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Chronic Pain and Prescription Painkillers

Chronic Pain and Prescription Painkillers The Dangers of Drug Abuse The Heroin Crisis Preventing and Treating Addiction Who Is Using Opioids and Opiates?

Chronic Pain and Prescription Painkillers

Grace Ferguson

Mason Crest Philadelphia

Mason Crest 450 Parkway Drive, Suite D

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Printed and bound in the United States of America. CPSIA Compliance Information: Batch #OPO2017. For further information, contact Mason Crest at 1-866-MCP-Book. First printing 1 3 5 7 9 8 6 4 2 Library of Congress Cataloging-in-Publication Data

on file at the Library of Congress ISBN: 978-1-4222-3823-3 (hc)

ISBN: 978-1-4222-7963-2 (ebook) Includes bibliographical references and index. ISBN 978-1-4222-3337-5 (hc) ISBN 978-1-4222-8622-7 (ebook)

1. Southwestern States—Juvenile literature. 2. Arizona—Juvenile literature. 3. California—Juvenile literature. 4. Nevada—Juvenile literature. I. Title. F785.7.L37 2015 979—dc23 2014050200

O PIOIDS AND O PIATES : T HE S ILENT E PIDEMIC series ISBN: 978-1-4222-3822-6

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Table of Contents 1: Introduction to Chronic Pain..................................7 2: The Evolution of Opioid Painkillers ....................17 3: Controlling the Epidemic......................................29 4: Physician and Local Enforcement Challenge ......39 5: Recommended Use, Alternatives and Addiction Treatment ....................................49 Series Glossary of Key Terms....................................58 Further Reading ........................................................59 Internet Resources ....................................................60 Index ..........................................................................62 Photo Credits/About the Author..............................64

Words to understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills.

Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational Videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news cover- age, moments in history, speeches, iconic sports moments and much more!

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Research projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series glossary of key terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.

Words to Understand in This Chapter

crisis— a serious event that can turn into a disaster or become destructive if it is not handled appropriately or in time. mortality rate— the death rate, or a measurement of the number of deaths—especially when related to a specific cause. prevalent— something that happens often, or is widespread. risk factors— in medical terms, anything that increases someone’s chances of developing injury or a disease.

Chronic pain patients may be hesitant to take prescription opioids due to fear of becoming addicted.

Introduction to Chronic Pain

W hen people experience physical pain, they may decide to seek medical care. The health care pro- fessional attending to them performs a physical examination and run some tests to determine where the issue lies. Once they understand why the patient is in pain, some form of treatment—such as medication or physical therapy—is prescribed. The patient begins to heal, and eventually they are able to return to their daily life. For many people, this type of experience will comprise the majority of their interactions with medical professionals. For other people, the situation might not be so simple. Some people never fully heal, or the cause of their pain is never uncovered. Many of these people end up living with chronic pain.

Chronic Pain and Prescription Painkillers

What is Chronic Pain? Chronic pain is pain that lasts from at least three to six months consecutively, or is present for three to six months non-consec- utively, in a twelve-month period. For example, someone who experiences pain from January to June may have chronic pain, which is more severe than just a small ache or pain. Sometimes, chronic pain can be traced to a certain injury that

Acute pain is usually caused by physical injuries. This type of pain typically disappears within a few weeks or months when appropriate treatment is given. But acute pain can turn into chronic pain if the cause of the underlying pain remains untreated.

Introduction to Chronic Pain 9

has healed, such as an infection or injury. And sometimes chronic pain has no identifiable trigger, meaning there is no prior injury or tissue damage. In this case, the cause cannot be determined, and the patient is unable to receive proper treat- ment and recover. In other cases, chronic pain is related to cer- tain medical conditions, such as arthritis, low back pain, migraine, and multiple sclerosis. Chronic pain can cause people who are normally very active to be bedridden. It can even lead to depression and sui- cide, particularly if the pain is really severe and relief is scarce. How Many People Have Chronic Pain? Chronic pain has become so prevalent that the Institute of Medicine referred to the situation a crisis . The American Pain Society reported in 2015 that nearly 50 million adults in the United States suffer from chronic pain or severe pain. As more people become afflicted with chronic pain, even more individ- uals—including family and friends—are affected. The total number of people directly and indirectly affected by chronic pain is therefore much higher than 50 million. Chronic pain is also a significant health concern in Canada, where one in five individuals suffered from chronic pain in 2010. The impact of chronic pain on patients, family members, and friends in Canada is similar to what such individuals in the United States experience. To help combat the difficulties of living with chronic pain, patients are often prescribed painkillers. The problem with painkillers is that they are highly addictive and do not treat the source of the problem.

Chronic Pain and Prescription Painkillers

Chronic Pain and Depression A ccording to the Perelman School of Medicine, almost one-half of all primary care patients in America experience persistent pain. Many of these patients also suffer from major depressive disorder (MDD), which is a depressed mood that interferes with daily life. People with MDD are more likely to report chronic pain, and people with chronic pain are more likely to develop MDD. Suicide is therefore closely linked to people suffering from both conditions. Suicidal ideation, or suicidal thoughts, may stem from being dis- abled or unemployed, poor sleep, and feelings of helplessness caused by chronic pain. In a study of 88 patients at several pain clinics, 24 per- cent reported active or passive suicidal ideation. Active suicidal ideation is the desire to die and having a specific plan for how the death will be carried out. Passive suicidal ideation is the desire to die without having a specific plan for how the death will happen. A study of 153 individuals with chronic non-cancer pain revealed that 19 percent had passive suicidal ideation, 13 percent had active sui- cidal ideation, and 5 percent had a plan for suicide. In most cases, drug overdose was the chosen method for suicide. People with chronic pain are twice as likely to commit suicide, com- pared to people without chronic pain. General risk factors include prior suicide attempts, history of suicide in the family, and depression. Pain- specific risk factors include widespread and intense pain accompanied by insomnia. Considering the high rate of depression in the pain pop- ulation, doctors treating chronic pain should screen patients for depression during each visit.

Introduction to Chronic Pain 11

How Does Addiction to Pain Medication Happen?

People who take prescription painkillers for an extensive peri- od of time develop a tolerance for the drug, meaning they need to take more in order to feel its effects. These people become physically dependent on the painkiller, and experience painful withdrawal symptoms if they suddenly stop taking it. Physical dependence can be resolved by slowly tapering, or weaning, off the drug. However, addiction—which is caused by taking too much of the drug—is not so easily managed. Once addicted, painkiller users have uncontrollable cravings that makes it extremely hard for them to stop using, despite the harmful con- sequences—which includes compulsive drug-seeking behavior and the inability to meet work, family and financial obliga- tions. Note that most people who become addicted to painkillers were prescribed the medication to help treat their chronic pain.

Who Becomes Addicted to Pain Medication?

Addiction is not limited by age, socioeconomic class, race, eth- nicity, or profession. Even celebrities can find themselves addicted to pain medication. The following are examples of a few of the many celebrities who have struggled with painkiller addiction.

Steven Tyler: Lead singer of the rock band Aerosmith and one of the judges of the television show “American Idol,” Steven

Chronic Pain and Prescription Painkillers

Tyler has had a long and illustrious career during which he sustained a fair number of performance-related injuries. Some of these injuries required surgery, which left him in sig- nificant pain for long stretches of time. Consequently, Tyler has battled with painkiller addiction and has completed rehabilitation programs designed to treat addiction at least twice. Matthew Perry: Known for his role as Chandler on the American television program Friends , Matthew Perry is an accomplished actor. After a ski accident in 1997, he was prescribed painkillers to help cope with the injury. He became addicted to the medication and attempt- ed to deal with the issue while acting on Friends, one of the most popular television shows of its time.

Steven Tyler

Matthew Perry

Educational Video

Scan here to see a short video on chronic pain and related problems:

Introduction to Chronic Pain 13

These examples show that there is no single “type” of per- son who becomes addicted to prescription pain medication. It can happen even to people who seem to have access to every- thing they could ever want. However, studies show that 50 to 80 percent of people who die from prescription opioid overdose struggled with chronic pain. Opioid Pain Relievers Derived from the opium poppy plant, opioid pain relievers are by far the most common form of prescription pain medication. This type of medication is used because it is very effective in

US Overdose Deaths Involving Opioid Painkillers, 1999–2014

20,000

15,000

10,000

5,000

1999 2000 2001 20022003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Source: Centers for Disease Control, https://www.cdc.gov/nchs/data/health_policy/AADR_drug_poisoning_involving_OA_Heroin_US_2000-2014.pdf

Chronic Pain and Prescription Painkillers

Opioid Overdose Deaths by State, 2014

NH MA

Deaths per 1,000 residents 2.8 to 11.0

MS AL

11.1 to 13.5 13.6 to 16.0 16.1 to 18.5 18.6 to 21.0 21.0 to 35.0

Source: Centers for Disease Control, http://www.cdc.gov/drugoverdose/data/statedeaths.html

treating pain and relieving discomfort. It is also highly addic- tive and can be dangerous. According to the Centers for Disease Control and Prevention (CDC), at least half of all opi- oid overdoses in the United States involve a prescription opi- oid. And in 2014, over 14,000 deaths occurred because of pre- scription opioid overdose. Similarly, the number of deaths from opioid abuse in certain Canadian provinces have increased over the years. From 1991 to 2010, the opioid-related mortali- ty rate in Alberta, British Columbia, and Ontario increased 242 percent. And in 2010, opioids were the cause of death for 12.1 percent of Ontario individuals aged 25 to 34.

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