx) drugs transition to heroin use. This percentage may seem small, but 80% of heroin users first misused prescription drugs. Reducing prescriptions is important because heroin overdoses have quadrupled since 2010.

One Possible Journey

How does someone go from taking drugs prescribed by their doctor to using heroin? Here is one possible path.

Annie is prescribed painkillers following surgery. After a few months, the dose is no longer working as well, so she takes more than prescribed. Then she starts to run out of pills... So Annie starts taking them from friends’ or family members’ medicine cabinets.

She tries snorting them and learns that it helps her feel better faster. A friend or spouse may confront her, but she denies any problems. Annie goes to her doctor and asks for a prescription refill, but he refuses. She starts to undergo withdrawal symptoms, including cramping, vomiting, and anxiety, and begins to grow desperate.

Her friend, Joe, says he doesn’t have any pills, but can get her heroin. She’s willing to try snorting it to make her symptoms go away. The heroin gives her the feeling she craves, plus it’s cheaper and easier to get than the pills. Over time she builds up a tolerance and requires more and more of the drug to reduce her cravings.

Joe says she can inject the heroin to get the same high, but with less heroin. She’s scared of needles and nervous, but her friend says he can inject it for her. Annie and Joe don’t know it, but the injection is laced with fentanyl, a much more potent drug. This injection causes her to stop breathing and leads to an overdose. Without help, this can lead to death.

Lucky for Annie, Joe calls 911 before leaving her as she turns blue. The paramedics arrive in time to give naloxone. It’s a drug that can reverse an overdose, if administered in time. Annie ends up in the hospital where she is under close observation. She enrolls in a treatment program after the close call and works hard to stay in recovery. Annie can lead a healthy life after addiction, but she could have also ended up dying from the overdose.

Why do doctors prescribe opioids?

If the risks of prescription drug use are so devastating, with 2.1 million Americans struggling with opioid misuse, you may wonder why doctors prescribe opioids at all.

According to the American Medical Association (AMA), doctors are tracking subscriptions more and prescribing opioids less. Physicians have reduced prescriptions by 22% since 2013, though the number remains high with 191 million prescriptions in 2017.

Doctors prescribe pain killers, like opioids, because they want to minimize their patients’ pain. But a study by Dartmouth researchers found that they prescribe enough to satisfy the patients who require the highest dose to ensure that no patient has pain after surgery.

Additionally, prescription opioids given under a trusted provider’s care are relied on by certain populations to reduce pain. This includes people in hospice care, undergoing cancer treatment, recovering from an acute, traumatic injury, and those with long-term disability and chronic pain.

However, the CDC does not believe opioids should be the first line of defense against chronic pain. They urge doctors to consider alternative treatments first. If opioids must be prescribed, they recommend doctors “start low and go slow” (start with a low dose and reassess before increasing it).

The Importance of Alternatives to Opioids

Lisa Hollier, M.D. and President of American College of Obstetrics and Gynecologists, states that "One of the most important elements of preventing and treating substance use disorders is understanding the safety and effectiveness of alternatives to opioid medications.”.

The U.S. Department of Health and Human Services agrees, saying, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”

Pain Relief Alternatives to Opioids

Medication

There are other non-opioid medications that you can take to relieve pain. Acetaminophen, the active ingredient in Tylenol, is one medication that helps reduce pain. Another option is ibuprofen and other NSAID pain relievers, known under brands like Motrin, Excedrin, and Aleve. These drugs reduce inflammation and pain. They’re stronger than acetaminophen, but taking too much can lead to kidney or liver complications.

You might be wondering if these over-the-counter drugs can offer the same relief as prescription medications. A study published in the Journal of the American Dental Association investigated pain relief after molar tooth extraction. The result? Acetaminophen & ibuprofen taken together provided greater pain relief than opioids.

Modalities: Ultrasound and TENS Treatment

Therapeutic modalities use electrical, thermal, or mechanical energy to help reduce muscle spasms and pain. Ultrasound uses high frequency waves directed into the deep tissue. This therapy is performed by PTs and OTs in a clinic to relieve your pain and muscle spasms.

TENS units are another option for pain relief. The small device delivers a low voltage electrical current through electrodes. The unit can be worn all day and used at home.

Hot and Cold Therapy

Hot and cold packs are commonly used to relieve pain. Ice is best for acute pain and to reduce inflammation and swelling. If you have chronic pain, heat might work better. Heat is also great for warming up the tissue before trying other solutions like massage or exercise. Therapearl packs can be used hot or cold, so you can see what works best for your condition.

Paraffin wax and mineral oil allow targeted heat application. Paraffin is usually used on the hands and feet where other heat sources are more difficult to apply.

Massage

Get a massage from a professional or ask your spouse for one to help reduce your pain. They can use an oil or creme to increase glide and make giving a massage easier.

You can use tools to self-massage your pain points too. A foam roller lets you give yourself a deep tissue massage for relief. Use a massage roller afterwards to target specific areas and trigger points.

Exercise

Chronic pain? Exercise is another solution. It can be as simple as going for a walk and using an exercise ball to stretch out your back. Or you can work with a medical professional to create a program targeted to your needs.

Many exercise options are backed by research showing their effectiveness for chronic pain. For example, one study found that home exercise plans using resistance bands significantly reduced osteoarthritis knee pain. Adding exercise to your daily routine can lead to a big change in your pain levels.

Newer Trends: Cupping, Dry Needling, and Kinesiology Tape

Both cupping and acupuncture are alternative forms of therapy that have existed for hundreds of years. But they have become more popular recently, especially when many athletes used cupping, which leaves circular bruises, during the Olympic Games.

Cupping uses about 3-7 cups upside down on your skin to create a vacuum. This used to be done using fire to heat the cup, but the modern version uses a rubber pump. The vacuum suction decompresses the tissue and can help relieve pain in some patients.

Acupuncture is used to alter the flow of Qi (pronounced ‘chi’) as part of traditional Chinese medicine. While acupuncture has been around for ages, a new practice that also involves inserting needles into the skin is becoming more common in physical therapy clinics. Dry needling focuses on releasing muscle tension by targeting trigger points. This western medicine practice can hurt a bit during needle insertion, but it works to relieve pain and relax your muscles.

Another popular choice at the Olympics and other sporting events is kinesiology tape. This tape is applied in patterns over the skin to help relieve pain. THERABAND Kinesiology Tape has Xact Stretch Indicators, making it easy to apply yourself, even if you’re a beginner.

JazBird2fly, an Amazon customer, reviewed the product giving it five stars and states, “I purchased this item due to recommendation of my physical therapist. I have used braces for knee and back pain and this is the first time I have experienced any relief from constant pain. This tape alleviates pain from long term chronic issues and sport injury...Can stay on for 3 to 5 days, in shower and the pool. Highly recommend for relief from pain and added stability.”

The Power of Biofreeze

Biofreeze Classic is a topical analgesic. This means you apply it on your skin for pain relief. It’s non-addictive and a safe alternative to NSAIDs and other oral pain relievers. You can use it to relieve pain from muscle strains, arthritis, lower back pain, and more.

Ann Libby gives Biofreeze five stars on Amazon, saying, “WONDERFUL!! I live in chronic pain, this HELPS. Ahhh makes it so much easier to get RID of chronic pain!! I use the roll on for my neck. For the back pain I use the spray...Thanks to these I NO longer am on ANY narcotics.”

Health Professionals

Sometimes pain management requires professional help. If treating your pain at home isn’t working, contact a medical professional to help you treat the pain and the underlying cause. Physical therapists, chiropractors, and massage therapists are some of the professionals that can help treat your pain.

You can help fight the opioid crisis…

• Only use prescription opioids as directed by your physician.
• Keep the medication out of reach of children and locked up if possible.
• 70% of prescribed pills are never taken, don’t leave yours lying around. Take expired or unused medications to authorized disposal locations including police station drop boxes, DEA-authorized sites, and mail back programs.
• Find a disposal location near you or call (800) 882-9539.

If you or someone you know struggles with opioid use…

• Contact 1-800-662-HELP (4357) for treatment referral and information
• Find an opioid treatment program in your state
• Learn about Naloxone, an opioid overdose-reversing drug, and carry it with you.
• In 2018, the U.S. Surgeon General issued an advisory recommending that Americans carry Naloxone. These advisories are rare; the last time one was issued, it was to advise against drinking while pregnant. Naloxone can save lives.

References
American Medical Association. (2017). Promote Safe Storage and Disposal of Opioids and All Medications. AMA. Retrieved https://bit.ly/2PljCB8
CDC. (2017). Opioid Prescribing. Center for Disease Control and Prevention. Retrieved from https://bit.ly/2uveWLd
CNN Library. (2018). Opioid Crisis Fast Facts. CNN. Retrieved from https://cnn.it/2sPtPuW
How Can Prescription Drugs Lead to Heroin Use? (n.d.). Partnership for Drug-Free Kids. Retrieved from https://bit.ly/2HNV7YV
Gilbert, S. (2016). Is Dry Needling the Same Thing as Acupuncture? Canyon PT. Retrieved from https://bit.ly/2RMiCmu
Johnson, S. R. (2018). Evidence shows docs are cutting opioid prescriptions:AMA. Modern Healthcare. Retrieved from https://bit.ly/2QHYbal
Katz, J. (2017). Short Answers to Hard Questions About the Opioid Crisis. The New York Times. Retrieved from https://nyti.ms/2v20oF2
Melemis, S.M. (2018). Opioids: Addiction, Withdrawal, and Recovery. Addictions and Recovery. Retrieved from https://bit.ly/2QBacxZ
Moore, P.A., Hersh, E.V. (2013). Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. The Journal of the American Dental Association. Retrieved from https://bit.ly/2qGrZIG
News Staff. (2018). AAFP, Other Groups Issue Joint Principles on Opioid Crisis. AAFP. Retrieved from https://bit.ly/2z3ShJt
NIH. (2018). Opioid Overdose Crisis. National Institute on Drug Abuse. Retrieved from https://bit.ly/2LFlM8E
Robeznieks, A. (2018). Physician-led effort slashes post-surgical opioid Rx by 63%. AMA. Retrieved from https://bit.ly/2LFlM8E
Surgeon General. (n.d.). Opioid Overdose Prevention. Office of the Surgeon General. Retrieved from https://bit.ly/2GzZuXR
Thomas K. S. et al. (2002). Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. Retrieved from https://bit.ly/2FmpDsO
United States Census Bureau. (2017). United States 2017 Population Estimates. Retrieved from https://bit.ly/2B5ljtP
U.S. Department of Health and Human Services (HSS). (2018). Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Office of the Surgeon General. Retrieved from https://bit.ly/2B2iZny
U.S. Department of Health and Human Services (HSS). (n.d.). Guideline for Prescribing Opioids for Chronic Pain. Office of the Surgeon General. Retrieved from https://bit.ly/2xw5CaZ

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