Opioids available more than ever

A map of Nebraska shows the amount of opioids prescribed per person in 2015. According to the Centers for Disease Control and Prevention, providers in the highest prescribing counties prescribed six times more opioids per person that the lowest prescribers.

When people think of drug abuse, what comes to mind are meth addicts or marijuana users. But the United States is seeing a crisis involving a much more accessible drug — opioids.

While opioids do include the illegal drug heroin, prescription opioids such as OxyContin and Vicodin are widely used to relieve moderate to severe pain. The synthetic painkiller fentanyl — which is many times stronger and typically used in advanced cancer cases — is also being made and distributed illegally, according to the Centers for Disease Control and Prevention.

According to 2016 data on the CDC website, 42,000 people died that year from opioid overdose. And 40 percent of overdose cases involve prescription opioids.

How did such a deadly trend begin?

Heather Jensen, a registered nurse and opioid abuse prevention coordinator for Community Connections, said it started after a paper published in the 1990s. Jensen is a registered nurse who has worked in critical care for 15 years. She is also the opioid abuse prevention coordinator for the local nonprofit Community Connections.

“(This paper) said we were undertreating people’s pain,” Jensen said. “We weren’t doing enough, there were too many people in pain.”

Jensen said medical professionals then added a fifth vital sign — pain — to the checklist they use for all patients. Insurance companies then were hesitant to support alternative therapy for most patients, Jensen said, so medications were the most common answer. Prescription opioids became available to the public, and overuse started causing problems.

“Doctors never had any intent to harm or addict people with these prescriptions,” Jensen said. She believes a bill currently in the U.S. House that would punish doctors for prescribing opioids is not the correct answer.

She believes two misconceptions have led to opioid abuse.

First, Jensen said, people have a perception that nothing should hurt.

“But things are painful,” Jensen said. “If you have a hip replacement, it’s going to be painful. We need to look at what is going to come from each surgery and how best to manage it without opioids.”

Pain management can take many alternative forms instead of drugs, Jensen said: physical therapy and exercise, or even something as simple as a distraction like reading or meditation.

Second, people often think that because these medications came from a doctor, they can’t possibly be harmful.

“Physicians are a trusted part of their communities, as they should be,” Jensen said. But the pattern of abuse can grow over time without the patient realizing.

For example, a person may start out taking the pills exactly as prescribed. But as they feel better, they take it less — but they keep the extra pills. They may then start using them to combat things like headaches or sprains. Not using the drugs as prescribed or using them too often creates dependence, Jensen said.

“With an antibiotic, we say, ‘Take it until it’s gone.’ It’s not the same with opioids,” Jensen said. An opioid user, even if they only took pills for one day, has a 6 percent risk of still using those opioids a year later. After eight days of use, Jensen said, that risk more than doubles to 13.5 percent.

“The day you start taking an opioid is the day you should start weaning off of it,” she said.