Opioids


person taking pillsWith the opioid epidemic making headlines every week, it’s understandable to be worried about the risk of addiction if you or someone you love has been prescribed opioids. However, you must remember that opioid medication does play a vital role in the management of chronic pain for certain individuals. It does these patients a disservice when a misunderstanding of addiction results in unnecessary withholding of opioid medications.

Chronic Opioid Use as a Last Resort

Although opioids are often used to control short term pain from surgery or injuries that are expected to fully heal within a specific period, this type of use is considered low risk. The primary concern in terms of addiction is the chronic use of opioids over an extended period of time.

According to the American Academy of Pain Medicine, chronic opioid therapy (COT) is only appropriate for use if the patient suffers from moderate to severe pain and more conservative measures have not been able to provide sufficient relief. This might include:

  • Non-opioid pain relievers
  • Physical therapy
  • Transcutaneous electrical nerve stimulation (TENS)
  • Ultrasound
  • Therapeutic massage
  • Chiropractic care
  • Mind-body techniques such as mindfulness meditation

Although the perception of pain can be subjective, there is no doubt that living with chronic pain greatly affects one’s quality of life. Pain limits the ability to engage the activities of daily living and increases a person’s risk for developing anxiety and depression. For this reason, healthcare professionals must struggle to find a middle ground between limiting access to addictive opioids and providing relief to sufferers of chronic pain.

Dependence Isn’t Necessarily Addiction

The term dependence means that the body has physically adapted to having a steady supply of a substance in the system. When the substance is no longer being used, withdrawal symptoms such as headaches, nausea, vomiting, diarrhea, fatigue, and restlessness can occur.

Dependence and addiction are often used interchangeably in reference to opioid painkillers, but it’s important to note that the two are not always the same. Although someone with an addiction is likely to also be dependent upon the opioid medication, it’s possible to be dependent without being addicted.

Dependence can occur whenever a medication is being taken for a long period of time, even if it is used precisely as prescribed and isn’t considered addictive. For example, patients can develop a dependence when they take antidepressants to treat chronic depression even though these medications aren’t thought of as addictive. If they wish to stop or switch to a different drug, tapering the dose helps to minimize the severity of withdrawal symptoms.

Distinguishing Between Tolerance and Disease Progression

Tolerance refers to the need to increase a dosage of a substance to experience the same effects due to prolonged use. Tolerance is often thought to be a warning sign of a substance use disorder, but chronic pain patients may confuse tolerance with disease progression. For example, someone taking opioids to cope with cancer pain may require higher doses due to the progression of the cancer even if he or she takes the medication as prescribed. Osteoarthritis is another of a condition where pain levels can be expected to increase over time as the disease progresses.

It can be difficult for the layperson to determine the difference between a patient developing tolerance and someone who is experiencing more pain due to disease progression. This is why careful monitoring of opioid use is necessary.

Seeking a Substance Abuse Evaluation

The fact that someone has been using opioids for a long period of time doesn’t necessarily mean he or she has developed an addiction, but a substance abuse evaluation is in order if any of the following apply:

  • Lying about the severity of symptoms to obtain more medication
  • Seeing multiple doctors to increase availability of opioids
  • Borrowing, stealing, or illegally purchasing medication
  • Becoming defensive or angry when asked about opioid use
  • Mixing opioids with alcohol or other addictive drugs
  • Decreased performance at work or school due to opioid use
  • Withdrawing from family and friends to spend more time using opioids
  • Feeling powerless to control opioid use

It is important to remember that addiction can affect people of all ages, races, and socioeconomic backgrounds. It’s not a weakness or a character flaw. In fact, this form of a substance use disorder is considered unintended addiction because sufferers often originally took their medication exactly as prescribed.

If you or someone you love needs help treating opioid addiction, St. Joseph Institute for Addiction provides a peaceful and serene environment in which to take the first steps towards recovery. Detox, counseling, holistic treatments, and access to aftercare resources provides clients with the tools they need to set a foundation for lasting sobriety.  

By Dana Hinders

To learn more about our programs, please visit our website.

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dentist officeDuring your next dental appointment, you may be asked about more than your brushing and flossing habits. A recent survey found that 77 percent of dentists now perform substance abuse screenings as part of routine exams.

Why Are Dentists Are Worried About the Addiction Epidemic?

Dentists may not be considered primary care providers, but dental health plays a key role in your overall physical health. This puts dentists in a unique position to fight substance abuse.

Dentists often see patients who have tooth decay due to substance abuse issues. For example, methamphetamines are a leading cause of tooth decay and tooth loss. Alcohol abuse is a primary risk factor for oral cancer. Tobacco use leads to gingivitis and tooth loss.

Addressing the risk of substance abuse is also important because dentists are the second leading prescriber of prescription opioids. This puts them at risk of inadvertently starting someone on the path towards addiction or feeding the habit of someone who already has a full blown opioid use disorder. Drug interactions could be another potential concern, since prescription opioids given for pain relief after a dental procedure could have dangerous interactions when combined with alcohol or illegal street drugs.

What Do Substance Abuse Screenings Look For?

Substance abuse prevention efforts often start the moment a patient walks into the office. Staff members may be looking for signs of potential problems such as:

  • Poor personal appearance, including bloodshot eyes
  • Slurred words, unsteady movements, or other signs of current intoxication
  • A history of broken appointments
  • Repeated requests for unusual prescriptions based on a self-diagnosis
  • Dramatic complaints of severe pain not in line with the issue the patient is being seen for
  • Someone who arrives near closing time seeking opioid prescriptions with the promise to return for an appointment the following day

In addition to a more informal evaluation, the dental hygienist may ask the following questions:

  • How often do you consume alcoholic beverages in a typical week?
  • Have you used tobacco products such as cigarettes or smokeless tobacco in the past three months? If yes, how much and how often?
  • Have you used marijuana more than five times in your life? If yes, when was the last time you used marijuana?
  • Have you felt you should cut down or otherwise control your drinking or drug use?
  • Do you get angry, upset, or annoyed when people ask you about your alcohol or drug use?
  • Do you feel guilty about your drinking or drug use?
  • Have you ever needed a drink or used drugs immediately in the morning to calm your nerves or get rid of a hangover?

Female dentists are more likely to believe addiction screenings are part of their professional responsible than their male counterparts, with 61 percent of women and 52 percent of men conducting screenings.

Age is another factor in how dentists perceive the importance of addiction screening, with 62 percent of dentists over the age of 53 and 47 percent of dentists under the age of 53 conducting screenings.

What Happens Next?

Although the rise of addiction screenings at the dental office should be encouraged, screening people at risk of substance use disorders is only a small part of the battle.

A 2013 study in the Journal of the American Dental Association reports that most dentists who screen patients for substance abuse do not provide referrals to counseling or follow up with patients who exhibit warning signs of addiction. Despite their concern for the well-being of their patients, they feel unqualified or not prepared to offer more extensive drug use prevention services.

Providing continuing education opportunities and additional training to help dentists refer at-risk patients to the appropriate resources would be a cost-effective way to tackle the public health concerns associated with substance use disorders. Until then, however, it’s up to each individual to look out for the signs of addiction and urge friends, family, neighbors, colleges, and others in need to the appropriate evidence-based treatment programs.

Based in Port Matilda, Pennsylvania, St. Joseph Institute for Addiction provides detox and counseling to address the issues contributing to substance use disorders. Our faith-based approach views addiction as physical disease in need of treatment for the mind, body, and spirit. This allows for a solid foundation of sobriety, setting the stage for a future free from the burden of addiction.

By Dana Hinders

To learn more about our programs, please visit our website.

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