Q&A with Dr. Surita Rao, UConn Health assistant professor of psychiatry
Can you characterize the U.S. opioid epidemic?
Our country’s opioid epidemic has been going on for several years. The U.S. is the biggest global consumer of prescription opioids. In 1997, 76 million prescriptions were written, more than doubling by 2013 to 207 million. Americans consume nearly 100 percent of the world’s hydrocodone (Vicodin) and 81 percent of its oxycodone. The majority of those physically addicted or overdosing are getting opioid prescriptions from their doctors’ offices.
What are the dangers of opioids?
These strong pain pills are very physically addictive and it’s often hard for patients to live without them, even after their pain subsides. The biggest dangers of opioids are overdose and death. After doctors stop prescribing them, some patients turn to the street to illegally get their pills, while some may even switch to heroin. When mixed with heroin, anxiety medications, or alcohol, opioids are even more likely to lead to overdose.
What do the new Centers for Disease Control and Prevention guidelines call for?
In March the CDC called on primary care doctors to more carefully assess each individual patient’s risk of taking an opioid and to take extreme caution when prescribing it for longer than seven days for acute pain, unless for terminal cancer or palliative care. The lowest-effective dose of non-slow-release pain pills should always be used, and patient use needs to be continuously reevaluated. Guidelines stress the critical need for increased education and communication about opioid risks including constipation, drowsiness, stopping breathing, drug and alcohol interaction, addiction, overdose, and death.
What should medical providers keep top-of-mind?
For patients, physicians should always consider first NSAIDS (such as acetaminophen and ibuprofen), routine exercise, physical therapy, hot and cold compresses, and possibly steroidal injections. If opioids are necessary, beware that long-term opioid use can lead to physical dependence and intense withdrawal. Patients should be slowly weaned off. Patients who have developed an addiction to opioids that goes beyond a physical dependence will need to undergo medical detox, or take agonist maintenance medication to curb their brain-receptor cravings. Psychotherapy specifically targeted for substance abuse disorders, including individual counseling and group therapy, is always needed for successful recovery from an addictive illness. Patients should be encouraged to proactively lower their daily pain risk factors, not abuse or share opioids, and seek medical attention if they start to experience withdrawal symptoms or addiction.