Picking Painkillers: Treating What Hurts Without Triggering an Addiction

It’s time to hear from Nora Volkow from the NIDA… because it’s Tuesday and Tuesday’s suck.


Though debate continues on Oxycontin’s ability to deter abuse, drugs designed to do so provide a potential safeguard in the swelling storm of opioid abuse. But these specially made formulations typically cost far more than their more simply designed generic counterparts. As a result, health insurance plans, including Medicare Part D plans, tend to favor generics, which don’t have abuse-deterrent formulations, as preferred medications in the lists of drugs they cover.

A study released in June by District of Columbia-based Avalere Health, a strategic advisory company that provides health care solutions, found Medicare Part D plan coverage for the now abuse-deterrent drug OxyContin decreased by 28 percentage points, from 61 percent to 33 percent, from 2012 to 2015.

By comparison, the generic Oxycodone Hydrochloride, which has no built-in mechanism to deter abuse, was covered by all Part D plans in 2015. Overall, the Part D coverage for all prescription opioids dropped 10 percentage points…

Pearson notes that the drugs are intended to stem intentional attempts at abuse, rather than keep patients from becoming addicted to painkillers in the first place…  But some patients who aren’t at high risk for abuse may still have cause to choose abuse-deterrent formulations, like concern that the drugs could fall into another person’s hands…

While a generic painkiller without safeguards against abuse can run less than $10 for a month’s supply, brand name OxyContin, with its abuse-deterrent formulation, can cost more than $150 per month, depending on factors such as dosing, pharmacy and available discounts.

And however awkward or embarrassing it may be, experts emphasize that patients should disclose to their providers any history of substance abuse, whether involving prescription drugs or substances.

Doctors are required to keep such matters confidential, and Volkow notes that a patient’s failure to disclose this information can undermine a physician’s ability to safely prescribe powerful pain medication.

There are these things called Electronic Health Records and PDMPs, which means that your medical record is no longer confidential.

She insists on the importance of full disclosure in addition to resisting the urge to take past opioid prescriptions to treat pain as it flares up, outside of recommended treatment protocols, since self-medication can increase the risk of becoming addicted to prescription drugs.

Really?  If it doesn’t sound reasonable, it’s probably not true.

Over time, patients develop a tolerance to opioids that requires taking more medication for the same level of relief. “The higher the dose, the greater the likelihood you can have adverse effects. And what are the adverse effects? One of them relates, of course, to addiction, and the other one relates to overdoses,” Volkow says…

You know, this “expert’s” opinion doesn’t take into account the millions of pain patients who remain on the same dosages for 5, 10 years, or more.

So what are some telltale signs a patient might be becoming addicted to a prescription opioid?

“If they start to feel that they are too preoccupied with the anticipation of getting this medication, they should actually discuss it with their physician,” Volkow says. She compares it to looking forward to a nice dinner. “You know that you’re going to have something that you like very much, and you start to think about it in an obsessive-compulsive way.”

Patients may not recognize this, thinking only that they’re looking forward to pain relief, so it’s important to be on guard to untangle the nuances, in discussing concerns with a physician, she explains. Conversely, putting off taking needed medication because of its powerful effect may, counterintuitively, also signify an issue.

“[Some patients] may have pain and they say, ‘I’m not going to take it, I’m going to last as long as I can to minimize the use.’ But what they are doing by allowing the pain to be very, very intense is that they increase the value of the medication because they are anticipating the relief from this very intense pain,” Volkow says. “So both of these behaviors can be early indications that the patient may be starting to be addicted to their medication.”

If you look forward to pain relief, you’re a drug addict.  And if you force yourself to suffer by delaying a dose of pain medication, you’re also a drug addict. Basically, if you take opioids, you’re a drug addict.

“People need to understand that these drugs are potentially addictive, even after short-term use in some people,” says Dr. Andrew Gurman,​ an orthopedic hand surgeon in Altoona, Pennsylvania, and president-elect of the American Medical Association. He prescribes opioids to help patients deal with pain when they recover from surgery.

“When you look at the number of people who are dying of drug overdoses, primarily opioids, the number of people who are impaired by addiction – these are the same kinds of numbers we were seeing at the height of the AIDS epidemic,” he says. “It’s frightening.” …

No, what’s frightening is the head of the AMA comparing drug addiction to the AIDS epidemic, even if it’s just the number of people affected.  And the number of people “impaired” by addiction? What does that mean? Who decides when a patient is impaired, the DEA?

The AMA announced last week the creation of a task force to reduce opioid abuse comprised of 27 physician organizations, including the AMA, American Dental Association, American Psychiatric Association and seven state medical societies, with an aim to identify best practices to address the epidemic…  Gurman does not serve on the AMA-led opioid abuse task force but is the AMA representative on the National Association of Boards of Pharmacy Stakeholders Group on Opioid Prescribing and Dispensing.

In addition to doctors looking at their prescribing habits and considering red flags, like patients seeking to obtain prescriptions for opioids from numerous doctors, health experts say it’s important to discuss all options to deal with pain. Heat, ice and even holding one’s hand above his or her heart, in the case of surgical patients at Gurman’s practice, as well as dealing with the mental components of pain, can all help relieve discomfort.

That can ultimately reduce the need for prescription opioids. “Both patients and physicians need to think about and perhaps talk about alternatives to manage the pain,” Gurman says.

Okay, I’m holding my right hand above my head, while my left hand is holding an ice pack to my face…  Oh no, I can’t reach the heating pad.  My hands are getting tired and my shoulders have started to throb.  If I had three hands, I could put an ice pack on my neck and shoulders…

Patients aren’t stupid.  They know about ice, heat, compression, and all the over-the-counter medications you can buy to treat and manage pain.  They also know you don’t have to see a doctor for these treatments. Usually, by the time someone spends money on a doctor for pain, they’ve already tried all these other methods and none of them helped.

So, how long can you hold your hand above your heart?  Maybe I should lie down to try this new pain treatment.

2 thoughts on “Picking Painkillers: Treating What Hurts Without Triggering an Addiction

  1. I’ve read some really really terrible articles…but that one. Lol. What’s heat? Ice? Never heard of it. What? Holding my hand above my heart will take away my chronic pain? If I pat myself on top of my head and rub my stomach at the same time, does that work too? (falls on floor in hysterics)

    Liked by 1 person

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