One of the hardest things to put into perspective as a healthcare provider is why a patient
should choose conservative care BEFORE moving onto drug based forms of care. It’s a
hard topic to tackle, especially in the United States where nearly the entirety of our
healthcare system is built on opioids. For one, it can be very tempting for patients to want
to believe that if they take this special pill then all of their pain will go away. Additionally,
people are very busy and often intimidated by the idea that they need to be putting in
some of the work to get better.
BUT, hard as this issue is to tackle, tackling it is SUPER important. There are a lot of
reasons why we need to be approaching our health from the conservative angle first. And
it begins with understanding what opioid care is, how it works and WHY it has become the
primary approach to healthcare in our country.
What is an opioid?
According to the National Institute of Drug Abuse: “Opioids are a class of drugs that
include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers
available legally by prescription, such as oxycodone (OxyContin®), hydrocodone
(Vicodin®), codeine, morphine, and many others.”
How do opioids work?
Inside our bodies we have what are called nociceptors. These are specialized nerves that
detect and communicate pain to the brain. When a “noxious (pain causing) stimuli” bonds
to a nociceptor, a signal is then sent to the brain to let you know that you are in pain. The
body does this so that you stop doing whatever is causing your pain so that the body isn’t
damaged. In this way, pain is good.
When you take an opioid, the opioid bonds to the same part of the nociceptor as a noxious
stimuli. Unlike noxious stimuli, when an opioid bonds to a nociceptor it doesn’t cause a
pain signal to be sent. Instead, the opioid blocks the area so that noxious stimuli can't bond to it. It's effectively a placeholder. The result is that no pain signal is sent to the brain. This is the pain relief that patients experience when taking opioids.
The problem is this: the thing causing the pain hasn’t stopped. All that’s stopped is the
patient's ability to feel the pain because the nociceptors aren’t sending pain signals. A lack of pain means that we don’t know that we need to stop doing what we’re doing. As a result we may end up doing something that ultimately causes damage to our body. Remember, pain is designed to stop us from causing damage by telling us to stop.
In a nutshell this is the tradeoff with opioid care. On one hand, yes it diminishes our pain.
But on the other hand, it diminishes our pain! It’s also important to note that opioids, like
all drugs, are substances that our body develops a tolerance to. This means that a given
opioid prescription that helps today, may not be nearly enough tomorrow. Also, and this is
maybe the most important part, opioids are ADDICTIVE! Which brings us to…
THE OPIOID CRISIS!
Since the 1990’s the United States has prescribed opioids for pain management at a
terrifyingly high rate. This has led to a dramatic increase in drug addiction and death by
overdose in the decades since the opioid crisis began.
Let’s look at the research!
● Despite the United States making up only 4.6% of the world’s population,
Americans consume 80% of all opioids produced world wide.