Pharmacies across the United States continue to see an increase in the prescription of opioids for the treatment of pain. To put this into perspective, according to the United States Center for Disease Control, over 191 million opioid prescriptions were dispensed in the United States to patients in 2017. This number continues to increase on a yearly basis. Pharmacists all around the U.S are faced at some point in their career with a decision of whether or not to continue to dispense an opioid pain medication or combination of opioids to a patient. Usually pharmacists use their professional judgement daily to come to a conclusion on the right action to take, which often requires communication with the patient’s physician to determine the best treatment plan.
Pain: Pain is generally loosely categorized by duration, into acute and chronic pain. Acute pain, sometimes referred to as muscular/skeletal pain, is typically described as mild aches and sharp pain that tends to go away after the causing injury heals (days to a few weeks) usually with the help of medication--topical or systemic. The goal here is to reduce pain and facilitate recovery as soon as possible. Usually, a non-opioid medication like Ibuprofen is used to achieve this goal. Chronic pain, lasting for several weeks to months, sometimes results when acute pain is poorly managed. Additionally, chronic pain is sometimes caused by diseases such as diabetes-neuropathy/neuralgia(nerve pain), cancer, auto-immune diseases and by interventions such as surgery. In the rest of this article, I will be referring to chronic pain as just the chronic non-cancer pain. Due to the complicated etiology (cause) of this pain, physicians typically work toward helping reduce pain to an acceptable level. The term “acceptable’’ here is quite objective. Thus, it is important that patients carefully describe their pain and work with their physician to ensure proper and adequate treatment. Patients with chronic pain often mention to pharmacists about how their functional abilities are affected, including not being able to lead a productive life. To help improve their quality of life, pharmacists work diligently with patients and their physicians to not only ensure appropriate use of their prescribed opioids medications, but counsel on possible side effects from using these medicines.
Treating chronic moderate to severe pain is not an easy task and has been a major problem plaguing the health care system in America. Health care professionals, particularly doctors and pharmacists are figuring out ways to help combat this problem. Insurance companies and government agencies are doing their best as well to ensure that opioids medications are prescribed at the lowest effective dose for the shortest period possible. This they hope will help prevent addiction and reduce cases of opioids overdose.
Pharmacist angle- Why Opioids:
Opioids (immediate and extended release formulations) are typically prescribed for pain management that are not relieved by ice or heat therapy, topical analgesics such as Lidocaine, Bengay, or Non-Steroidal Anti-Inflammatory medicines—ibuprofen, naproxen etc. They work by producing analgesia-pain relief- at the recommended dose. There are many reasons or indications why patients are prescribed opioids for the management of chronic pain as mentioned earlier. Often times, problems arise from inappropriate prescribing—when patients are being prescribed these medications for acute or mild musculoskeletal pain without considering other alternative, longer than normal length of therapy without de-escalation plans, lack of understanding of treatment goals leading to inappropriate use, and lack of accountability from the prescribers end. Health providers who are prescribing opioids should be knowledgeable about the risk factors for opioid abuse and adverse events (slowed breathing, drowsiness, and sedation among others) especially at higher doses. Pharmacists routinely observe miscommunication between several physicians taking care of the same patient, which often leads to therapy or treatment duplication and cases of dangerous medication cocktails (anti-anxiety medicines and muscle relaxants) further increasing patients' risk of adverse events or potential overdose.
Pharmacists now counsel patients who are taking a daily dose of 50 milligram equivalent of morphine or more on the risk of overdose as part of the recommendations from the recent CDC guidelines on treating chronic non-cancer pain. Also, we do recommend that patient discuss with their pain management physician about having Naloxone on hand in the case of an overdose. Narcan (Naloxone)works to reverse the effects of opioids depression partially or completely in the case of overdose. Patients can also get this medication furnished to them at the pharmacy in some states without a prescription from their doctor.
For the Patients-Other Options:
Chronic non-cancer pain is a complicated disease state to manage and it often leads to inability of the patients to lead a productive life when not effectively treated. Thus, effective treatment is often achieved through a good physician/patient relationship and a solid