Each pain killing "miracle" drug seems to have had its day. From morphine to oxycodone to hydrocodone (Vicodin), these drugs have brought welcome relief to the many people who are in situational pain after surgery or who suffer from chronic pain.
Many prescribed pain relieving drugs are opioids—either natural or synthetic. An opioid is any chemical that resembles morphine or other opiates (e.g. codine, thebain) in its pharmacological effects. Opioids work by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract.
While there are legitimate uses for narcotic pain relievers, including long-term use for some people, these drugs are easily abused. Often unknowingly and innocently, people in pain become dependent or addicted.
Recently, doctors have become more reluctant to prescribe these drugs, and for good reason. According to The Centers for Disease Control (CDC) there is currently a growing, deadly epidemic of prescription painkiller abuse. They say that nearly three out of four prescription drug overdoses are caused by prescription painkillers.
Stronger restrictions have been placed on doctors and clinics when it comes to how these drugs can be prescribed and how the prescriptions can be filled. Many prescription orders now need to be hand-carried from the clinic to the pharmacy, rather than phoned in or faxed in, like they were in the past.
A doctor speaks out
Dr. Jay Redan serves as Medical Director of Minimally Invasive General Surgery at Florida Hospital Celebration Health. Dr. Redan's approach is to minimize pain by using alternatives to narcotic painkillers. During a recent interview with Dr. Redan, I asked him what he thought of the current restraints on opioid prescriptions and whether this is a new problem or a long standing issue that is just now being addressed more forcefully.
Dr. Redan said, "No, this is not a new problem and I'm glad it's getting a lot of attention. According to the CDC [Centers for Disease Control and Prevention], prescription drug abuse is now an epidemic, and a Canadian study finds that patients using opiate painkillers within a week after minor surgery greatly increase the odds of developing an opiate addiction."
When I asked Dr. Redan about the changes in the laws about how these medications are prescribed, such as the need to hand carry the prescription to the pharmacy, he said that he "absolutely" agrees with this change. "The patients do need to be well-informed and involved. Well-informed patients are our best patients," he said. He believes that these restrictions will help curtail overuse of the narcotics.
Since Dr. Redan's major objective is to help people get through surgery and recovery without needing pain medication other than some over-the-counter drugs, I asked him specifically about caregivers who must return to working with their older family members shortly after the caregiver has had surgery. These caregivers are often already under significant stress and they may feel the need for more pain relief in order to continue with their duties.
Dr. Redan advises everyone to go over their medications with their doctor, prior to surgery. This discussion includes informing your doctor about what demands will be placed on you once you return home. However, he's adamant that people should not depend on opioids unless there's no other choice.
When I asked Dr. Redan about people already taking opioids, he said that they shouldn't be taken off the drugs just before surgery, but it is best not to increase the narcotics that these patients are on. Using local analgesics and over-the-counter medications to alleviate pain is a better alternative, he said. He'd rather not see people start on opioids at all.
According to Dr. Redan, elderly people who've been on opioids for years need to go over the medical plan with their doctor to see if there is another alternative. The risks of narcotic pain relievers include trouble breathing and increased risk of falling. Opioids can also affect cognitive ability for some people, so Dr. Redan thinks that elders with cognitive issues should, whenever possible, be slowly and carefully weaned off of the drugs by their doctors.
He feels that it's important to get at the cause of the pain and take care of that, rather than use opioids to mask it. There are over-the-counter medications such as Aleve, Motrin, Tylenol and others that can be used for most pain. If the doctor determines that narcotics are needed, the smallest amount possible should be given.
I asked Dr. Redan about joint replacement since that's a common type of surgery for older patients. He agreed that some types of surgery may require more medication than others but that the best thing to do is discuss it with their own physician. "The key," he says, "is to reduce the need for these medications." One reason that Dr. Redan specializes in minimally invasive surgery is that the need for pain medication afterward is vastly reduced with this type of surgery.
While Dr. Redan doesn't address illnesses that actually do require long-term opioid use—and there are some—it's obvious that he's against using addictive drugs if there is any possible alternative. From articles that I've recently read, including those coming from the CDC, I've gathered that we'll likely be hearing this same argument from most doctors, even those who used to routinely prescribe Vicodin for oral surgery and other short-term pain.
This new attitude toward narcotic pain relievers may present a challenge for those who truly need the power of narcotic pain relief. Doctors seem to feel that these people will be in the minority. Overall, it's thought that a more conservative approach to prescribing opioids will lower the accidental addiction rate for the average person who only needs pain relief to get through surgery. For those with long-term pain, the approach will be unique to their condition.
Dr. Jay Redan has more than 20 years of experience in advanced minimally invasive surgery. Dr. Redan serves as Medical Director of Minimally Invasive General Surgery at Florida Hospital Celebration Health. He is also the Director of the Chronic Abdominal and Pelvic Pain Program at Celebration Health and has been a pioneer in the field of laparoscopic surgery since its infancy.
