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Should you or shouldn’t you? A patient’s guide to painkillers

Posted at 3:45 PM, May 11, 2016
and last updated 2016-05-11 15:45:45-04

You’re in pain, and your doctor wants you to give you a heavy-duty drug like OxyContin or Vicodin or Percocet.

Should you take it?

On the one hand, you’re hurting. Really hurting.

But on the other hand, you’re afraid. You’ve heard how dangerous these prescription opioid drugs can be — that nearly 2 million Americans either abused or became dependent on them in 2014, according to the Centers for Disease Control and Prevention (PDF).

In that one year alone, more than 14,000 people died from overdoses involving prescription opioids, according to the CDC.

The should-I-take-it-or-shouldn’t-I is a choice many of us will have to make.

In 2013, U.S. doctors wrote nearly 207 million prescriptions for opioid painkillers, according to the National Institute of Drug Abuse, to treat everything from cancer and post-surgical pain to bone fractures and headaches.

Here are questions you should ask your doctor — and yourself — before saying yes or no to your doctor’s offer of a prescription for opioid painkillers.

Am I at a high risk for becoming addicted to these painkillers?

You’re more prone to becoming addicted to prescription painkillers if you or someone in your family has a history of substance abuse, and that includes legal and illegal drugs, alcohol and tobacco, according to Dr. Jane Ballantyne, professor of anesthesiology and pain medicine at the University of Washington and president of Physicians for Responsible Opioid Prescribing.

You’re also at a higher risk for addiction if you have a history of a psychiatric disease, including depression or anxiety, she added.

Will something else help my pain?

Experts generally agree that opioid painkillers are a good choice in certain situations, such as if you’re suffering from cancer pain or you’ve just had major surgery.

But on the other end of the spectrum, they say these drugs are bad choices for chronic pain, such as headaches or back pain.

First, chronic pain needs a long-term solution, and your chances of becoming dependent on opioids goes up the longer you take them.

“After 12 weeks, you will have severe withdrawal attacks if you stop taking these drugs,” said Dr. Gary Franklin, a research professor at the University of Washington and medical director of the Washington Department of Labor and Industries.

Second, he said, opioids aren’t very effective in these situations.

“There’s no evidence that these drugs actually help for these kinds of conditions, and it may actually make the pain even worse,” he said.

He said there are better alternatives to opioids, such as Advil and other nonsteroidal anti-inflammatories and other treatments such as physical therapy.

How long will I be taking these drugs?

Opioids can be effective shorter-term, but even then, you want to get a very clear definition from your doctor about how long he or she expects you to be on them.

Oftentimes, an opioid prescription will start when something sudden happens: someone throws their back out moving furniture, for example, or they injure themselves playing sports.

In these types of acute situations, the CDC recommends prescribing the drugs for just a matter of days.

“Three days or less will often be sufficient; more than seven days will rarely be needed,” the guidelines state.

But that’s not how many doctors prescribe these drugs.

“Many doctors are giving prescriptions for 15 to 30 days; that’s way more than what people need,” Franklin said.

Dr. W. Michael Hooten, a professor of anesthesiology in the division of pain medicine at the Mayo Clinic College of Medicine, said he doesn’t prescribe opioids at all in these types of acute situations, such as when people throw out their backs.

He cites a study showing that 27% of patients who were prescribed the drugs on a short-term basis ended up taking them for considerably longer.

“These people weren’t meant to be long-term users, but they ended up becoming long-term users,” he said. “And these aren’t bad people; they’re our neighbors. They’re people we know and like.”

Are you prescribing me the lowest possible dosage?

The CDC guidelines emphasize that doctors should “start low and go slow.”

What’s the plan to taper me off?

Hooten suggests you ask your doctor for his or her plan if you do become dependent on these drugs.

“Also ask if they know how to taper someone off of drugs,” he added.

The Veterans Administration has more information (PDF) about tapering off of opioid drugs.