Opioid Use in Those With Chronic and Acute Pain: It is Time for a Change

The human species has been using opium as medical treatment for thousands of years, almost as far back as human existence itself. Countless medical practices and treatments have been discarded once better methods are discovered, yet very little has changed with opioid therapy in the thousands of years it has been used. Opioids are used in modern medical practice everyday and it is impossible to deny that there are valid reasons as to why they have stayed relevant for so long. Their effectiveness in treating pain and the elated feeling people experience when taking opioids are what make this drug so powerful, and dangerous. Regardless of the potential dangers, there are still many opioid advocates who claim that opioid use is too important to the treatment of certain medical conditions for it to be prohibited due to its lethal side effects. If opioids suddenly disappeared from pharmacies and doctor’s offices, millions of people would die from pain or withdrawal. It is important to understand that opioids are a vital part of the medicinal world, and that they will never go away. But it is also important to realize that, though opioids prolong the absence of pain, they also shorten lifetimes. Opioids’ ability to withstand the test of time is impressive, but the idea that a long history of using something means that it is a valid practice is pseudoscientific and causes serious harm to people.

Dr. Elliot Krane discusses the importance of opioids in The Clinical Journal of Pain’s article titled, The Opioid Debate-Pro: Opioids Have an Important Role in Pain Management in Children where he argues that those on the anti-opioid side believe that “all society must do is to restrict and curtail the availability of opioids to patients, beef up law enforcement, incarcerate over-prescribers and users, and the fire will be extinguished.” In a perfect world, this is all we would have to do, but experts know that this issue is too complicated for such a simple plan of action. It is extremely unreasonable to believe that opioids help people with certain medical conditions, and it would be detrimental to their health if opioid medications are prohibited. In the article, There’s Never Just One Side to the Story: Why America Must Stop Swinging the Opioid Pendulum, Bioethicist Travis Rieder discusses the two sides of the opioid argument, and how he believes that the solution to the opioid epidemic is inevitably going to come to a compromise, though it won’t be easy. Rieder talks about how “the pendulum swing toward radical permissiveness was, undeniably, incredibly harmful—it helped launch today’s drug overdose crisis, and even as that crisis moves away from prescription opioids and toward illicit drugs, it continues to feed it. But a full-on swing back toward the prohibitionist attitude that led us to withhold opioids from desperate patients would also be a tragedy.” Those on the anti-opioid side are aware that, if opioids were abolished, it would likely lead to a spike in illegal opioid use, which is the opposite of the goal both sides want to achieve. If people can no longer receive their treatment from a doctor, they will find another way to treat their pain. Both sides of the opioid argument want to see patients struggling with pain get the treatment they need, and both sides also wish to put an end to the opioid epidemic. But the anti-opioid side wants to take it a step further by advocating for pain relief options that do not have extreme risks.

 In cases where no other therapy or medication is able to soothe a patient’s pain, opioids have proven to be 100% effective. Opioids have played a large role in helping professionals make breakthroughs in medicine, and Dr. Elliot Krane claims that “opiates have brought relief to the suffering, made surgical procedures possible and routine, and have salvaged countless lives that otherwise would have been lost.” Opioids are especially helpful in surgeries, and without opioids to help patients handle their pain, none of them would not be able to withstand any surgery. Many patients who have struggled with their pain and have exhausted every other type of therapy have found that opioid medication will change their lives for the better.

In 2018, a randomized clinical trial launched by Dr. Erin Kreb, Dr. Agnes Jensen, Dr. Beth DeRonne and other researchers to test the effectiveness of opioid vs. non-opioid pain treatment in patients with chronic back or hip pain. This trial lasted a year and had 240 participants, with one group receiving either an “immediate-release morphine, oxycodone, or hydrocodone/acetaminophen” and the second group receiving “acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug.” The results of their study found that “adverse medication-related symptoms were significantly more common in the opioid group over 12 months” and concluded that opioid treatment “was not superior to treatment with nonopioid medications for improving pain-related function over 12 months.” This clinical trial shows that opioid use is not a reasonable treatment option for those with chronic pain, and that it is possible to tolerate pain with over the counter medication. The “adverse” side effects of opioids are life ruining, and opioids are only a temporary life saver. Opioids make the pain manageable, but daily use builds a tolerance that knows no limit. Eventually, even opioids will not be enough to tolerate the pain. 

A key difference between opioids and nonopioid treatments is that opioids bind to opioid receptors in the brain, releasing endorphins. Opioids not only make people feel great physically, but it also gives them a feeling of euphoria. This combination is what makes opioids a valuable pain reliever. The euphoric feeling is also the reason thousands of people end up addicted to opioids. The National Institute on Drug Abuse suggests that “the best way to avoid opioid addiction is to take opioid pain medications only as prescribed by a doctor, and only for as long as you need them.” Those in favor of opioids fail to mention the effects of opioid euphoria in pain management. There are safer alternatives that can have similar effects as opioids, but without the deadly consequences.

Sources

Krane, E. J. (2019). The Opioid Debate—PRO. The Clinical Journal of Pain, 35(6), 468–472. doi: 10.1097/AJP.0000000000000700.

Krebs EE, Gravely A, Nugent S, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872–882. doi:10.1001/jama.2018.0899

Rieder, T. N. (2018). There’s never just one side to the story: Why america must stop swinging the opioid pendulum. Narrative Inquiry in Bioethics, 8(3), 225-231. doi:http://dx.doi.org.ezproxy.rowan.edu/10.1353/nib.2018.0071

What is an opioid? (2016, May 25). Retrieved from https://archives.drugabuse.gov/blog/post/what-opioid