Typically, taking opioids for a week to 14 days is safe for patients after trauma or surgery to offset acute pain.
But six weeks is too long, says Dr. David Tauben, a pain medicine expert and University of Washington School of Medicine professor. He will speak on “The Opioid Epidemic” on April 19 in Spokane.
Over the past two decades, use of prescription opioid medication to relieve pain grew at an alarming rate, becoming a national epidemic with overdoses hitting especially hard in smaller communities, Tauben said. He’ll talk about those trends and what patients should know.
“When we do prescribe for pain – if we find a need to prescribe opioids – we need to do it right,” Tauben said. “It’s making sure this merits a need for opioids; that the number of pills given represent the smallest reasonable number.”
Patients should ask questions regarding opioids risks, he said, such as asking how soon they can try other medications such as acetaminophen or ibuprofen to alleviate pain, he said.
Other questions include:
Do I have a condition producing pain for which there is evidence to suggest that opioids will help?
How long is it safe for me to stay on them, and what can I do to take as few pills as possible?
How do I avoid needing to increase my dose because tolerance will develop?
“Tolerance will develop in everyone … over time, meaning you need a higher dose to get the same effect,” he said.
But Tauben also strongly believes that certain cases do call for short-term use of opioids, such as when someone is injured in a serious car accident or during cancer treatment. Some inflammatory conditions can require periods of pain management.
“The swing is now to the point where I frankly fear that those circumstances for which opioids are appropriate are going to be swept away with the bathwater,” he said. “Opioids do play a role in acute, severe painful injuries and painful conditions.
“But we also know that for headaches, back pain and many widespread pain conditions like fibromyalgia, where pain is in many places simultaneously, opioids not only don’t help, they them make them worse.”
Tauben also has empathy for people who have taken prescription opioids for a lengthy period and need help getting off them. They need support from the medical community.
“These legacy patients need to be respected as having a challenging problem. They don’t need to be called an addict.”
A care plan with a health provider works best, he said, rather than being cut off completely.
“A good many of those will go off and try to acquire them illicitly because they’re so desperate,” Tauben said.
Washington state has a substance abuse recovery hotline for support at (866) 789-1511, along with a telemedicine program at (844) 520-7246 for health providers dealing with cases. Both are free.
Tauben acknowledges some people seek the drugs just to get high. It’s a risk to keep leftover pills at home that might be stolen by visitors or family, he said. Another problem is when opioids are combined with alcohol and prescribed sedatives, he said.
For hospital patients receiving opioids, just less than 10 percent of them go on to use them long-term, Tauben said. He and other experts believe that after about two weeks of continuous use, some changes start to occur in the nervous system that can promote long-term dependency.
“We see between 30 to 60 days is a very critical transition point,” said Tauben, regarding possible addiction. Generally, pain from common surgeries and moderate trauma is reduced within two to four weeks. “Nearly everybody after a hospital discharge is better within a week.”
Self-management of pain can help people get off doses faster, he said, from better sleep and trying to relax the mind to being as active as possible.
In recent decades, health professionals had few educational guidelines or scientific data on risks, other than information given by drug representatives and patient “advocacy groups” largely funded by manufacturers, according to Tauben. Starting in the late 1990s, opioid prescriptions grew rapidly.
“This was done with an abundance of good intentions that chronic pain can be treated like acute pain, or pain that would resolve of its own accord,” he said. “It turns out that despite the best of intentions, we had insufficient data.”
Washington state developed prescription opioid educational guidelines in 2007. Closer adherence came under 2010-11 state law, leading to a clear drop in the number of deaths from prescribed opioids, he said.
The reason there’s more news on the topic the past couple of years is that state and national health organizations, including the Centers for Disease Control and Prevention, have recognized it as an epidemic in the realm of accidental poisoning, he said.
While Washington state and national data show recent declines in rates of prescription drug overdoses, trends show increased overdoses from illicit opioids, such as illegal fentanyl and heroin.
“Those are doing quite well across the state and the country right now,” he said. “It’s an enormous problem.”