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OPIOID CRISIS
like oxycodone or heroin if used concurrently. These medications
can also cause withdrawals from suddenly discontinuation, just like
other opioids, but this can be beneficial by encouraging continuation
of the maintenance therapy.
Opioid receptor antagonists like naltrexone have been used as
well, but with less encouraging results (19). These patients need
to be motivated to abstain from using opioids, as cessation of nal-
trexone will not precipitate withdrawals like with opioid agonist
therapy. This leads to poorer adherence to the treatment, and thus
higher rates of relapse.
Counseling and therapy groups are helpful treatment options as
well, with approaches such as motivational interviewing, cognitive
behavioral therapy in either an inpatient or outpatient setting being
shown to reduce relapse. Typically, these approaches work best in
conjunction with pharmacologic methods to enhance outcomes and
results (19).
Conclusions:
The opioid epidemic, while now recognized as a significant prob-
lem in the United States, continues to grow yearly. Though opioids
themselves can be useful for a variety of pain conditions in patients
with specific diagnoses, their use should be limited to those cases
where other options have been attempted unsuccessfully. Using ap-
propriate monitoring, such as urine drug screens and prescription
access databases, is highly recommended. Attempts should also be
made to use the lowest doses possible, and wean the patient when
treatment has failed or is no longer needed. Unfortunately, prescrip-
tion opioids are many normal people’s first foray into addictive sub-
stances, and many times, this occurs unintentionally after an injury
or surgery for which opioids were prescribed, perhaps for longer
than recommended with the newest guidelines. Without proper ed-
ucation and precautions, many of these people begin to misuse the
medications and eventually become addicted. Ultimately, physicians
should be the first line of defense by limiting their prescribing to
appropriate cases for the good of our patients and their families.
Dr. Brian Boies is an Assistant Professor in the Department
of Anesthesiology at the University of Texas Health Science Cen-
ter at San Antonio (UTHSCSA), and is board-certified in both
Pain Medicine and Anesthesiology.
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