What are the chances a patient will be on opioids after initial use of opioids?  I recently attended a lecture discussing opiate addiction and its far-reaching aspects.

How soon does habituation to opioids occur? There was an interesting study out which confirms that opioids should be avoided if any other method will help.  This study shows opioid habituation is a real issue.

• The probability of long-term use increased after 3-5 days.  So, if a patient is only given 3-5 days of opioids, the risk of long-term opioid use is low.
• Contrary to that…. if you’re on opioids for 8 days, you have a 14% chance of being on opioids at 1 years.
• If a patient is on opioids for 31 days, 30% are on opioids at 1 years.
• 14% of patients that get a 2nd opioid prescription are on opioids at 1 year.

This data is extracted from Shah et al (2017) CDC Morbidity and Mortality Report.   https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm

Also, if you’d like to read a Freakonomics-type book about the opioid crisis, look at the book Dark Paradise : A History of Opiate Addiction in America by David Courtwright.

What is the government doing?  The Department of Justice is data mining to pinpoint physicians who prescribe more opioids than their peer physicians.  Physicians who give opioids outside of the CDC Guidelines, will need to document WHY a different amount or duration of opioids is given, or the physician may be liable.

What are medical schools doing?  Most physicians see 50,000 patients in our work lives.  So, the pain management standards and guidelines are changing and this will affect future generations of physicians and patients.  Medical schools are beginning to teach “multimodal pain education” to reform pain medicine  to avoid addictive medicines.  Even after a surgery, there are “enhanced recoveries” with protocols to maximize non-opioid pain management.

Providers want to give good care.  And, just know that NO opioids may be prescribed.  It’s for patient safety as opioids can cause memory disorder and endocrine issues AND, of course, opioid overdoses can cause death.

How to taper opioids?  Tapering opioids is technical and complex.  10% dose of opioids may be tapered per month.

If a patient is on opioids and benzodiazepine, this increases risk of overdose death by 400%. Have your physician help taper you off one of them! Gabapentin with opioids may also increase overdose risk.

Be careful.  See your physician.