Stopping Prescription Opioids

Most people on chronic opioids are not addicted

Withdrawal does not mean you are addicted

• Recent research has shown that people that take opioids for more than 3-7 days are at high risk to remain on them for years. 

• The reason for this is opioids actually begin to increase pain and distress by a process called hyperalgesia, physical dependence, and dysphoria (uncomfortable mood). None of these indicate addiction. They are natural processes. 

• The hyperalgesia prolongs and worsens pain, even if the original source of pain has resolved. People think the opioids are helping because when they don't take them they have withdrawal. This sets up a vicious cycle that is difficult to break.

• There are few places for patients who want or need to stop opioids but are not addicted to receive care specific to them

• Most treat addiction and assume and diagnose all patients on opioids as having an addiction. Sometimes its ignorance. Other times their licenses are behavioral health and must diagnose addiction to be able to treat you or bill insurance.

• It is very unfair and keeps many people from getting the care they need

• I see many patients who are clearly not addicts and are able to stop opioids if they get help for their withdrawal

Opioids for Chronic Pain

Do they work?

• This is a very controversial subject

• There is no published evidence that chronic opioids work for chronic pain, but abundant evidence they can cause harm

• That doesn't necessarily mean they shouldn't be used

• I see and hear of many patients on opioids who do well on them

• This does not prove they work, it could be a placebo effect.

• Most (more than 90%) of patients I have withdrawn from opioids have much less pain and better function on them, but they were on high doses and getting very poor relief from them. 

• My opinion is that if the dose is within current guidelines and the person is doing well without side effects why not continue

• I do not believe in high dose opioids. Some doctors, encouraged by drug companies, said there is no upper limit. This never made sense to me, the body only has so many places opioids can work. Even oxygen has upper limits and is toxic and lethal in too high a dose.