In addition to cannabis, ecstasy, LSD, PCP, mescaline, peyote, psilocybin, psilocin,
cocaine, methamphetamines, and a variety of opioids, opium, morphine, heroin,
oxycodone (OxyContin), hydrocodone (Vicodin), fentanyl, meperidine (Demerol),
oxycodone and acetaminophen (Percocet), codeine, etc., are mind-altering drugs
that have a spectrum of risks and some benefits—especially in the case of opioids
for control of pain. Using these drugs may lead to confusion, euphoria, hallucinations,
and other undesirable side effects that impair physical and mental health and
day-to-day functioning. Unless medically indicated, they should be avoided.
In a previous blog I noted that a rapidly increasing epidemic of
deaths from poisoning caused by prescription and illicit drug overdoses, mostly
from opioids, was estimated to have reached more than 68,500 in 2018 and to have
become one of the top ten causes of death. The wider use of synthetic opioids,
mainly fentanyl and its even more dangerous analogs such as carfentanil, are key
drivers of the epidemic.
Between 1995 and 2010, opioids prescribed for older adults increased by a factor
of nine. Of course, there are legitimate uses of opioids for acute and chronic pain,
but the risk of habituation and dependence is a severe adverse effect of their use.
Opioid overdoses may start with a first opioid exposure from a prescription, from
illegal sources, or from experimentation with a medication prescribed to a friend or
relative.102 Both prescribers and patients should strive to avoid the use of opioids
and employ nonopioid drugs for mild or moderate acute pain.
When acute moderate or severe pain necessitates the use of opioids, prescribers
should limit the course to the lowest dose and shortest duration possible, and patients
should recognize that physical dependence develops quickly, especially after
the fifth day of use. The risks of opioid use are mainly related to dose. They include
sedation, depression, constipation, reduced libido, motor-vehicle collisions,
sleep-disordered breathing, and accidental overdose. Excessive dose escalation in
the management of chronic pain should be avoided except during end-of-life care.
The prescribing of opioids for chronic pain is not supported by strong evidence.
Over time, the efficacy of pain control declines to the point that other less addicting
and less dangerous drugs work just as well. Patients should also recognize that
discontinuing opioids after habituation to them may be difficult, very unpleasant,
and is best undertaken under the supervision of a physician who can provide counseling
and a variety of drugs to help to taper off of opioids.
The drugs used to limit withdrawal symptoms and treat habituation with opioids include
methadone and buprenorphine. Methadone is used mainly for higher levels
of opioid dependence. Methadone is an opioid, a schedule 2 controlled substance
that requires dispensing from a specialized clinic. Buprenorphine is also an opioid
that can be used alone or in combination with naloxone, an opioid antagonist. It
is used mainly for treating lower levels of opioid dependence. It has improved the
treatment of opioid dependence for some patients because it causes less analgesia
and euphoria but ameliorates withdrawal symptoms. It has less potential for addiction
and has a better safety profile because buprenorphine causes less respiratory
depression than methadone. Buprenorphine is a schedule 3 controlled substance so
it can be provided from an individual physician’s office.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.