One of the more challenging aspects of emergency medicine is pain management. Emergency departments are filled with patients suffering from terminal and chronic diseases, including cancer, lupus and sickle cell anemia. Unfortunately they are also frequented by drug-seeking patients with manufactured complaints meant to obtain prescription pain medications, particularly opioids.
Opioids are among the strongest medications that will be prescribed by your physician. You know these drugs well. They include codeine, hydrocodone (e.g., Vicodin), morphine and oxycodone (e.g. OxyContin and Percocet). Other opioids include remedies for cough and diarrhea, including codeine preparations and diphenoxylate (Lomotil), respectively.
The US Centers for Disease Control and Prevention (CDC) notes marked increases in unintentional poisoning deaths over the last 25 years. Opioid pain medication abuse, often in combination with alcohol or other medications are a major reason for this increase. You may or may not be surprised to know that approximately 10% of high school seniors have used opioids in the last year for non-medical purposes. At the other end of the age spectrum, elderly patients prescribed these medicines for various reasons often find their supplies pilfered.
You know at least half of the reason why, based on the pleasurable acute effects of opiates. Acute effects of opioids involve relieving pain by dulling the intensity of pain signals headed toward the brain (according to our brains, that tree in the forest with no one around doesn’t make a sound). Basically, if the brain doesn’t receive the signals coming from painful stimuli, you don’t know you’re having pain. Opioids also stimulate pleasure centers within the brain, additionally helping us to ignore sensations of pain. Other acute effects include nausea, drowsiness and constipation.
The other half of the story regarding acute effects of opiates often involve the consequences of snorting or injecting medications meant to be taken orally, or misusing/abusing prescribed medication even if taken orally. Opioids also lead to depressed breathing (respirations), which facilitates coma and death – particularly when used while drinking alcohol.
Long-term effects of opioids are often not thought of by those looking for a high, but they are devastating. In addition to developing tolerance (decreasing effects if taking the same dose over time) and addiction (cravings and inability to function without ongoing drug use), opioids are associated with spontaneous abortions and births of low birth weight babies.
One of the reasons to avoid getting started down the road of becoming addicted to opioids is ending the addiction is difficult. The withdrawal syndrome includes vomiting, diarrhea, involvement leg movements, restlessness, insomnia, muscle and bone pain and cold flashes. Many individuals attempting to end addiction find themselves relapsing due to the severity of withdrawal symptoms. That said, good treatment options exist for combatting opioid addiction. These include both medications and behavioral therapies that have been proven effective.
There is a time and place for strong pain management. When this is the case, get the medicine you need. Just be aware that there’s a very slippery slope involved with opioids, and a level of caution should be applied when deciding to take pain medications. Feel free to contact your SMA expert consultant for any questions you may have on this topic.
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