Why Is This A Problem Today?You’d think that we’d have learned our lesson by now. Opioids—a class of painkilling drugs including both legal and illegal drugs, like oxycodone and heroin—are exceptionally dangerous. If I had my way, we’d get rid of the lot of them. Except in very rare circumstances—like terminal cancer patients—I never prescribe them to anyone that comes to see me. However, while they are very dangerous, they are a highly effective way to treat pain. All pain. And that’s the rub. The best way to treat pain is to find out what’s causing it, get to the root source, and then give a highly personalized solution. I have a number of pain solutions that I like to use, and each does a great job treating different kinds of pain. But it takes time to diagnose and figure out the best possible approach. And if you’re dealing with an emergency—like in an emergency room—doctors often don’t have that time. That’s why emergency rooms are where a lot of opioid addictions start. A patient goes in with an acute problem, and the doctor gives them a very limited dose of opioids to tide them over. However, opioid addiction can develop very fast—in as little as a week. So even just a week’s worth of pills can lead to addiction problems. And worse, when a patient follows up with their primary care physician, something called clinical inertia has a tendency to take over. Basically, if you still have the same complaints, one physician will just continue the treatment of the previous one. Which, in the case of opioids, can lead to some very bad outcomes. While this downstream risk is great, we’ve recently seen progress in diagnosing the upstream risk, caused by the initial prescription. A new research study found that there’s huge variance in how often different doctors prescribe opioids. The lowest-prescribing quartile of emergency room physicians only prescribed opioids in about 7% of cases. But the highest-prescribing quartile gave them to 24% of patients—more than three times as often. Unsurprisingly, patients who saw the highest-prescribing quarter of ER doctors wound up with higher incidents of opioid addiction. 30% higher, to be exact. Part of the problem is that there’s no clear set of guidelines for when prescribing opioids is considered good or bad practice. Right now, doctors and researchers are trying to figure that out. But, in the meantime, you’ve got to navigate the world as it currently stands. And it’s a world awash in opioids.
Pain Management OptionsThe best way to avoid opioid addiction is to avoid opioids altogether. That means seeking out alternatives. Lots of people like ibuprofen—and there’s no doubt, it’s an effective pain treatment, and much safer than opioids. But that doesn’t mean ibuprofen is entirely safe. Indeed, it can cause kidney problems or bleeding. It’s not a perfect cure. Aspirin causes other problems, like liver damage. However, white willow bark contains salicin—the chemical precursor to aspirin. It is much safer, and milder, yet many studies show it’s just as effective a pain reliever. Especially for headaches, lower back pain, and osteoarthritis. It doesn’t work well with everyone, though, so if you have diabetes, gout, kidney or liver issues, you should avoid white willow bark. For everyone else, it makes sense to consult your doctor and let him or her know what you’re taking. But in most cases—especially if you aren’t taking it regularly—500 mg of willow bark will relieve most headaches, pains and strains. Another great option for pain relief, if your pain is related to inflammation, is curcumin. Curcumin is one of the best solutions for inflammation around, and it can strongly counteract any inflammatory pain. That includes injuries. Normally, a dose of curcumin is 500 mg. But I suggest going with a high dose for pain relief—taking 2-4 regular doses, twice a day. Because curcumin is so safe, you don’t need to worry about taking too much. The same goes for essential fatty acids, like omega-3. I once had an elderly but active patient complain to me about knee pain. He took high doses of omega-3s, and within half a week his pain was completely gone—he was playing racquetball again. The normal dose of omega-3 is 500 mg, but you should take 2-4 times that amount, twice a day, when you’re taking it for pain. Finally,
Dealing With The Last ResortOdds are good that, even if you’re managing whatever pain you have well, you’re going to run into opioids at some point. Whether you go to the ER with an injury, you have acute pain from an illness like kidney stones, or you’re recovering from surgery, you may, one day, have to face opioids. The first thing you should do is ask if they’re absolutely necessary. In some cases, your doctor may be able to find a suitable alternative. But in other cases, you might not be given a choice. The key in those instances is to get off the opioids as soon as possible. Ask for a small prescription, and as soon as you have a follow-up, ask for an alternative to opioids. It may sound silly. You may think that opioids will never wind up causing you the problems that they cause for others. But trust me—everyone is susceptible. These are highly addictive, highly dangerous drugs. Don’t take the risk—avoid them whenever you can, and get them out of the your system as fast as possible when you can’t. Don’t take a chance here. Opioids are simply too dangerous. And there are too many great, safe alternatives you can use instead.
- Gold, Jenny. How Long You Stay On Opioids May Depend On The Doctor You See In The ER. Kaiser Health News. Published Feb 15, 2017. Accessed Mar 30, 2017.
- Staff. Prescription Opioid Overdose Data. The CDC. Reviewed Dec 16, 2016. Accessed Mar 30, 2017.
- Staff. Willow bark. University of Maryland Medical Center. Reviewed Aug 5, 2015. Accessed Mar 30, 2017.