ACUTE PAIN: OPIOID ABUSE

Opioids are a family of related drugs that relieve pain. All of the opioids (sometimes called narcotics) are chemically related to opium, which is a substance collected from the poppy plant. Opioid drugs include opium, codeine, fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, paregoric and sufentanil. When prescribed by a doctor, the pain-relieving properties of opioids are used during and after surgical procedures, for the pain of childbirth, for injury and for other pain problems. Although opioid medications have helped millions of individuals with pain, these drugs can be used inappropriately. The September 15, 2004, issue of JAMA includes an article about abuse of prescription opioid medication.

Abuse and Dependence

Drug abuse is a pattern of inappropriate drug use that leads to recurrent problems in fulfilling obligations, impaired physical functioning, conflicts with family and friends, and legal problems. Drug abuse may progress to dependence (sometimes called addiction), manifested by a strong desire to continue the drug despite the increasingly severe problems it causes, tolerance (a need for larger amounts of the drug to get the same effects), and withdrawal symptoms if the drug is stopped.

· Sedation, sleepiness or lethargy

· Avoidance and withdrawal from usual activities

· Multiple visits to multiple doctors to increase amounts of prescription drugs available for abuse

· Confusion

· Weight loss

Complications of Opioid Abuse

· Blood-borne infections from unsterile injections, including human immunodeficiency virus (HIV), hepatitis viruses and bacterial infections

· Job loss with possible financial devastation

· Loss of family, friends and career-related relationships

· Increased chance of risky behavior, including driving under the influence

· Drug overdoses, which can lead to brain damage or death

· Miscarriage, stillbirth or infants with low birth weight due to opioid abuse during pregnancy. Babies born to addicted mothers will be born addicted to the opioid and will have withdrawal symptoms after birth.

Treatment of Opioid Addiction

Recognition and admission that drug abuse exists is the first step in treatment. Drug addiction is a chronic medical problem. It is a treatable disease but relapse is a prominent feature. Relapse must be considered as part of a treatment plan. Drug abuse counseling is an important part of treatment. Participation in support groups, such as Narcotics Anonymous, may help individuals in treatment for opioid abuse. Certain medications may be used as a part of treatment. These include methadone, a long-acting opioid taken by mouth, which can substitute for the harmful injection of illegally obtained opioids.