What Is an Opioid?
Opioids are narcotics that help relieve pain. These drugs are quite addictive and include Percocet, Vicodin, Actiq, Duragesic, Fentora, Hysingla ER, Zohydro ER, Lorcet, Lortab, Norco, Dilaudid, Exalgo, and Demerol. Because they’re addictive, patients can abuse them, and this has become an epidemic of gargantuan proportions. Worldwide, 26-36 million people fall into this category, and that includes 2 million individuals in the U.S.
The New Study
The new study tracked the prescription opioid use of 1,300 cancer-free patients without an addiction history who had never taken opioids before. The findings were astounding. Even a one-day prescription resulted in a 6% chance that the patient would still be taking opioids a year later, and the percentage increased from there. With an original five-day prescription, those chances increase to 10%, a six-day prescription results in a 12% chance, and when the original prescription is for a ten-day supply of opioids, there is an alarming 20% chance that the patient will still be taking opioids a year later! Giving a patient a 30-day initial prescription increases that addiction percentage to 45%! The findings also demonstrated that the type of opioid and the dosage was a very important factor. Long-acting opioids and prescriptions that included a cumulative dose of >700 milligrams of morphine or its equivalents had the greatest impact.
Yikes!
Millions of patients a year are handed an opioid prescription after surgery. I’ve often written post-op pain scripts with a 20- to 30-day supply mostly because I think I’m being nice by giving the patient more than enough. I often write for Percocet 10 mg #20 or #30 script. If we add all of that up for a 30-day script, that’s 300 mg of oxycodone, which converts to 240 mg of oral morphine. Phew! So I’m way under that 700 mg limit!
I also have colleagues who write for much stronger drugs, like Dilaudid. If you write a script for this medication at 4 mg for number 60, you’re over the 700 mg addiction limit! I doubt these doctors know that they’re risking the creation of a narcotic addict.
The upshot? While it looks like my postprocedure scripts are pretty tame for the likelihood of getting a patient hooked, they still carry some risk. As physicians, we write these generous post-op scripts because we think we’re being kind to the patient, but we may be bringing gasoline to the campfire of addiction!
This posting arrived in my mail box just as I finished using oxycodone after a hip replacement surgery. Whereas two years ago I was able to terminate my oxycodone usage quite easily only three days after a shoulder surgery, this time I found that a week after surgery I still wanted to use the oxycodone heavily, particularly in order to get sleep. At the end of the 1st week, I attempted to cut back the oxycodone by using it only prior to going to bed, while using acetaminophen during the day for pain management. At the end of each of the first two days of this regimen, I found myself extremely irritable as each evening approached – I started to surmise that I was actually suffering “withdrawal” symptoms! Now, at two weeks post-surgery, I have weaned off the pain meds enough that I am just using acetaminophen at bedtime. My thoughts about how easy it was to become dependent on the oxycodone align exactly with your posting.
Doug,
Smart man!
Great article Dr Russo. I follow your posts and agree with your philosophy. I have ran a spine and pain program for over 20 years and have seen first hand the horrific side effects of these medications. I am a chiropractor by training and obviously have never prescribed one of these meds. Having said that , what do you do with a patient with severe pain secondary to advanced degenerative joint disease that has maybe 3 or 4 botched spine surgeries? As you know, some patients can’t take anti inflammatory meds, are exercise intolerant- maybe lazy on some level with exercise and desire to stay functional and continue to work. All the docs in our center use regenerative treatments on ourselves and RX them when the can but we don’t have to pay exorbident fees for these procedures like our patients do. We also have litttle evidence to justify selling these procedures to our patients because the paucity of data to indicate they work…. Thanks for what you are doing. Would appreciate any advice you have. Respectfully, James
James, we run a 6 physician practice here in CO and treat about 50% spine without using chronic narcotics. We use mostly platelet-based therapies, so the difference may be in the training and experience of the providers in regen spine.