THE OPIOID CRISIS
Opioids have been a dark side of medicine for me. Being from Huntington, West Virginia, the overdose capitol of the country, I have lost multiple friends to narcotics. Many more of my acquaintances have had to attend rehab due to faulty and greedy doctors who inappropriately dispensed oxycontin like candy. I became one of the bad guys when I succombed to a system that said narcotics were the ultimate answer to chronic or acute pain. I wrote many a prescription for Vicodin, believing that they were the correct answer. Most of us would do better, if we knew better. Its hard for me to believe, however, that the pharmaceutical companies didn’t know how addictive and life threatening these drugs were. Unfortunately, medical doctors are influenced by pharmaceutical companies, both directly and indirectly through direct contact or studies and textbooks, respectively.
In the United States in 2016, overdoses accounted for 48,000 deaths. This number is on the rise. From 2010 to 2014, overdose deaths rose 23%. The midwest saw a jump of nearly 30% in overdoses over the summer. What happens to many people? Once their source of opioid is removed, many don’t just quit. They become heroin addicts, which is cheaper on the streets. This is exactly what happened in my hometown of Huntington.
ARE OPIOIDS BETTER FOR PAIN?
With the numbers becoming ever increasingly alarming, a new year long study was published in the Journal of American Medical Association (March 2018 https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true) shows that narcotics may not even be that effective. REALLY?
The study was a double blind, placebo controlled study and sought to answer this question: For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?
What they found was quite surprising and I think most doctors will find it disheartening. I know I did. The study sampled 234 VA patients who were randomly assigned to receive a narcotic vs a non narcotic for their low back, hip, or knee pain. It showed with statistical significance that opioids worked SLIGHTLY WORSE than nonopioids or over the counter pain relievers at relieving pain related to sleeping or walking! Opioids include drugs like Norco, Morphine, Fentanyl, Vicodin, or Oxycontin. Nonopioids are referring to medications like Ibuprofen, Tylenol, or muscle relaxers.
Patients reported changes in function or pain on questionnaires. Function scores improved in each group by about two points on an 11-point scale, where higher scores meant worse function. Both groups started out with average pain and function scores of about 5.5 points.
Pain intensity dropped about two points in the nonopioid group and slightly less in the opioid patients.
I’m really surprised by this study since we, as medical doctors, are taught that the most effacacious treatment for any sort of pain are narcotics or prescription pills. Considering their laundry list of unwanted consequences, which are listed below, I believe doctors most urgently move away from prescribing these DRUGS.
ALTERNATIVE SOLUTIONS FOR PAIN THAT WORK
So if you or a loved one suffers from chronic pain, this study may persuade you to look elsewhere for treating your pain. Here are some approaches I use which are widly successful, especially when combined, for reducing pain issues without horrendous or life threatening side effects.
- Medical Marijuana: A new study by the World Health Organization shows that CBD, or cannabinoid oil, shows no abuse potential. Meanwhile, opioids are a top killer. This plant has been unfairly criminalized and honestly I can’t sing its praises enough. It has helped me with children with seizures, people with insomnia or anxiety, and especially, chronic pain. Some patients do find that they need higher THC to help remove the pain, while others can use high CBD and low THC for adequate pain control. My hope is that in the near future, the government will be cracking down on pharmaceutical companies who promote unsafe drugs and less on natural plants that grow on the earth and can treat pain perfectly well when used responsibly.
- Herbs: Natural plant medicine works in different ways and can often be paired to work synergistically in the body. Herbs like frankinscence, pine bark, shiitake mushroom, resveratrol, alpha lipoic acid, curcumin or turmeric, and grape seed extract all work to decrease inflammation, which leads to chronic pain. HINT: I put all of these in my Inflammation Master and it helps wean people off of anti-inflammatories and even narcotics like Vicodin. Even a couple of these supplements along with lifestyle changes can make a big difference. Some of these compounds, like alpha lipoic acid or curcumin, you can find at integrative medical clinics in intravenous form. This is a big plus for those patients who have leaky gut or malabsorption problems leading to pain.
- Stem Cells: Stem cells are basically the pain treatment epitome. I inject them myself at Create Wellness in La Jolla, California http://createwellnesslajolla.com/our-team/ and follow along with the patients. Their recovery is nothing short of a miracle, but the science behind stem cells is there. Think of how a baby forms in the womb. Stem cells are the orchestrators of forming tissues and organs; they oversee the development. When injected from umbilical cord and amniotic waste products donated by screened women undergoing C-sections, stem cells differentiate into any cell in the body that is needed. They respond to beacons of inflammation and work over a 9 month period to heal the body where it needs it. There has never been one rejection! We have patients walking miles that could hardly get around the house previosuly. This is the ultimate pain relief treatment. The only downside is the cost. Running upwards of 7-10k, stem cells are not covered by insurance.
- Diet/Exercise: Diet always has the potential to create gut inflammation and later, brain inflammation. The two are intimately connected and leaky gut equals leaky brain. Moreover, if proteins cross the gut membrane into the bloodstream, the body will attack them, leading to possible autoimmune conditions if this continues chronically. Inflammation then increases which can trigger symptoms like pain in the joints. Cut all chemicals from the diet including breads, processed carbs, boxed or convenience foods, junk foods, fried or fast foods. Ensure that any meats that you are purchasing are organic and free of antibiotics and hormones. Eat a diet full of a variety of daily organic fruits and vegetables. Consciously avoid any pesticides and genetically modified ingredients.
- Emotional Wounds or Uncontrolled Stress: I speak a lot about adrenal fatigue, self care, and repressed emotions leading to physical wounds. Science is now showing that traumatic events can kick off stress responses that scar our immune systems. Nearly 8 out of 10 of my autoimmune patients have had a traumatic life event that set off the beginning of their symptoms. Repressed emotions can be stored deep in our bodies. Emotional pain is connected to physical pain. Addicts are usually addicted to a pill because of a traumatic event. Many use it to suppress even emotional pain. Our pain receptors are intimately connected to our mood, sleep hormones and immune systems. But the good news is that your mind and body can change when you do the hard, brave self work it takes to be honest about why you are hurt or what you have not dealt with. This can include counseling, therapy, journaling, closure, meditation, or forgiveness. Sometimes it means being accountable for ourselves. Everyone’s work is different and emotional detoxes are very real. This is some of the scariest, but most rewarding work that you can do for your overall health.
- Low Dose Naltrexone: This is one of the only prescriptions I consistenly write. It works on the concept that are opioid receptors are connected to neurotransmitters, mood, immunity and more. When given in very low doses at 4.5mg, it pulses doses the opioid receptors and can not only improve pain, but mood, immunity and sleep for many chronic pain, cancer, and autoimmune patients. I have seen it improve many patient’s pain. If only doctors knew!