Opioids are medications prescribed to relieve a person's pain. Unfortunately, prescription drug abuse is on the rise and opioids are being used for non-medical purposes across the US by men and women of all ages. Teens and young adults are the greatest abusers of prescription drugs. With all of this in mind, what is a person to do who is experiencing pain?
Listen in as Dr. Matthew Monsein, a physician specializing in chronic pain management with Courage Kenny Rehabilitation Institute, discusses opioid abuse and what it could mean for those who really need it.
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What You Need To Know About Prescription Drugs
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Learn more about Matthew Monsein, MD
Matthew Monsein, MD
Matthew Monsein, MD is a physician specializing in chronic pain management with Courage Kenny Rehabilitation Institute. His professional interests include inpatient pain treatment, pain rehabilitation and opioid reduction or elimination.Learn more about Matthew Monsein, MD
Transcription:
Melanie Cole (Host): Opioids are medications prescribed to relieve a person's pain. Unfortunately, prescription drug abuse is on the rise and opioids are being used for non-medical purposes across the U.S. from men and women of all ages. But, if you're suffering from chronic pain, what are you to do? My guest today is Dr. Matthew Monsein. He's a physician specializing in chronic pain management with the Courage Kenny Rehabilitation Institute. Dr. Monsein, welcome to the show. So, what’s going on with opioids today and why are so many people choosing this as their first method for pain?
Dr. Matthew Monsein (Guest): The use of opioids in the United States has grown dramatically over the last 20 years and there are a number of reasons for that. Certainly, the pharmaceutical companies have marketed very heavily and, initially, tried to present opioid therapy for non-cancer related pain as a panacea and as a cure but what we found out fairly quickly was that's not the case. Many patients take these medications and, even if they don’t become addicted, they do develop a tolerance. They become physically dependant meaning that when they’re not taking these medicines they start withdrawing. We also found that, for many patients, the medications can actually intensify their pain through the phenomena called “hyperalgesia” where narcotic pain medications can actually make people's pain worse. Now, there's a certain small percentage--because there are literally millions of people taking these medications or hundreds of thousands--but in the United States, every year about 15,000 patients or individuals, some of them are being prescribed opioids by their physician’s. Others are taking these drugs by getting them illicitly. But, they overdose and they die from these drugs. I think the physicians in the medical community and the federal government are beginning to look very carefully at whether prescribing opioids for the treatment of non-cancer pain is really in our patient's best interests. For myself, I've been involved with pain rehabilitation for over 30 years, and our whole focus has been to try and help patients who are on opioids taper off them and to try to find other ways to manage their chronic pain.
Melanie: There's so many avenues to discuss here Dr. Monsein. Are there certain factors that make a person more susceptible to addiction on these opioids than others?
Dr. Monsein: There are certain factors that we believe can make people at a higher risk for becoming truly addicted: a history of chemical dependency either to alcohol or other medications, cocaine, methamphetamines. Those are risk factors. Family history for chemical dependency is a risk factor. Psychosocial support can be a risk factor. Age is a risk factor. Younger people are more at risk of becoming addicted. So, there are those genetic factors and psychosocial factors that would predispose people to becoming addicted. Anyone, though, and this I think is very important: anyone--I don't care if it’s me, you, Barack Obama, Donald Trump, Hillary Clinton--anybody who takes opioids will physiologically develop a physical dependence on the medication because that’s how it works. Even if you’re taking it for all the right reasons, your body and your brain become habituated to that medication.
Melanie: So, are there considerations or monitors that are put in place when a person is prescribed a drug classified as potentially addictive like Oxycontin or some of these others. The pharmacist--you can’t even call in a prescription for this. It must be walked in. How do they regulate this?
Dr. Monsein: Well, the federal government and the state governments are trying to. Well, they do regulate it. They've been regulated for many years. The restrictions have gotten tighter. There are certain drugs that are considered to be Class II drugs and those include the ones that you just mentioned and you cannot call those medications in. There is a medication called Vicodin or hydrocodone that was a Class III drug for many years, so you could call in prescriptions for that. That was probably the number one opioid that was being abused in this country. That's no longer a Class III drug. You need the hard copy. Each state and the federal government are publishing guidelines about the use of opioids. The Center for Disease Control, for example, just put out new guidelines recommending limited use of opioids for post-surgical pain, limiting the amount of opioids that a person should be taking on a daily basis, if they’re taking for chronic pain. The State Board of Medical Examiners for individual states are also looking at this to try to minimize the risk for addiction, abuse, overdose and death but it’s a daunting problem.
Melanie: So, how do we recognize in a loved one, if they have been suffering from chronic pain and they've been put on an opioid, then they say, “It helps me” and, of course, you don’t want to argue with them about their pain but how do you recognize it? Then, what is the course of action to take? As you mentioned, it can oversensitive those nerves anyway and make them more susceptible to pain. So, do you treat it as an addiction like cocaine or alcoholism? What do you do?
Dr. Monsein: This is a very complicated question and a difficult issue to answer in a few words but let me try. I think if you have a loved one on opioids for chronic pain, you do need to look at how they're responding: are they back to work, are they involved with life, are their functional activities increasing? Or, are they just saying, “Well, it helps my pain” but that individual is becoming more socially isolated, they're sleeping more, they've lost interest in other family issues and they're just not able to function the way they had prior to starting that type of therapy. I think there are also patients who are on opioids who have the diagnosis of substance abuse. They truly are addicted to these medications. For those patients that have a diagnoses of substance abuse, there are medication--the ones that we hear most about are methadone and suboxone--to treat addiction. Patients who try to get off opioids who are truly addicted to them oftentimes fail. But, there is also a large subgroup of individuals who are on opioids for chronic pain who don’t have a lot of the risk factors for substance abuse who have developed a physical dependency but who can be successful in slowly tapering off of those opioids and not relying on them to try to treat their chronic pain. There are a number of pain rehabilitation programs who focus on that type of approach to try and help individuals ween off of opioids. The interesting phenomena is that patients who are successful, not infrequently, will report that their pain is no worse when they're off the narcotics but that they have less pain once the opioids are out of their system and they have enough time for their brain to re-equilibrate to its normal or homeostatic state.
Melanie: So, what's your best advice in this last couple of minutes for people who have chronic pain, managing that chronic pain without the use of opioids and what do you want the public to know about this abuse and misuse of them?
Dr. Monsein: The first thing that I want people to understand is that if you look at the chemical structure of most of the opioids, they're very similar to heroin. These drugs have a lot of good benefits. That’s why we use opioids. They're the strongest, best painkillers. We use them a lot for acute post-surgical pain in the hospital for surgery. They can make people who have cancer, who are dying from cancer, improve the quality of their lives but these are very powerful drugs and they will hijack people's brains. That’s just the nature of how these medications work. I would encourage patients or individuals who have chronic pain to try to look at other alternatives for managing and dealing with their long-term pain issues. There are lots of different alternatives including non-addicting medications and other lifestyle changes including things like exercise, relaxation training, cognitive behavioural therapy, physical therapy. It can be very effective in helping people deal with pain. It's not that opioids are good or bad. They can be potentially dangerous and like any potentially lethal substance, they have to be approached very carefully.
Melanie: Really, really important information, Dr. Monsein and such great advice. It’s something that people really need to hear about. Thank you so much for being with us today. You're listening to The WELLcast with Allina Health and for more information you can go to allinahealth.org, that's allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Opioids are medications prescribed to relieve a person's pain. Unfortunately, prescription drug abuse is on the rise and opioids are being used for non-medical purposes across the U.S. from men and women of all ages. But, if you're suffering from chronic pain, what are you to do? My guest today is Dr. Matthew Monsein. He's a physician specializing in chronic pain management with the Courage Kenny Rehabilitation Institute. Dr. Monsein, welcome to the show. So, what’s going on with opioids today and why are so many people choosing this as their first method for pain?
Dr. Matthew Monsein (Guest): The use of opioids in the United States has grown dramatically over the last 20 years and there are a number of reasons for that. Certainly, the pharmaceutical companies have marketed very heavily and, initially, tried to present opioid therapy for non-cancer related pain as a panacea and as a cure but what we found out fairly quickly was that's not the case. Many patients take these medications and, even if they don’t become addicted, they do develop a tolerance. They become physically dependant meaning that when they’re not taking these medicines they start withdrawing. We also found that, for many patients, the medications can actually intensify their pain through the phenomena called “hyperalgesia” where narcotic pain medications can actually make people's pain worse. Now, there's a certain small percentage--because there are literally millions of people taking these medications or hundreds of thousands--but in the United States, every year about 15,000 patients or individuals, some of them are being prescribed opioids by their physician’s. Others are taking these drugs by getting them illicitly. But, they overdose and they die from these drugs. I think the physicians in the medical community and the federal government are beginning to look very carefully at whether prescribing opioids for the treatment of non-cancer pain is really in our patient's best interests. For myself, I've been involved with pain rehabilitation for over 30 years, and our whole focus has been to try and help patients who are on opioids taper off them and to try to find other ways to manage their chronic pain.
Melanie: There's so many avenues to discuss here Dr. Monsein. Are there certain factors that make a person more susceptible to addiction on these opioids than others?
Dr. Monsein: There are certain factors that we believe can make people at a higher risk for becoming truly addicted: a history of chemical dependency either to alcohol or other medications, cocaine, methamphetamines. Those are risk factors. Family history for chemical dependency is a risk factor. Psychosocial support can be a risk factor. Age is a risk factor. Younger people are more at risk of becoming addicted. So, there are those genetic factors and psychosocial factors that would predispose people to becoming addicted. Anyone, though, and this I think is very important: anyone--I don't care if it’s me, you, Barack Obama, Donald Trump, Hillary Clinton--anybody who takes opioids will physiologically develop a physical dependence on the medication because that’s how it works. Even if you’re taking it for all the right reasons, your body and your brain become habituated to that medication.
Melanie: So, are there considerations or monitors that are put in place when a person is prescribed a drug classified as potentially addictive like Oxycontin or some of these others. The pharmacist--you can’t even call in a prescription for this. It must be walked in. How do they regulate this?
Dr. Monsein: Well, the federal government and the state governments are trying to. Well, they do regulate it. They've been regulated for many years. The restrictions have gotten tighter. There are certain drugs that are considered to be Class II drugs and those include the ones that you just mentioned and you cannot call those medications in. There is a medication called Vicodin or hydrocodone that was a Class III drug for many years, so you could call in prescriptions for that. That was probably the number one opioid that was being abused in this country. That's no longer a Class III drug. You need the hard copy. Each state and the federal government are publishing guidelines about the use of opioids. The Center for Disease Control, for example, just put out new guidelines recommending limited use of opioids for post-surgical pain, limiting the amount of opioids that a person should be taking on a daily basis, if they’re taking for chronic pain. The State Board of Medical Examiners for individual states are also looking at this to try to minimize the risk for addiction, abuse, overdose and death but it’s a daunting problem.
Melanie: So, how do we recognize in a loved one, if they have been suffering from chronic pain and they've been put on an opioid, then they say, “It helps me” and, of course, you don’t want to argue with them about their pain but how do you recognize it? Then, what is the course of action to take? As you mentioned, it can oversensitive those nerves anyway and make them more susceptible to pain. So, do you treat it as an addiction like cocaine or alcoholism? What do you do?
Dr. Monsein: This is a very complicated question and a difficult issue to answer in a few words but let me try. I think if you have a loved one on opioids for chronic pain, you do need to look at how they're responding: are they back to work, are they involved with life, are their functional activities increasing? Or, are they just saying, “Well, it helps my pain” but that individual is becoming more socially isolated, they're sleeping more, they've lost interest in other family issues and they're just not able to function the way they had prior to starting that type of therapy. I think there are also patients who are on opioids who have the diagnosis of substance abuse. They truly are addicted to these medications. For those patients that have a diagnoses of substance abuse, there are medication--the ones that we hear most about are methadone and suboxone--to treat addiction. Patients who try to get off opioids who are truly addicted to them oftentimes fail. But, there is also a large subgroup of individuals who are on opioids for chronic pain who don’t have a lot of the risk factors for substance abuse who have developed a physical dependency but who can be successful in slowly tapering off of those opioids and not relying on them to try to treat their chronic pain. There are a number of pain rehabilitation programs who focus on that type of approach to try and help individuals ween off of opioids. The interesting phenomena is that patients who are successful, not infrequently, will report that their pain is no worse when they're off the narcotics but that they have less pain once the opioids are out of their system and they have enough time for their brain to re-equilibrate to its normal or homeostatic state.
Melanie: So, what's your best advice in this last couple of minutes for people who have chronic pain, managing that chronic pain without the use of opioids and what do you want the public to know about this abuse and misuse of them?
Dr. Monsein: The first thing that I want people to understand is that if you look at the chemical structure of most of the opioids, they're very similar to heroin. These drugs have a lot of good benefits. That’s why we use opioids. They're the strongest, best painkillers. We use them a lot for acute post-surgical pain in the hospital for surgery. They can make people who have cancer, who are dying from cancer, improve the quality of their lives but these are very powerful drugs and they will hijack people's brains. That’s just the nature of how these medications work. I would encourage patients or individuals who have chronic pain to try to look at other alternatives for managing and dealing with their long-term pain issues. There are lots of different alternatives including non-addicting medications and other lifestyle changes including things like exercise, relaxation training, cognitive behavioural therapy, physical therapy. It can be very effective in helping people deal with pain. It's not that opioids are good or bad. They can be potentially dangerous and like any potentially lethal substance, they have to be approached very carefully.
Melanie: Really, really important information, Dr. Monsein and such great advice. It’s something that people really need to hear about. Thank you so much for being with us today. You're listening to The WELLcast with Allina Health and for more information you can go to allinahealth.org, that's allinahealth.org. This is Melanie Cole. Thanks so much for listening.