Use of Opioids as First-Line Treatment a Slippery Slope

What do Michael Jackson, Heath Ledger, and Chris Farley have in common? These are celebrities who developed dependence on prescription drugs that started with legitimate use after injuries or procedures. They subsequently developed an addiction, which culminated in their unfortunate and untimely deaths due to unintentional overdose. Just a few examples of other celebrities who had opioid-related fatal accidental overdoses:

  • Juice WRLD – Rapper (2019 – Died at age 21) – Percocet 
  • Mac Miller – Rapper (2018 – Died at age 26) – Fentanyl, Alcohol, Cocaine
  • Art Bell – Broadcaster (2018 – Died at age 72) – Hydrocodone, Oxycodone, Valium, Soma 
  • Lil Peep – Rapper/Singer (2017 – Died at age 21) – Fentanyl, Xanax
  • Tom Petty – Singer (2017 – Died at age 66) – Fentanyl, Oxycodone
  • Prince – Singer (2016 – Died at age 57) – Fentanyl 
  • Chyna – Wrestler (2016 – Died at age 46) – Oxycodone, Opana, Restoril, Valium
  • Philip Seymour Hoffman – Actor (2014 – Died at age 46) – Heroin, Cocaine, Benzos, Amphetamine

The list goes on… 

When opioids are taken alone, overdose could occur. But overdose has a higher chance of occurring when opioids are used in combination with other substances. Overdose happens without warning. Opioids, when not taken according to doctor’s instructions or when combined with other substances, increase the chance for an unpredictable and fatal outcome. 

Following minor surgical procedures, dental procedures, many orthopaedic injuries, work injuries, motor vehicle accidents, some areas of our body sustain “injury,” and local tissues at the area of injury become “inflamed.” Inflammation is a complex response our body mounts to harmful stimuli (e.g. injured or damaged cells, irritants, infection). Inflammation is a protective response that is orchestrated by our immune system, which involves numerous types of cells, and cytokines, which help us attack the harmful stimulus. Although inflammation is a protective response, some inflammatory mediators (chemicals released by immune cells) inadvertently interact with local neurons and nerves to produce hypersensitivity and pain.  What we do when we experience pain is critical in ensuring we do not turn a normal human response to injury and inflammation into a long-lasting condition. 

No human is immune to addiction or its consequences. Opioid dependence can occur fast and leads to long-term changes in neurons and brain circuits.  Addiction sets in when there is an uncontrollable or overwhelming need to use a drug, especially despite negative consequences. A lot of us have a friend, loved one, or acquaintance who is currently dealing with problems associated with opioid addiction, and some of us know someone who has died from opioid-related overdose. 

When it comes to pain control with opioids, taking higher doses of opioids does not provide more pain relief. It instead leads to more side effects, dependence, and possibly addiction. As dependence sets in, opioid requirement does not directly target any anatomic cause of pain, instead: a) it helps minimize effects of the changes in brain chemistry; b) for a few hours it helps with our quest to feel normal from the negative effects of drug tolerance; and c) it helps with our quest to avoid withdrawal symptoms. Remember that withdrawal can be very painful akin to generalized body aches from a severe flu illness.  

The best pain control strategies do NOT involve opioids as a first-line treatment for a vast majority of conditions. Instead, they involve first identifying the exact cause of pain, then focusing effective treatments to the specific pain generator(s).  

Dr. Okafor is an Orthopaedic Spine Surgeon at the Spine Institute of Central Florida

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