As readers are well aware, over the past decade the abuse of opiates has become the major public health crisis facing our nation. Drug overdose has become the leading cause of death for Americans under the age of fifty, and in 2017 opioids were responsible for over 47,000 of the nation’s total 70,237 drug overdose deaths (NIDA, 2019). On a daily basis, 135 Americans die from opioid-related overdoses (NIDA, 2019).
Our opioid epidemic has been described as a uniquely-American phenomenon. Large segments of our population are fixated on finding a pill for every problem (Carr, 2017; Bekiempis, 2012). In terms of demographics, opiate addiction and overdose in the US are largely concentrated among whites and the working class (Nolan & Amico, 2016). While abuse is most prevalent in adults, abuse and overdose are also on the rise among teenagers with access to their parents’ medicine cabinets (ONDCP, 2008).
Historically, in the late 1990s, the prevalence of chronic pain among an estimated 100 million Americans prompted both drug companies and the federal government to call for expanded use of painkilling opioids (“America’s opioid,” 2017). Between 1991 and 2011, painkiller prescriptions in the US tripled, going from 76 million to 219 million per year (US Public Health Service, 2018).
Annual opioid prescribing rates began to slowly decrease in 2012, reflecting better physician education and increasingly stringent regulations concerning prescribing (Reiss, 2018). Ironically, many suggest that the decreased supply of prescription opioids has prompted people who are already addicted to seek out heroin and other less expensive illegal opiates.
In short, legitimate prescribing of opiates has increasingly been diverted to the underground market, leading to dramatically increased rates of misuse, addiction, and death. In recent years the introduction of fentanyl—a synthetic opioid painkiller that is thirty to fifty times more potent than heroin and that is generally obtained through illegal channels—has greatly compounded the problem. As only 2 mg of fentanyl constitutes a lethal dose, widespread use has dramatically increased the risk of overdose deaths. Unscrupulous dealers often adulterate other drugs with fentanyl and many unaware users have unintentionally overdosed, believing they were taking pure heroin (Caldwell, 2017).
A key reference employed in this section is an article titled “What Are Some Pain Management Options for Opiate Addicts?” (2019) published online by American Addiction Centers, a substance abuse treatment provider.
It is estimated that over 100 million Americans suffer from chronic pain, “a debilitating condition in which pain sensations continue for a period of twelve weeks or more” (AAC, 2019) and often significantly decreases people’s overall quality of life. Most chronic pain sufferers also suffer from depression.
While opiates still constitute a mainstay for treating patients with chronic pain, these drugs are highly addictive and generally not intended for long-term use. The highly addictive nature of opiates calls for special precautions when prescribing these drugs to persons with a history of chemical dependency. Consequently, substance abuse treatment programs should be especially vigilant at intake concerning possible misuse of opioid medications when assessing persons with a history of chronic pain.
Alternatives to opiates in treating patients with chronic pain include a wide variety of nonopiate medications, physical therapy, counseling, and a variety of holistic or complementary and alternative medicine (CAM) modalities. Pain sufferers considering employing one or more CAM modalities are advised to discuss their plans with their physicians or other trusted health professionals. The following is a partial listing of CAM modalities that may be of help in dealing with chronic pain:
I firmly believe that a balanced orientation toward treating persons suffering from chronic pain and/or opioid addiction should emphasize a total-person approach that fully supports patients in adopting a wellness-oriented lifestyle to lay the groundwork for sustained recovery. Sustained recovery entails taking proactive steps to increase overall state of health, quality of life, and functionality. In many cases that will entail learning to live an active life while effectively coping with a persistent and residual level of pain.
Medication-assisted treatment (MAT), employing methadone and other relatively innocuous opiate replacements for addictive drugs such as heroin and fentanyl, tends to produce better outcomes than abstinence-based programs and is most effective when employed alongside a behavioral treatment component (McCarty, Priest, & Korthuis, 2018). Effective counseling modalities may include both addiction counseling and psychotherapy—many believe the latter may be particularly effective when a cognitive behavioral therapy (CBT) approach is employed.
A regimen of therapeutic exercise, including physical therapy, benefits many chronic pain sufferers as this combination helps reduce pain by strengthening the underlying bodily systems. Additional benefits associated with exercise include boosting people’s senses of self-efficacy together with the pleasant sensation accompanying aerobic exercise due to production of endorphins, which trigger the pleasure centers of the brain.
Guided imagery can be a powerful adjunct in treating both chronic pain and opioid addiction. Working with a skilled practitioner, patients focus on vivid images that deflect attention from the constant perception of pain.
The current buzzword in therapeutic and self-help circles, mindfulness entails the art and practice of completely focusing attention on being in the here and now. The cornerstone of mindfulness is mindful breathing, in which patients ground themselves in the now by consciously focusing on their breathing. Mindfulness is a powerful modality for sharpening concentration and becoming free from distracting mind chatter and intrusive perceptions, including chronic pain. To learn more about this fascinating subject, I recommend any of a number of books by Thich Nhat Hanh.
In addition to the aforementioned therapies, I advocate that anyone struggling with chronic pain and/or opiate addiction cultivate a personal relationship with a beneficent higher power, together with a strong sense of central purpose, a nurturing social support system, and a strong predisposition toward imbuing life with joy.
While the federal Centers for Disease Control and Prevention (CDC) acknowledges the opiate epidemic is our nation’s major public health problem, as a public health professional I am seriously disappointed that our nation is not doing more in the realm of primary prevention to quell this epidemic. An ongoing, multifaceted effort is most definitely needed in the realm of public education. Such an effort should include the following:
Course offerings in health and physical education must be strengthened. Health education curricula should include a substantial focus on alcohol and drug abuse, with a significant component focusing on factors underlying our opioid epidemic and steps individuals and families must take to avoid placing themselves at risk of opiate addiction.
We clearly need massive educational outreach to the general public, possibly via infomercials addressing the opiate epidemic, its root causes (particularly the widespread misuse of medically prescribed opiates in treating chronic pain), alternatives to opioids for pain management, warning signs of opiate addiction, and available resources to help people addicted to opiates. Funding for this programming should come from the federal government and/or foundations, augmented by time donated by TV networks as a public service.
Doctors’ offices must take proactive steps to educate patients concerning ramifications of the opioid epidemic as a major public health crisis. Educational pamphlets should be prominently displayed in every doctor’s office. Hospitals need to take a proactive role in educating their medical staff concerning appropriate pain management modalities and monitoring activities by their physicians in treating and managing chronic pain.
In this column I have attempted to provide useful information concerning the practical applications of wellness principles in managing chronic pain and combating opioid addiction, together with necessary efforts in the realm of primary prevention that should be immediately implemented to address this epidemic at the root cause level. Until next time—to your health!