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Is There A Way To Keep Using Opioid Painkillers And Reduce Risk?

By NPR. Click here to view the entire article or to hear it online.

by Allison Aubrey

Jon McHann, 56, got started on prescription opioids the way a lot of adults in the U.S. did: he was in pain following an accident. In his case, it was a fall.

“I hit my tailbone just right, and created a severe bulging disc” that required surgery, McHann says.

McHann, who lives in Smithville, Tenn., expected to make a full recovery and go back to work as a heavy haul truck driver. But 10 years after his accident, he’s still at home.

“After the surgery the pain was just excruciating,” McHann recalls. “I was unable to function.” His spinal problems turned out to be more complicated and hard to treat. And he developed other health problems, too. He had several more surgical procedures for his back, but he got no relief. He says on days when his pain is through the roof, “I can’t open my eyes because I know if I blink it’s going to hurt.”

His doctor prescribed methadone, a powerful opioid. He stayed on the drug for seven years.

“It helped immensely, it brought my pain down to a 5 or 6 [on a 10 point scale],” McHann says. “I could function fairly well throughout the day. I could go to church every weekend, I could help my wife shop, I could help around the house a little bit.”

McHann knew the risks of opioid drugs, including the risk of dependence. “It was a concern to me,” he says. His goal was to get off the drugs. But for many years, it felt like the benefits of the pain relief outweighed the risks.

But as concern about the opioid epidemic grew, McHann started getting pushback from his doctors. They began reducing the strength and dose of his prescription. “Every time I saw a clinician, my opioids were reduced,” McHann says.

As the dosage was decreased, his pain began to increase and he worried that he’d be cut off the drug. “Life wasn’t going to be worth living if I couldn’t get the pain under control,” McHann says.

McHann is not alone; pain is one of the most common and debilitating medical conditions, with about one-third of Americans dealing with some form of acute or chronic pain. In 2014, 3 to 4 percent of adults were prescribed opioid painkillers long term — 9.6 to 11.5 million people.

In response to the epidemic of opioid addiction and deaths, in 2016 the Centers for Disease Control and Prevention released guidelines urging physicians to try non-opioid methods first for chronic pain. In a viewpoint published last month in JAMA, the journal of the American Medical Association, CDC officials wrote that while illicit opioids such as fentanyl seem to be driving the recent increase in opioid-related overdose deaths, “unnecessary exposure to prescription opioids must be reduced to prevent development of opioid use disorder in the first place.”

But figuring out what’s unnecessary, and how best to reduce the risk, can be a challenge.

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