Managing pain key to managing opioid addiction

December 20, 2017

Opioid addiction is labeled an epidemic, and Minnesota is not immune.  While there are multiple schools of thought on the source of the epidemic, the number of deaths related to this class of drugs continues to rise, in some states, by more than 100 percent in the last few years. Recent reports show more Americans now die from heroin overdoses than from gun homicides. An even greater number of individuals succumb to prescription opioid overdose.

“The demographic of people having problems with opioids is changing and expanding,” said Jason Varin, Pharm.D., pharmacist and assistant professor in the Department of Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy. “It’s affecting every community. Often the people getting addicted are those undergoing routine surgery. Many who are falling victim to addiction, are well-established and middle-aged. Some will then turn to illicit opioids such as heroin when they are unable to procure any more of the prescription medicines.”

The broad scope of people living with addiction and facing threat of overdose has led several states to make naloxone, (Evzio®,Narcan®) more available to the public. Naloxone is a medication often used in emergency situations to block the effects of opioids, including respiratory depression, sedation and hypotension. In September of 2015, naloxone became available in many pharmacies throughout Minnesota.

In the medical field, there has been a strong focus on reducing opioids in perioperative medicine, with a greater emphasis on multimodal therapy, or using two or more non-opioid medications to reduce patient’s pain. Doctors are also reducing the amount of opioids prescribed to a patient both in the hospital as well as after being sent home.

“We have increased our use of regional anesthesia to again minimize post-surgical pain, and provide patients with non-pharmacologic options for pain control as well,” explains , assistant professor in the Department of Anesthesiology and director of Regional Anesthesia, Acute Pain, and Ambulatory Anesthesia for University of Minnesota Health. “Our goal is minimizing pain for our patients, and minimizing opioids and the side effects of those opioids. We are also working to educate patients about how to best manage pain as well as the benefits and risks of the various options.”

Hutchins said one of the reasons for the opioid epidemic is linked to the overemphasis on patients having complete pain control.

“It’s important for surgical patients to understand that pain is to be expected as part of the postoperative recovery,” said Hutchins. “Therefore communicating that we want to minimize opioids as well as how long the patient can expect to use them post operatively is helpful for patients.”

Varin agrees, alluding to an overall change of perspective for how the public generally, views opioids. “The role of opioids should be to make the pain tolerable, not to eliminate it.  Trying to eliminate the pain creates a spiraling dependence where you need more drug to get the same effect. This is the fast lane to addiction,” said Varin.