What are the risks of long term opioid treatment?

Medicare Part A/Part B or Part C Advantage with Drugs coverage or Medicare Part D drugs coverage ensure that prescribed pain management care while part of a medical procedure is included in your plan.

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Among the drugs available to you on prescription as part of your pain management treatment, and covered by your health insurance plan, will be a group of drugs categorized as opioids.

Sooner or later any of us could face the need for pain deadening treatment.  It is important to understand the dilemma that opioids present.

All opioids come with a Doctor’s warning and all medications come with the financial impact of co-pays, co-insurances and out of pocket limits. Most health insurance plans have annual or lifetime limits which include ‘pain relievers’.

If you are reading this article it is probable that you are concerned, either for yourself or for a loved one, about the impact that opioid dependency is having. ACA compliant health insurance plans, Medicare Advantage plans, and Medicare Part D will help with the financial implications but will not resolve the long term inter-personal issues.

Pain management care

Let us be clear, Opioids are very good at what they are prescribed for i.e. pain relief. They are also highly addictive.

There are alternatives!

But first, we consider the risks of opioid treatment.

In fact, the longer you take an opioid medication the greater the risk of addiction. For just this reason, first prescriptions have been limited to 7 days’ supply (since 2019).  The evidence suggests that 20% of patients are at an increased risk of opioid addiction after as few as ten days of use.  So rapidly can a relief become a dependency?

Of course, opioids are a valid source of pain relief especially for acute pain i.e. pain caused by trauma or surgery.  These are pains which diminish or disappear with recovery (typically 3-7 days).  It[d1]  is important to cease medication as soon as the pain is manageable or to discuss the alternatives with your physician.  

One of the recurring examples of acute pain is associated with dental treatment, an extraction for example.  An opioid is often the most effective painkiller and dental surgery often the first introduction to their addictive effects.

What is addiction?

Addiction is the third stage of an individual’s response to the extended use of a drug(s).

The first stage is ‘tolerance’. An individual’s response to a drug changes over time and in general, even after a few days, a higher dosage is required to achieve the same effect.

The second stage is ‘dependence’. Opioids in particular, stimulate the excess production of dopamine, the ‘reward’ hormone.  As the brain adjusts it requires more opioid to feel the same effect, commonly experienced as euphoria.  Dependence is when the individual requires the drug, not necessarily to relieve pain but in order to feel ‘normal’.

The third stage ‘addiction’ is when an individual continues to use the drug despite knowing the harmful consequences, whether on their health, social engagement or financial situation.

Read more about OPIOID Crisis and Addiction

What is an Opioid?

An opioid is a strong pain deadening medicine either produced naturally from the opium found in poppies or artificially using the same chemical structure.

Opioids act by limiting the ‘pain signals’ from the pain ‘site’ to the brain. This is, of course, the beneficial intention of the medication. There are, however, significant side effects.  Opioids can cause slowed breathing, confusion, and euphoria (the feeling of reward often described as feeling ‘a little high’) and it is this that makes it easy to want ‘more’.

Common prescription opioids 

  • Morphine
  • Oxycontin
  • Percocet
  • Fentanyl
  • Hydrocone
  • Codeine

There others, and it is wise to consult your doctor but you can check on-line if your medication contains an opioid.

Pain management treatment options

  • Medication
    • ask your doctor about non-opioid pain relievers.  The first step is to reduce the dependence on opioids, preferably to zero
  • Exercise and Nutrition
    • Specific exercises can increase your range of motion and help to stretch and strengthen muscles
    • Eating fresh foods, avoiding caffeine, and following an anti-inflammatory diet can reduce the side effects of reducing opioid dependency.

It may also take a little bit of experimenting to discover which options work best for your individual needs.

However, before beginning an exercise program you should always consult your doctor or qualified physiotherapist. Specific exercises that may help you should be appropriate to your personal circumstances.

Making dietary changes related to the type of pain you experience may help you manage some of your symptoms. There may be very specific instructions for your condition (such as eating a gluten-free diet to manage pain associated with celiac disease).

Finally, Many of the major health insurers have programs to assist opioid dependent clients and others seeking chronic (long-term) pain relief. E.g. Pain management clinics.

If you or someone you care for is seeking advice/support they should contact their healthcare plan provider.  If your provider does not have a suitable program e.g. a pain management clinic, contact your Health Insurance Exchange.  They can direct you to the providers best able to meet your pain management treatment needs.  Even if you switch to a 5* plan this will almost certainly be a good investment.

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