Sitting innocuously in many medicine cabinets, right alongside our serums and eye creams are opaque amber bottles of Percocet, Vicodin, or Demerol. Though the commonly prescribed drugs help to heal immediate acute pain caused by everything from oral surgery to broken bones, they’ve become some of the most addictive, and lately deadliest, medications around. The new opioid epidemic that’s developed into a public health crisis prompted the Centers for Disease Control and Prevention (CDC) to publish its first set of national standards advising doctors not to prescribe the addictive painkillers for long-lasting or chronic pain, to limit supplies for short-term use to three days, and to avoid writing scripts for longer than seven days.
The meds, originally derived from morphine (from opium poppies, to be exact), act on receptors in the central nervous system to quickly relieve pain. And they’re often the only thing that really works post-surgery, according to Dr. Marvin Seppala, M.D., chief medical officer at the Hazelden Betty Ford Foundation. “Surgical wounds heal better if you take care of pain,” he says. “If you don’t, you get tense, muscles don’t form back correctly, and you can’t heal.” After all, you’re not Leonardo DiCaprio on the American frontier. Still, the CDC announcement, combined with stark news accounts of everyday people becoming long-term addicts—and even overdosing—has us wondering when to risk popping the pills we’ve been prescribed, how to smartly manage meds, and when to avoid them or seek alternatives. Here, a guide to understanding short-term painkillers and how best to use them.
Consider the facts.
Dr. W. Clay Jackson, M.D., vice president of the board at the American Academy of Pain Management, says those suddenly facing acute postoperative pain or a new injury who are wondering about whether to take a few days’ worth of opioids for short-term recovery should know how this current crisis came about. He explains it’s the result of practices beginning in the mid-1990s, when doctors began using opioids for long-term, non-cancer–related chronic pain that lasts more than three months (rather than just for short-term acute pain). Now, he says, doctors realize that this practice has often backfired, leading to worsened conditions and sometimes even addiction. This triggered the new CDC rules that have led some states, including Massachusetts, to limit opioid prescriptions to a seven-day supply and allow patients to voluntarily reduce the amount of pills they receive from the pharmacy.
Create a plan.
If you find yourself in pain and clutching a script for three to seven days of opioids, you’ll first want to evaluate your ability to take them correctly. Seppala says most doctors leave you some leeway to decide how to take newly prescribed opioids based on your pain (the standard formula: take one to two every four to six hours). “But, if you’ve had previous addictions or a genetic link to addiction in the family, you’re at a higher risk than the general population,” he adds. In this case, Seppala recommends discussing your background with the prescribing doctor to agree on a structured plan that doesn’t allow you to make independent decisions to increase dosages. “Also, involve someone else in your life who will monitor the meds with you; you’re not thinking clearly when you’re in pain,” he adds.
When you take an opioid, it works. That’s one main reason the drugs have been so widely prescribed. But, Seppala says, everybody develops tolerance, and everybody will have withdrawal symptoms—that’s not addiction, that’s a physiological response. If you stop suddenly, you may experience upset stomach and vomiting, which is why tapering is your best bet. (Even if you do, however, sleep can become disrupted, and anxiety may set in.) Under the new guidelines, you’ll most likely be taking a short course of the meds before a doctor-supervised tapering; you can start tapering days after oral surgery, though orthopedic procedures like total knee replacements combined with aggressive post-op physical therapy can require a longer course of meds. Schedule a return visit to the doctor after a few days or a week (depending on your prescription length) to be sure everything is healing correctly, then find out if your community has a medicine take-back program and get rid of the extra pills.
Seek alternative therapies.
High doses of ibuprofen and aspirin can sometimes be effective, though Jackson warns that longer-term use can harm kidneys or damage gastrointestinal tracts. Dr. Wendye Robbins, M.D., clinical associate professor at Stanford University Medical Center’s Systems Neuroscience and Pain Laboratory, says though she’d studied their effects, she had never taken an opioid herself until she had foot surgery a few years ago. “I got OxyContin and felt nauseous. I was much happier with the local anesthetic nerve block I got during surgery,” she says. Jackson, Robbins, and Seppala favor holistic recovery plans that also incorporate physical therapy, meditation, and group counseling. Robbins adds, “You want to get patients back to a version of their former selves, without the drugs, as soon as possible.”
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