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Managing the Risks of Opioids While Trying to Stay on Them

NPR recently did a story on how some people who have been prescribed opioids find their benefits to outweigh their risks. How can people who have more difficulty functioning without opioids than with them minimize their risks to addiction and side effects? All it takes is a bad fall that can cause the kind of chronic pain that encourages a patient to seek help, and when that help is in the form of an opioid that takes away excruciating pain and allows them to function, it is easier said than done to forsake the opioids out of fear of becoming addicted to them.


To need strong drugs for the long-term is a scary prospect. No one wants to be in a situation where they have to choose to either deal with severe pain on a daily basis for years on end, or to become dependent on drugs to get them through the day. This situation becomes especially stressful when doctors begin to reduce patients' strength and dosages of prescriptions. The intention is good in that doctors are trying to reduce the chances their patients will become addicted to their prescriptions, but by this point, for many people it's already too late.


For those for whom it is not too late and who have not developed an addiction to the drug, how are they to get through the day with the pain that remains after the drugs have been taken away? Some patients feel that a life lived in severe, daily pain is not a life worth living.


Pain is one of the most common and most incapacitating malady among the possible medical conditions one can be afflicted with. It is estimated that about one-third of Americans live with some form or another of acute or chronic pain. Between three and four percent of all adults were prescribed long-term opioids in 2014 for pain. This is between 9.5 and 11.5 million people.


The CDC released guidelines last year for doctors to follow insofar as prescribing their patients non-opioid methods of pain management so as to reduce "unnecessary exposure to prescription opioids" in order to "prevent development of opioid use disorder in the first place." There's a lot of pressure out there right now to limit people's prescriptions so as to reduce the ever-growing number of patients who succumb to overdoses.


But when patients' prescriptions are reduced and their pain remains, the problem then becomes how to best reduce their risks while also providing them with some way to manage their pain. Dr. Stefan Kertesz, who also serves as a professor at Birmingham's University of Alabama, hit the issue right on the nose when he said: "I think human suffering is really complicated and doctors need to have the room to make professional decisions — together with their patients — about what works best for them."


Kertesz agrees that doctors have overprescribed opioids in the past and inadvertently created addiction in some patients. But, he says: "the idea that you can [then] simply take [these prescriptions] away, sometimes from people who need them, is mistaken."