Opioid crisis: addiction & chronic pain

When it comes to managing chronic pain, opioids such as codeine, morphine or fentanyl are highly effective in providing relief but they can also be highly addictive. In fact, it's now leading to what's known as the "opioid crisis" in the UK.

Here, pain management specialist Dr Giancarlo Camilleri explains why opioids are prescribed, if they really are effective in long term use, the possibility of becoming addicted and reliant on these drugs, and alternative therapies for chronic pain.

[ninalee]

I've had chronic pain from undiagnosed fibromyalgia since I was 20yrs old. I tried every medication and therapy available. I preferred natural treatments as I did not want more chemicals in my body in addition to what we are exposed to in the environment. I did take codeine in the form of cough syrup when I had pneumonia on several occations. I found this to be effective for the pain I experienced from my constant coughing; the muscle pain in my chest & the burning of my airways. I was prescribed Percocet when I developed gall stones. The pain of passing a stone for 6 hours was excruciating. Despite never taking an opioid stronger than codeine, the Percocet barely contained my pain until my surgery. The morphine they gave me post-operatively had to be increased from the initial dose, but was very effective. By the time of discharge, I was no longer experiencing enough pain to complain about, but I was given codeine. My fibro pain continued to plague me upon my return to work. I tried every OTC to no avail & tried my left-over codeine, despite the side-effect of nausea. It was take that or go home. I had already been written up for absenteeism due to severe fibro-fatigue & pain. Codeine was effective, but I ended up vomiting & suffered through that the rest of the day. It was this side-effect that I rarely took opioids & that codeine was effective for moderate to severe pain until my late thirties. I had a breast augmentation when I was 38yrs old & was prescribed Vicodin 5mg. I was in agony & the Vicodin was not effective. I suffered through the weekend as I was alone & could not go out to an ER or pharmacy. I supplemented the Vicodin with ibuprofen without relief. I then used my left-over Vicodin for my fibromyalgia with good results, but the nausea was still a problem. I was finally diagnosed with fibromyalgia when I saw a colleague of Robert Bennett, MD at OHSU where I worked at the time. He prescribed Ultram (tramadol) & temazepam for sleep. I had taken benzodiazepines with opioids previously without problems with over-sedation. When I was diagnosed with PTSD, panic disorder & anxiety I was prescribed Xanax & had to discontinue to temazepam. While the tramadol was effective for my fibro pain, I was experiencing many intolerable side-effects which are now called serotonin syndrome. I had to change to methadone & discontinue the Xanax which left me with having to deal with my PTSD & panic attacks. I do subconscious things like holding my breath until I become dizzy & think I may pass-out until I realize I'm not breathing. I become removed from the world; removed from reality. This is obviously dangerous if I'm driving - I've blown through red lights; walked into traffic. I was on methadone 10mg 4xdaily for 5yrs, but couldn't deal with my PTSD & panic attacks any longer. I had several nervous breakdowns during the more than 20yrs it took to be diagnosed & medicated. I found a fibromyalgia clinic & was prescribed clonazepam & morphine ER 30mg 3xdaily; morphine IR 15mg 6xdaily for breakthrough pain. Obviously, we came to this dose after trying other medications & working our way to meds & doses to help me become functional. I did not lay around in a half-coma, drooling & incoherent. I worked in my garden; landscaped my yard; played with my dog; sewed garments; made jewelry & my favorite activity of cooking with fresh ingredients. Many chronic pain patients take between 200mg-300mg morphine equivalents per day. Some medical professionals believe I was on too high a dose & should not be taking benzodiazepines. We did not come those doses overnight. It was 10yrs of trial & error. I was on the same dose of morphine for more than 5yrs. Now they've taken all my medication away from me with this opioid & benzodiazepine hysteria. I've never overdosed, been over-sedated or abused my medication in any way. Those so-called doctors that manipulate facts then say post-operative pain & chronic pain can be treated without opioids are making some outrageous claims. I am now 63yrs old with two grown sons I had through natural childbirth. If I had chose to have more, I would take drugs! I tried everything for my chronic pain & PTSD. I've suffered for more than 40yrs desperately trying everything legitimate & crazy. I put "magic" crystals in my car & my house. No stone was left unturned. I shouldn't have to live out my retirement in mental and physical pain.

[neddludd]

Just accept pain for what it is. Just tough it out! What garbage.
I've been on opioids for 3 years. I finally have the ability to live life. I don't care about addiction. I am pain free. Everyone had an opinion they want to apply to everyone and thus make a diagnosis based on the prevailing political flavour no on true assessment.

[spooky]

All drugs should be legal and freely available to anyone who functions better on them. They are God's gift to those in pain. The idea that there is something wrong with taking as high a dose of narcotic pain medicine as is required to function... is cruel, ignorant and 100% misguided.

[ronaldclayton]

I'm tierd of having my pain meds cut over a bunch of junkies shooting illicet brown and black crud in their arms and dying from it, that has nothing to do with me.

[greg]

The problem is doctors saying “this works for patients, this doesn’t” but they drive home in their comfy cozy car.. to their comfy cozy house to their happy family. Because most went straight through college out of high school without doing any back breaking labor. It’s rare to find a doctor who’s endured a lot of physical pain, but when you do, you will find empathy, and they are not totally apposed to taking opioids.

[robinalexander]

Example. I had her a operation 2 years ago. After surgery, in the hospital I was given an opioid pain killer for pain that I did not need an opioid for, panadol would have been enough. I took no pain medication. Health care can be the start of the addiction that causes the problems. Had another hernia operation on Monday took no pain killers of any type, no problems with pain.

[serinadelmar]

Even as you ignore studies which are very clear about how efficacious opioids are for the subset of intractable pain patients, in terms of long term evidence, knowingly putting intractable pain patients into a study without any analgesia is not possible because of the human rights issue. An absence of evidence does not illustrate the opposite, however as it did not fit the CDC narrative and subsequent consequences, as that misinformation spilled into the world, Pain patients are suffering, many have even committed suicide as a consequence, while overdoses are skyrocketing. The latter because it is an illicit drug problem not that of pain patients.

The exact figure is 1% for addiction, which is in line with all other national averages and remains consistent. The 0.025% risk of overdose in opioid naive patients can be carefully managed by doctors whose knowledge and medical care is sagacious as it is compassionate. Force tapering intractable pain patients, who are functioning well and now who are housebound or bedridden, having lost all quality-of-life, despite often taking these medications without any problems or dose increase for years (personally it was a decade), is absolutely inhumane and the opposite of doing no harm. It is also important to note that they are always the final option, having exhausted all other healing natality is, and frequently they facilitate other healing resources such as daily physical therapy etc. Spreading information like this does not help any patient.

[terrysmith]

70 years old, 30 years of chronic pain, how about some relief in your later years. Patients with genuine pain NEED OPIATES< I would not let a dog suffer as I have

[LF-tumy]

Typical sweeping statements made about 'risks'. Absolutely nothing said SPECIFICALLY about what these so called risks are. And more importantly a reference/link to the research on this. I.e how this concussion is reached.

[bonnieplastino]

OPIOID BEING DISTRIBUTED FROM CHINA YOU CAN ORDER IT WITHOUT A SCRIPT AND BBN IU T HAS FENTANYL IN IT. AND ITS COMING IN THE UNITED STATES AND THE PEOPLE THAT ARE TRULY IN NEED OF CARE BY OPIOIDS .AND ONLY TYPE OF DRUG FOR THEM TO TAKE, IS
BECAUSE OTHER MEDS ARE NOT WORKING OR COULD CAUSE DEATH. SO OPIOID IS THEY ONLY HELP. BIG DIFFERENCE BETWEEN
CHINA KILLING AMERICANS
IF YOU HAVE CANCER YOU MUST TAKE IT YOU ARE GOING TO LO EARN HOW IMPORTANT IT IS TO BE VERY CAREFUL SO A POSITIVE RESULTS ITS NOT OK TO GO TO BLACK MARKET DRUGS AND THINK. WELL THE GOVERNMENT TOOK AWAY ARE MEDS. ITS STUPID TO HAVE GOVERNMENT AND FEDS AND OUT SIDE HEALTHY PEOPLE TO KNOW HOW LIVING AT HOME IN SUCH PAIN THEY JUST DO AND SAY DOCTORS ARE OVER PRESCRIBING. ( NO) ITS LEVELS THAT YOU SLOWLY HAVE TO TAKE. KNOW. IF WE WORK TOGETHER AND HELP INSTEAD OF MAKE TV SHOWS ABOUT HE DID IT SHE DID IT (NO)
( COME DO A DOCUMENTARY AT MY HONE FOR 6 MONTHS

[mealex]

I've been on methadone for 17 years and it's killing me and is impossible now for me to stop I have depression suicidal thoughts stomach issues heart problems and not getting help my Dr's want me out as fast as I go in I cannot get prescribed anything that helps for my depression or anxiety or panic attacks. It's ridiculous can someone else help me???

[happyheidi]

I have been on opioids meds for 20 years, my body is dying, I so want help to come off them I was in a rta and broke my neck