** Trigger Warning** Opiates used for chronic pain is a hard topic for many. This blog post may be difficult for some to read. As you read, remember, that my heart is to bring you accurate information. I support you, no matter where you are in this journey.
Opiates are a class of drugs derived from the opium poppy plant that has been used for centuries for medical and recreational purposes. These powerful drugs produce both therapeutic and potentially harmful effects. While opiates have had a long history of medicinal use, they have also been responsible for significant social and public health issues, including the current opioid epidemic. In this blog post, we’ll explore their history, the problems that the Sackler family introduced to the world, how opiates can increase pain sensitivity, and alternatives to using opiates for managing chronic pain.
Opiate History
Ancient Civilization
Opiates have a rich and complex history that dates back centuries. Societies throughout the world have been impacted by the use of these powerful drugs, for both medicinal and recreational purposes.
The use of opium, the substance from which opiates are derived, can be traced back to ancient civilizations such as the Sumerians and Egyptians. These early societies recognized the potent analgesic properties of opium and utilized it for its pain-relieving effects. In fact, opium was often used as an anesthetic during surgical procedures, proving its efficacy even in the most dire of circumstances.
As time went on, the knowledge and use of opium spread to other cultures, including the Greeks and Romans. They too valued the therapeutic benefits of opium and used it for a variety of medical conditions. However, opium also began to be used recreationally, with individuals seeking its euphoric effects.
The 19th century
During the 19th century, the widespread use of opium and the resulting societal issues led to the development of more refined opiate derivatives. Morphine, named after Morpheus, the Greek god of dreams, was synthesized from opium and quickly became a widely prescribed medication. During the American Civil War, doctors frequently administered morphine to soldiers to relieve their pain and suffering.
Following the invention of the hypodermic syringe in the mid-19th century, the use of injectable opiates became more common. This method of administration allowed for more precise dosing and quicker onset of effects, further contributing to their popularity.
The 20th Century
In the early 20th century, the development of synthetic opiates, such as heroin, posed new challenges and dangers. Initially marketed as a safer alternative to morphine, heroin quickly revealed its even more addictive and higher potential for abuse. The widespread abuse of heroin in the early 20th century led to strict regulations and efforts to control its distribution.
Despite these regulations, opiates continued to be a significant societal issue. In recent years, the rise of prescription opioid abuse has reached epidemic proportions. The introduction of OxyContin, a powerful extended-release formulation of oxycodone, by the Sackler family’s pharmaceutical company, Purdue Pharma, played a significant role in the current opioid crisis.
The history of opiates is a complex and multifaceted one, with both positive and negative aspects. While these drugs have provided much-needed relief for countless individuals, they have also caused immense harm. Understanding the history of opiates is essential in order to address the challenges they present and find alternative solutions for managing pain.
The Sacklers and Oxycontin
Any post about Opiates must include a discussion on the Sackler Family, Purdue Pharma, and their infamous drug, OxyContin. Netflix produced a miniseries called Painkiller and Hulu has Dopesick ( which I preferred) exposing the story of how the epidemic started. The Sacklers, a wealthy and influential family, own Purdue Pharma, the pharmaceutical company responsible for the production and marketing of OxyContin.
OxyContin was introduced in 1996 as a revolutionary breakthrough in pain management. It was marketed as a safe and effective long-lasting painkiller, with the potential to provide relief for up to 12 hours. This extended-release formulation was meant to reduce the need for frequent dosing, offering patients a more convenient and manageable solution for chronic pain.
To promote the drug, Purdue Pharma engaged in aggressive marketing tactics, downplaying the risks of dependence and exaggerating its benefits. They deceived people by minimizing the dosage frequency and making false claims that OxyContin was less likely to be abused compared to other opioids. The company also incentivized doctors to prescribe OxyContin, creating a profit-driven culture that prioritized sales over patient safety.
Lies they told to make a profit
- Oxycotin is not addictive
- In order to sell medication they created a movement for pain to be seen as the 5th vital sign
- Instead of admitting their medication didn’t last 12 hours, they made up the term breakthrough pain to sell more pills.
- They lied to doctors and patients – those lies are still part of medicine today and need to be dug out.
- and so many more
The consequences of Purdue Pharma’s actions were dire. OxyContin flooded the market, trapping many individuals who had legitimate medical reasons for taking it, in a cycle of dependence and addiction. The devastating impact of OxyContin use has resulted in countless lives lost and families torn apart.
The story of the Sacklers and OxyContin is a glaring example of the ethical and moral issues surrounding the pharmaceutical industry. It exposes the dangers of prioritizing profit over patient welfare and the devastating consequences that can result from such actions. The fallout from OxyContin and Purdue Pharma’s practices has fueled public outrage and lawsuits seeking accountability. There are many other agencies that also deserve blame.
Efforts are now underway to hold the Sackler family accountable for their role in the opioid epidemic. Many organizations, including museums and universities, have rejected donations and sponsorships from the Sacklers. The family is facing lawsuits filed by those affected by OxyContin addiction, seeking justice. In August of 2023, the Supreme Court blocked the Sacklers from declaring bankruptcy. This was a huge win for those hurt by this family and its greed. I encourage you to learn more.
Addiction vs Dependence
When it comes to opiates, it’s important to understand the difference between addiction and dependence. People often use these two terms interchangeably, but they should be aware that they carry different meanings and implications.
Addiction is not a choice or a moral failing. It is a medical condition. A complex and chronic disease that affects the brain. Characterized by compulsive use, despite harmful consequences. Various factors such as genetic predisposition, environmental influences, and psychological factors, actively influence the development of addiction. It is a chronic condition that often requires ongoing management and support to maintain recovery.
Dependency
On the other hand, dependence is a physiological response to the presence of a drug in the body. When someone becomes dependent on any substance, their body adapts to the drug and requires it to function normally. Dependence can occur even when opiates are taken as prescribed for a legitimate medical reason and taken as prescribed. It is not necessarily indicative of addiction.
Dependence can result in withdrawal symptoms when the drug is discontinued or reduced. These symptoms can be physically and emotionally uncomfortable, and they can vary in severity depending on the individual and the duration of opiate use. Common withdrawal symptoms include nausea, vomiting, muscle aches, anxiety, and insomnia. Many individuals who use opiates develop a dependence but are able to stop taking the drug under the guidance of a healthcare professional without experiencing addiction.
However, dependence can also contribute to addiction. For some individuals, the need to avoid withdrawal symptoms can lead to ongoing drug use. This can progress to addiction as the individual becomes preoccupied with obtaining and using opiates, to avoid withdrawal symptoms.
In summary, addiction and dependence are distinct but interconnected concepts when it comes to opiates. Addiction requires comprehensive, long-term treatment that addresses both the physical and psychological aspects of the disease. Dependence, on the other hand, can often be managed with a gradual tapering of the drug under medical supervision. This allows the body to gradually adjust to the absence of opiates and minimizes the severity of withdrawal symptoms.
Lessons from Current Research
As our understanding of opiates and their effects continues to evolve, ongoing research is providing valuable insights into how we can address the challenges associated with these powerful drugs. Here are some of the key lessons we have learned from current research.
- A person is at risk of developing an addiction to opioids after 3-5 days of taking a prescribed pain reliever. Approximately 3/4 of individuals who use heroin, started by using opioid pain relievers.
- The highest probability of continued opioid use at 1 and 3 years was observed among patients who started on a long-acting opioid followed by patients who started on tramadol. (Tramadol is an opiate)
- As the dose of opioids increases, there is a significant trend toward higher scores of pain intensity, greater pain-related disability, poorer physical functioning, lower self-efficacy for managing pain, and greater fear avoidance beliefs about physical activity
- Recent studies have made it clear that continued exposure to opioids induces more than tolerance. It also induces a degree of hyperalgesia. (extreme sensitivity to pain)Whereas, in principle, tolerance can be overcome by increasing opioid dose, hyperalgesia is made worse in the long run by increasing the opioid administration.
- Acute non-specific low back pain or neck pain- no significant difference in pain severity compared opiates with placebo.
- Half of the former opioid users reported their pain to be better or the same after stopping opioids.
The Bottom Line
So what am I saying? More than 3 days on opiates create dependence. The more you take, the worse your long-term outcomes for recovery are. Opiate use can increase your experience of pain – they can make it worse. A study from June of 2023 shows patients with acute pain ( 6 weeks) showed no difference in pain on or off the medication. Other studies have shown stopping long-term opiate use left people feeling the same amount of pain, or less pain after stopping.
Alternatives Solutions to Opiates
By staying informed about the latest research findings, we can better understand the complexities of opioid use and addiction. Armed with this knowledge, we can work towards implementing evidence-based solutions that prioritize the well-being and recovery of individuals affected by chronic pain. You know I strongly believe that starts with accurate information. You can learn more about our current understanding of chronic pain here. It’s a free course from me to you, so you can heal.
Other Solutions Worth Considering:
1. Non-Opioid Medications: Anything that can calm the nervous system can also help with chronic pain. Don’t write off anti-depressants or anti-anxiety medication just because they are offered to you. Talk with your treatment team about alternatives to opiates that will work best for you. This often takes time and experimentation.
2. Movement: Maybe that is Physical Therapy, or a personal trainer, or walking with a friend – the choice is yours. But movement is essential to healing.
3. Lower your stress: Talk therapy, throw things, set boundaries, ask for help, delegate. I don’t know what your needs are to lower your stress, but I know it’s imperative.
4. Build confidence in yourself and your body: our ability to bounce back, our ability to believe in our future, and our love of the life we have are integral to healing chronic pain.
As a coach, I have a million ways to help you with these aspects of healing and want to do just that. Let’s get started by clicking “work with me” at the top of this page. What are you waiting for?
Research
Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:265–269. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a1external icon.
Morasco, BJ. Higher prescription opioid dose is associated with worse patient-reported pain outcomes and more healthcare utilization. J Pain. 2017;18(4):437-445
Hayhurst CJ, Durieux ME. Differential Opioid Tolerance and Opioid-induced Hyperalgesia: A Clinical Reality. Anesthesiology. 2016 Feb;124(2):483-8. doi: 10.1097/ALN.0000000000000963. PMID: 26594912.
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomized placebo-controlled trial Published: June 28, 2023DOI:https://doi.org/10.1016/S0140-6736(23)00404-X
Video San Diego Pain Summit 2020: Dr. Marcos Lopez DPT – Clouded Hope: Our Role In Addressing Opioid Use Disorder
Video. San Diego Pain Summit 2019 Understanding and Improving Pain Assessment Mandates In Healthcare by Dr. Kathryn Schopmeyer https://www.facebook.com/watch/?v=410448987956062
