Abuse of opiate drugs is skyrocketing in many countries around the world, triggering severe health problems and social ills such as broken families, homelessness, poverty, child neglect, violent crimes and imprisonment. Sometimes, it seems there’s no end in sight.
The National Institute on Drug Abuse (NIDA), estimates that globally, between 26 and 36 million people abuse opiate drugs. Opiates include natural substances like morphine or opium that are extracted from the opium poppy plant; or manmade drugs, such as the many painkillers formulated in labs and prescribed by physicians.
Heroin and other illegal street drugs, which have no approved medical purpose, take the blame for the staggering rise in use of opiate drugs. The truth is, prescription painkillers, highly addictive and often abused, are responsible for at least half of all deaths due to abuse of opiates. Most are legitimately prescribed by medical providers to relieve acute pain.
According to the United Nations Office on Drugs and Crime, at least 190,000 people around the world die prematurely from drug use every year. Most of those deaths are attributed to use of opioid drugs.
Opiate abuse has risen across every demographic group, from the poor and homeless to the middle class and the wealthy and privileged.
The United States, Western Europe and Canada consume approximately 95 percent of the world’s supply. Overdoses due to opiates, including heroin, are responsible for about half of all drug deaths in Canada. In the United States, opiates are the leading cause of accidental death, claiming about 90 lives every day and even surpassing deaths due to automobile accidents.
More than half of opiate-related deaths are associated with prescription painkillers, which are now considered to be among the most dangerous drugs available, along with tobacco and alcohol.
However, this doesn’t mean that heroin poses no threat. In England and Wales alone, deaths involving morphine and/or heroin or are at the highest level ever recorded. Use of the drugs doubled in just three years between 2012 and 2015.
Painkillers are relatively safe for most people when taken as recommended. However, approximately one-quarter of prescription recipients misuse their prescribed medications. Many turn to heroin, typically inexpensive and readily available on the street, when their painkillers run out and doctors are no longer willing to oblige with new prescriptions.
New Recommendations for Physicians
The Center for Disease Control in the United States, and the European Pain Federation have issued similar recommendations for opioid use in management of chronic pain.
Physicians are advised to:
- Carefully and thoroughly review each patient’s prescription history.
- Consider opioids only when expected benefits are anticipated to outweigh the risks.
- Discuss known risks and benefits with patients, along with patient responsibility for managing use.
- Establish realistic treatment goals with each patient, including how the prescription will be discontinued if benefits no longer outweigh risks.
- Prescribe the lowest effective dosage and no greater quantity than needed.
- Reevaluate for benefits and problems at least every three months.
- Implement drug testing before prescribing, and at least once every year thereafter.
- Avoid medications containing a combination of opioids and benzodiazepines whenever possible.
- Recommend treatment for patients with opioid use disorder.
Limiting Use of Opiate Painkillers: Alternatives
Use of opiate painkillers should be limited to extreme pain, after-surgery care, end-of-life treatment, or severe burns. In spite of that, the pharmaceutical industry spends billions of dollars on drug promotion and marketing to physicians every year, and many doctors prescribe pain meds at the first visit, even for relatively minor pain.
Alternatives to prescription painkillers include:
- Ibuprofen, acetaminophen and other over-the-counter pain relief medications
- Chiropractic treatment
- Massage therapy
- Mindfulness meditation
- Swimming, stretching, yoga or other gentle exercise
- Physical therapy
Common Prescription Painkillers
Following is a list of a few of the most commonly prescribed opiates in Europe, the United States and elsewhere, along with brand names:
Hydrocodone/dihydrocodeinone (Zohydro, Lortab, Hysingla)
Hydromorphone (Exalgo, Dilaudid, Jurnista, Palladone)
Oxycodone (OxyContin, OxiNorm, Roxicodone, Oxecta)
Morphine (Avinza, Kadian, Ora-Morph, Astramorph, Dolcontin, Oramorph, Malfin)
Demerol (Meperidine, Pethidine, Petidin)
Fentanyl (Fentora, Duragesic, Actiq, Matrifen, Matrimed, Quatrofen, Durfenta)
Codeine (Parakodin, Ardinex)