Q&A: Life After Opiates

With the new opiate prescribing laws fully in effect, many doctors are switching patients to non-addictive medicines. Daniel Passerman, D.O., Henry Ford’s Associate CMO of Primary Care and Interim Chair of the Department of Family Medicine, addresses some of the most pressing questions regarding this issue.

Q. If a patient has been taking opiates for pain related to fibromyalgia, back pain, knee pain or other chronic conditions, what do they do now?

A. If they’ve been on the prescription for more than 90 days, they can still get the medicine, but they will have to go through state-mandated one-time opioid education. A lot of the changes with this new law goes on behind the scenes. Doctors need to check with the Michigan Automated Prescription System, called MAPS before prescribing an opiate. And every pharmacy filling a prescription must submit it to MAPS. Any opioid prescribed to the patient must be filed with MAPS.

Q. Why do you think this has become a problem?

A. When I started medical school some 18 or 20 years ago, they talked about pain being the 5th vital sign. It was engrained in us that we take care of people’s pain. In the end, we have found that doing all we can to address a patient’s pain probably did more harm than good. The overprescribing of opioids is a self-made mess. We have people who have significant pain issues and have become dependent. The medications alter the receptors in the brain. They make the person more intolerable to routine pain. This means they don’t cope as well with normal pain, like stubbing their toe or twisting their ankle. In addition, they begin to build a tolerance to the medication. In short, we have overtreated their pain and caused more harm than good.

Q. What does this mean to patients now?

A. The expectation has been that we, as doctors, can control any pain. The reality is that sometimes we can’t safely control the pain.

Q. How is this shift going to happen?

A. Through communication and education. We’ve done it before, for instance with antibiotics. Patients don’t come in now expecting antibiotics for a viral infection; they know they don’t work for that. Something like this takes time. Most physicians know that we need to greatly reduce the amount of opiates we are prescribing. But it’s hard when the patient is sitting in front of you asking for help with their pain. Are the opioids allowing them to function? Can they live independently because the medication is allowing them to walk, go grocery shopping and not hurt?

Q. What are other options to relieve pain?

A. Patients should check with their doctor, but options can include: physical therapy, procedures such as injections of cortisone, epidurals, implantable nerve stimulator, radio frequency oblation of the nerve, even osteopathic manipulation, which is performed by select D.O.s. Even some over-the-counter medications can help.

Q. What are common withdrawal symptoms?

A. Back pain, back spasms, nausea, vomiting, headaches. Withdrawal symptoms are your body’s response not having the opiate anymore. How long it lasts will depend on how long you were taking the opioid medication. Your doctor can work with you to help wean you off the opiates to lessen the withdrawal symptoms.

Q. Do you have any suggestions for people who are finding it hard to wean off opiates?

A. First, I understand it can be really hard. They need to keep in mind that the pain gets worse if they’re just sitting or lying in bed. Being active helps reduce the pain. Try your best to maintain as much activity as possible. If it’s arthritis, movement and exercise helps keep those joints lubricated so the stiffness is reduced. If it’s muscle spasms, moving around helps stretch things.

Q. Who can they call for help?

A. They should not hesitate to contact their primary care doctor if they need assistance. We want to help everyone get through this and move on to a healthier place.

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