by Dr. Tim Urell, M.A., D.O., More MD LLC
Let’s talk for a minute about a common sense approach to the opiate crisis.
“Opiate” or “opioid” is a general term for all the derivatives of the opium poppy, natural or synthetic. Opiates are used for pain relief. In reality, there are only three types of pain relievers.
These are the aspirinlike drugs called NSAIDS, the morphinelike drugs called opiates, and the cocainelike drugs called local anesthetics. Of these, opiates are the most potent pain-relieving medications we have, by far. NSAIDs are far weaker, and the cocainelike drugs only make a relatively small area go numb.
Types of Opioids
The pain relieving effects of the sap of the opium poppy have been known for thousands of years and the active ingredients were scientifically identified starting in the 1850s and are pretty well understood by medical science.
There are a number of opioids these days, most of them synthetically produced in laboratories. Morphine, hydrocodone, oxycodone and fentanyl are all opioids. So is heroin, but that name is confusing. “Heroin” is actually an old brand name for diacetyl morphine or “diamorphine” — just another synthetic opiate.
Opiates work in the brain by causing the brain to stop paying so much attention to pain signals. It’s much like the difference between alcoholic beverages. The only significant differences between a glass of wine and a shot of Everclear is the concentration of the alcohol and the flavorings in each.
Opiates work great when given systemically, however, because they do not work on peripheral nerves but on the brain and spinal cord, they just make the brain quit caring about pain signals so much. Unfortunately, opiates also have other effects on the brain that lead to real problems. The worst one is that opiates slow down and eventually stop the brain’s mechanism that causes breathing. Take too much opiate and you pass out, quit breathing and die. This is the cause of almost all opiate overdose deaths.
The Addiction Factor
In some people, opiates can also cause a complex neurobehavioral pattern we call addiction. Alcohol and a number of other substances do this as well and so do activities like gambling and sex. Addiction is not unique to opiates, it is a problem caused by the “reward system” of the human nervous system.
It can also affect other animals and has been studied extensively, although it is still not understood well. But addiction is powerful and addicted animals and humans will often seek out the thing they are addicted to and use it compulsively until it kills them. Have you ever known anyone who drank themselves to death over many years? If so, you have seen addiction in action. It is terrible.
A Doctor’s Perspective
Therefore, modern doctors are in a difficult situation. We cannot identify who is at risk for addiction — a potentially lethal side effect of the only strong pain relievers we have to offer. Under these circumstances, the wisest path available to us is to be very stingy, indeed, when prescribing opiates. We are wise to use the smallest amounts of the least potent drugs we can get away with, and to use even those for the shortest time possible.
The dangers of opiate medications are real, however, even if addiction didn’t exist. As an informed patient, it is always your best choice to use these medications only if unavoidable and in the lowest possible doses for the shortest possible time.
If you have questions, consult your doctor. If you don’t have a doctor we are always happy to accept new patients at More MD. Call 928-216-3160 or find us at MoreMd.net.