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Worried about becoming dependent on opioids?

The Galax Gazette - 5/16/2018

Each day, 91 Americans die from an opioid overdose, according to the Centers for Disease Control. Patients and family members who are prescribed opioids for pain relief may worry about growing dependent on the medication. Dr. Charles Dunham is a psychiatrist and internal medicine physician who sees patients in several Winston-Salem, N.C.-area locations. Dunham has answers for some of the most commonly asked questions about taking opioids to relieve pain.

Q: I've been prescribed an opioid and I'm worried about becoming dependent on it. What should I ask my doctor?

A: Although opioid pain medications are some of the most commonly abused prescription drugs, the risk that properly vetted patients will become addicted is relatively low, according to a 2015 study on opioid misuse and addiction among individuals with chronic pain. But it's still critical to share your worries with your doctor. Many providers are using an opioid risk screening tool to help minimize the risks for patients with chronic pain prescriptions. Your provider will ask you questions that will help gauge your risk for opioid use.

Some questions to ask your provider:

What's my risk of becoming dependent?

Should I stop taking opioids if my pain goes away before my medication prescription period is over?

What's a good safety plan for us to follow to monitor my opioid use?

Q: I have a history of addiction. Should I tell my doctor?

A: It's not easy to acknowledge a history of substance abuse, but your doctors need that information to find a pain management option that works best for you.

"Even if you come in and tell your provider that you do have a history of addiction, it doesn't mean that we won't effectively treat you ? it just means that we're going to treat you with medication that's less addictive or not addictive at all, or maybe we need more guard rails around the medication as far as how much we give you and how often," Dunham said.

Q: What puts me at higher risk for becoming dependent on or addicted to opioids?

A: Dunham recommends that patients take the risk tool to better understand the major factors that can help you gauge your risk levels. "Generally, the higher the risk category (that you can identify after taking the assessment), the more we may need to specialize your needs (for treating pain)," Dunham said.

Q: What does my doctor need to know about other medicine or supplements I'm taking?

A: Make sure your provider knows all of the medications you're taking ? everything from prescriptions to over-the-counter medication to herbal supplements. Some common drugs may react with opioids and have fatal consequences. Nearly a quarter of people who died of an opioid overdose tested positive for common medications like benzodiazepines, such as Valium, Xanax and Klonopin, according to the CDC.

Q: What are common non-opioid alternatives for pain?

A: There are many beneficial treatment approaches that you and your provider can explore which include:

Physical therapy with exercises.

In some cases, over-the-counter options like acetaminophen, the active ingredient in Tylenol, when used with ibuprofen, the active ingredient in Advil, has been found to have worked just as well as opioids for reducing severe pain, according to a study published by JAMA. Patients should consult with their providers about the safe amounts to take of each medicine and confirm that they are good candidates for combining the acetaminophen and ibuprofen.

Mindfulness-based strategies involving yoga and meditation.

Therapy and other behavioral approaches that address conditions like depression and anxiety, because untreated mental illnesses can worsen pain.

Q: I'm worried that someone I know is becoming dependent on opioids. What can I do?

A: Approach your friend or loved one with a positive and respectful attitude and treat his or her possible addiction as a medical issue. Encourage that person to see a doctor or a treatment center near you. Your respectful manner will help someone not to feel judged or rejected. Set clear boundaries and expectations with someone engaging in addictive behavior.


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