Opioid Treatment And Chronic Pain: The Risk For Addiction

Opioids are drugs with a high addiction potential. They’re also a common treatment for chronic pain conditions. Opioid use doesn’t always lead to addiction, but it can be helpful to understand the risks of opioid use for chronic pain.

How Opioid Addiction Treatment Affects Chronic Pain

Opioid drugs are commonly prescribed for the treatment of severe acute pain and chronic pain conditions.

For some, opioids can be the only drug capable of effectively relieving pain associated with severe health conditions like cancer.

Still, opioid medications carry a risk for dependence when taken chronically, and can lead to addiction if misused.

Here’s what to know about opioid treatment, chronic pain, and the risk for addiction.

What’s The Link Between Chronic Pain and Opioid Addiction?

Opioids are a class of analgesic substances that depress central nervous system activity and change the way your brain perceives and responds to pain.

Common examples of opioids include:

  • morphine
  • oxycodone
  • hydrocodone
  • methadone
  • fentanyl
  • heroin (an illicit opioid)

Opioids are taken by an estimated five to eight million Americans for chronic pain conditions, including pain caused by cancer and neuropathic pain.

Even when taken as prescribed, opioid use can lead to dependency on or addiction to opioids.

Does Opioid Treatment Help Chronic Pain?

Opioids can be effective for the management of chronic pain. By attaching to certain opioid receptors in the body, opioids can help to reduce your sensation of pain.

But opioids can also be misused and are abused by millions of Americans.

Still, when the U.S. government advised clinicians to prescribe opioids less often several years ago, this cut off many chronic pain patients from effective pain relief — sometimes, with deadly consequences.

Why Are Opioids Prescribed Less Often?

In 2016, the U.S. Centers for Disease Control and Prevention (CDC) changed guidelines for how and when a physician should be prescribing opioids for chronic noncancer pain.

This change was made to help combat the opioid overdose crisis. But research shows this move led to healthcare providers unsafely cutting chronic pain patients off from opioid analgesics.

More than that, the move has not effectively addressed the ongoing crisis of drug overdose deaths in the United States, which has only grown worse in recent years.

Earlier this year, the CDC updated its guidelines to address the fact that previous changes had had unexpectedly harmful effects on patients’ access to effective pain care.

Does Chronic Pain Increase The Risk Of Addiction?

Not inherently, no. Anyone who misuses opioid pain medicine can be at risk for opioid addiction, also known as opioid use disorder.

If you’re prescribed an opioid for the treatment of chronic pain, your drug use will likely be monitored by your doctor to ensure it doesn’t become a problem.

Those who don’t have access to prescription medication, however, may turn to illicit drugs like heroin, either to self-medicate or to avoid opioid withdrawal symptoms.

The nonmedical use of opioids, and other addictive drugs like benzodiazepines, can lead to the development of an addiction over time.

What Can Help Prevent Addiction In People With Chronic Pain?

Cutting off someone with opioid dependence from an opioid medication suddenly and all at once can be dangerous.

What’s the alternative? These are some potential mitigation strategies for preventing addiction without sacrificing effective pain management.

Prescribing Non-Opioids

If someone with mild to severe pain has not yet taken an opioid, a doctor may consider first prescribing an non-opioid medication with little or no abuse potential.

This may not be possible in all cases. But if your pain is mild or not associated with a chronic health condition, an opioid may not be the first-line treatment in clinical practice.

Monitoring Opioid Use

Prescription opioids can be safe and effective when taken as prescribed. Although chronic use can cause dependence, this is not the same as addiction.

While opioid dependence is a physical reliance on opioids, and can lead to withdrawal, addiction is associated with compulsive drug use, even at the expense of one’s physical or mental health.

Monitoring for signs of opioid misuse or addiction can help prevent this. And it may be safer than the discontinuation of chronic opioid therapy.

Tapering Off Opioids

Tapering a person off an opioid that they’ve become dependent on through long-term opioid therapy can help prevent some of the greatest risks associated with drug withdrawal.

This is a process of gradually reducing a person’s use of a medication, or their drug dosage.

During this time, a primary care doctor may introduce a different pain medication, or another form of treatment, to address the ongoing pain condition.

Alternative Pain Control Methods

Not all experiences of pain necessarily require the use of opioids, or prescription drugs more broadly, in order to get relief.

Certain complementary or alternative therapies, such as acupuncture, may help relieve certain types of pain, or serve as a supplement to a medical treatment plan.

What Are The Risk Factors For Addiction?

Getting prescribed an opioid drug for chronic pain is not the only risk factor for addiction. Various factors, including family history of drug abuse, can influence this.

A person may be at high risk for opioid addiction if they:

  • have a history of substance use disorder
  • take higher doses than directed
  • have comorbidities (e.g. an untreated mental health disorder)
  • have a social or family environment that encourages drug misuse

What Are The Dangers Of Opioid Addiction?

Opioid addiction can harm your health, as well as affect your ability to work, your relationships, and have other short-term and long-term side effects on quality of life.

Opioid addiction is also a risk factor for overdose, which occurs when you take too much of one or more drugs (including alcohol) at once.

The effects of opioid overdose can cause respiratory depression, brain damage, and can have fatal consequences if severe and left untreated.

What To Do If Someone Overdoses

If someone is experiencing an overdose, call 911 right away. If you have Narcan on hand, begin administering that using proper naloxone administration guidelines.

What Is The Treatment For Opioid Addiction?

The most effective treatment for opioid addiction is medication-assisted treatment (MAT).

This intervention involves the use of behavioral therapy, substance use disorder counseling, and certain medications.

Medications that are FDA-approved to treat opioid addiction include:

  • methadone (a long-acting opioid agonist)
  • buprenorphine (i.e. Suboxone, Subutex, Zubsolv)
  • naltrexone (Vivitrol)

An inpatient rehab program, or a residential treatment program may also be recommended, depending on your medical and mental health needs.

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