The use of opioids across our nation has risen to epidemic proportions, and regulators, government agencies and, of course, the workers’ compensation industry have implemented actions designed to address this problem. Their efforts are commendable, and the workers’ compensation industry has made good strides toward stemming the complications associated with opioids.
But lost in this conversation is an understanding of who, how and why opioids affect certain people. The best way to truly prevent the potential negative consequences of opioid use is to act from a position of knowledge.
Who do opioids affect?
A first-time opioid user can die from the effects of opioids, and everyone who uses them soon becomes physically dependent on them. Despite the dependency, not everyone develops a tolerance to the drugs, and even fewer become addicted. It’s not possible to accurately determine those most vulnerable to addiction or when that shift will occur. But there is a lot we do know that can help us as we make decisions.
What is physical dependence?
Many substances produce physical dependence without addiction. Caffeine and SSRIs — a class of antidepressant drugs — are two examples. To be physically dependent on opioids means that a person needs to take the drug in order to feel normal, and if they suddenly stop taking the drug, they will experience abstinence syndrome or withdrawal, the symptoms of which may include anxiety, tremors, body aches, gastrointestinal issues, runny nose, sweating, and increased heart rate and blood pressure.
What is tolerance?
If a patient develops a tolerance to opioids, it means they need an increased dose of the drug to receive the same effect, or that the patient feels a diminished effect from continuing the same dose.
What does addiction look like?
- While related to physical dependence, addiction affects different brain sites than the brain sites that mediate physical dependence. Opioids affect the brain’s reward/pleasure center, and addiction occurs when the drugs lead to cravings that go beyond pain relief. It may be subtle. Injured workers who are addicted don’t use the drugs as prescribed.
- Signs that determine a potential addiction include a patient running out of medication before the prescription is up, receiving opioids from several doctors and lying about having lost a prescription. Some people even turn to street drugs, such as heroin, to satisfy their cravings. If an injured worker with a history of substance abuse develops a painful condition, they should consult an addiction specialist.
- Some injured workers taking opioids may actually have other conditions incorrectly labeled addiction. For example, pseudo addicts have a pattern of drug-seeking behavior similar to addicts, but it’s due to receiving inadequate pain management. Taking pain reduction medications, such as ibuprofen or acetaminophen, can resolve this problem.
- Opioids may also be inappropriately used by injured workers to manage their stress, a condition called chemical coping.
- Finally, there are injured workers who need an increased dosage, not due to tolerance but because of other issues, such as disease progression, new disease, increased physical activity, lack of compliance, change in medication, drug interaction and deviant behavior.
While only an estimated 2-5 percent of those who take opioids become addicted to them, this is the most dangerous effect. If left untreated, opioid addiction can ruin and even end lives.
Uses and dangers of opioids
Terminally ill patients with pain benefit a great deal from opioids. Injured workers in need of severe pain relief following an injury or surgery also benefit, but should only use opioids for a short time. In addition, research shows that chronic pain patients should not be prescribed opioids as the first line of treatment.
Opioid use can bring about complications, including hyperalgesia, a condition in which the brain interprets normal sensations as painful. Extended opioid use can actually increase pain, and the injured worker will only feel better and experience less pain after being weaned off the opioids.
Opioids become extremely dangerous when used with other medications, especially benzodiazepines, such as Xanax and valium. Taking these drugs together increases the risk of overdose, as they can increase the likelihood of respiratory depression.
Opioids can be a lifesaver for people experiencing excruciating pain, but they should be used only for a short time or after all other treatments have failed. Using opioids for an indefinite period changes the interaction between the brain and the nervous system and also raises the risks that the injured worker will become susceptible to the drug’s negative consequences.
High-risk injured workers and those with chronic pain should be treated with alternative methods, such as cognitive behavioral therapy. CBT and other strategies teach injured workers to soothe themselves, greatly reduce pain and allow them to return to functionality and work.
Founder and Network Medical Director of IMCS Group, Michael Coupland, RPsych, is a psychologist, author, speaker, trailblazer and internationally renowned expert in chronic pain and PTSD assessment and treatment. A registered psychologist, Mr. Coupland has more than 35 years’ clinical experience in workers’ compensation, disability and personal injury,
IMCS – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. IMCS makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.