Prairie Doc: Opioids: The Good, the Bad and the Ugly

Richard P. Holm, MD

My patient was in severe pain, suffering from an obstruction in his gastrointestinal tract as a result of spreading cancer. I knew that morphine, one of the opioids, would provide immediate and merciful relief, and it did. We are thankful that we have something that can palliate pain and provide comfort for severe acute pain, especially for patients at the end of their lives. That’s good!

In contrast to the good that opioids can do for certain acute pain, we know they are not very effective for musculoskeletal or neuropathic pain and fail terribly in helping long term pain and chronic pain syndrome. Despite this inadequacy, opioids are still being over-prescribed for most post-operative musculoskeletal pain.

Also, our bodies quickly develop tolerance to opioids, thus continually requiring increased doses to get the same effect. In addition, withdrawal symptoms from opioids can be significant making it difficult to stop taking opioids once hooked. It is estimated that about 75 percent of those taking illicit opioids got started from a prescription, more than 100,000 people are regularly using heroin and about 12 million people are taking non-prescribed illicit opioids. That’s bad!

It gets worse. Opioids have an insidious potential for overdose which depresses the drive to breathe so much as to suffocate people to death. In the U.S., it is estimated that about 70,000 people die each year from opioid overdose. In comparison, 83,000 die from diabetes, 56,000 from influenza and pneumonia, 47,000 from suicide and 40,000 from motor vehicle crashes. That’s very bad!

Ultimately, care providers need to prescribe opioids very judiciously and people must be careful when taking prescribed opioids. AND people need to avoid dangerous illicit forms. We do have an antidote to opioid overdose called naloxone (or Narcan®). If given soon enough, it displaces the opioid from the brain pain receptor and the victim starts breathing again. Thus, every ambulance and emergency room have multiple doses of this lifesaving reversal agent readily available.

Unfortunately, in response to this opioid epidemic, the drug manufacturer of naloxone, which costs 50 cents to six dollars to make, raised its price up to $4,000 for a dual pen auto-injector. Fortunately, a generic version will be available soon with a two-pack of auto-injectors for $180. Until then, we pay the higher price. That’s ugly!

Bottom line: If we hope to find help for this crisis, we need to understand the good, the bad and the ugly about opioids.

Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.