One big challenge with opioid use is its effectiveness against pain, and pain is very real. Addiction is a chronic, treatable illness. Treating patients with opioid use disorder (OUD) requires continuing care rather than an episodic, acute care approach. Patients should have access to medical treatment, mental health services, addiction counseling, and other recovery support services. Treatment should be tailored to each patient’s needs and preferences (ASAM, 2015). In fact, there is no single best approach that works for all patients. A comprehensive approach to treatment is part of addressing the problem of drug diversion. Research shows that many people in need of treatment for substance use disorder do not receive treatment.
Long-term treatment relies on pharmacologic therapy and behavioral therapy, known as medication-assisted treatment (MAT). The objective of treatment is to reduce the dependence and addiction on opioid drugs, prevent opioid overdose, and thus to decrease the opioid-related deaths and mortality. Clinical studies show behavioral modification isn’t effective on its own because the body has physical dependence that must be addressed. Opioid abuse is not an ethical or moral addiction, but rather a physiologic response to the need for opioid receptor activation.
Physical withdrawal is painful and difficult, and those with opioid addiction will do anything to avoid it. With careful management, a person can successfully overcome the physical withdrawal; however, the psychological withdrawal is often more difficult and requires continual emotional support. Programs such as Alcoholics Anonymous can help guide the person through a series of steps towards independence from opioids, drugs, and pain.
Pain clinics can be effective
Pain clinics are a newly developed specialty that allows patients suffering from chronic pain to work with a pain specialist for more effective management using a variety of modalities. It is estimated that at least 100 million Americans live with chronic pain. Pain clinics can offer help by focusing on procedures that deal with specific pain (eg, neck, lower back pain). They can also approach pain in an interdisciplinary way involving psychologists, physical therapists, nutritionists, and occupational and vocational therapists, in addition to physicians and nurses. They can suggest other modalities such as acupuncture, biofeedback, cognitive behavioral therapy, water therapy, massage, and meditation as options for chronic pain in lieu of opioids. Both patient education and prescriber need to include these alternative treatment strategies.
Recognition of opioid use within healthcare professionals has been addressed by the National Council of State Boards of Nursing. A free educational webinar for understanding substance use disorder and help in identifying signs of opioid use is available to nurses and managers. The webinar also outlines a system for helping professionals into therapy and recovery. It can be accessed here.
- Physical therapy
- Massage therapy
- Tapering opioids gradually over many months
- Nutrition therapy
How can you be an advocate to improve pain control without the use of opioids?