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A Doctor’s Outlook: Opioids and Mindfulness

As a young doctor, I carried around my toolbox with pride.  Just as the crisp and tailored white lab coat I wore symbolized my knowledge and competency in the face of complex disease – my doctor’s box (a worn brown vintage bag slung over one shoulder) was a tangible representation of my ability to fix things on things on demand.

When I entered training as a psychiatrist, I developed skills that surpassed whatever you could once fit in my box.  The stethoscope was replaced by an attentive ear just as my scalpel morphed into a sharp and accurate interpretation of one’s neurotic conflict.

Doctors are Working in an Opioid Crisis

Doctors are laboriously working now alongside government and regulatory agencies to put something new in our toolbox to correct the opioid crisis. These medicines – coming in the form of codeine, heroin, methadone, oxycodone and the like – are commonly used for pain relief, cessation of cough, and relief from diarrhea.

In healthy and functioning people, these receptors are normally stimulated by endogenous opiates and are important for analgesia (or pain relief). They can also be troublesome, causing sedation and dependence.-Helen FarrellBut they also produce feelings of euphoria, tranquility, and sedation – these contribute to their desirability and misuse amongst even the most conscientious of people. Opioids are widely misused by the least suspecting patients and doctors alike.

Opioids are compounds that stimulate the opiate receptor (mu, kappa and delta). In healthy and functioning people, these receptors are normally stimulated by endogenous opiates and are important for analgesia (or pain relief).  They can also be troublesome, causing sedation and dependence.

Opioids also have an effect on the dopaminergic system, which mediates their addictive and rewarding properties.  This is what can drive the addictive process. Dependency does not discriminate amongst educational levels or socioeconomic classes.

Opiate intoxication has a lot of signs:

  • Drowsiness
  • Nausea/vomiting
  • Constipation
  • Slurred speech
  • Constricted pupils
  • Seizures
  • Trouble breathing

And while opiate withdrawal is not life threatening, it can be extremely uncomfortable. Signs and symptoms include:

  • Dysphoria/Depression
  • Insomnia
  • Tearfulness
  • Rhinorrhea
  • Yawning
  • Weakness
  • Sweating
  • Piloerection
  • Dilated pupils
  • Muscle aches

Misuse of Opiate Painkillers

The Centers for Disease Control and Prevention (CDC) reports that opioid abuse has reached epidemic proportions in the United States and accounted for 28,000 deaths in 2014.

And the problem with this is that misuse of opioids can be deadly. Just like all chronic conditions, the clinical course of addiction is one with periods of exacerbation and remission. Just like diabetes and asthma, the chronic illness never completely goes away.

Opioid abuse leads to early death from a myriad of causes:

  • Overdose
  • Accident
  • Trauma
  • Suicide
  • Infectious disease

And just like with chronic conditions – due to noncompliance and the remitting course of the illness, treatment of opioid addiction is a challenge.

This is a rampant problem and there needs to be a new solution to pain in our toolboxes, other than opioids, to treat chronic pain so that people won’t become hooked in the first place.-Helen Farrell

Searching for Solutions

The CDC offers a unique solution in the realm of non-pharmacologic interventions for pain management. And one that can go a long way in both reducing chronic pain and controlling the opioid epidemic – in other words, this might actually work!

One such strategy is Mindfulness-Based Stress Reduction (MBSR). Mindfulness focuses on relaxation, awareness of breath and physical sensations. The goal is to stay present in the moment while noticing breath and sensations, and letting them pass without judgment.

The studies thus far are limited, in terms of volume of those tested – but the results are promising.

To learn more about the recommendations from the CDC, check out their website which includes a link for patients and providers alike.

And for those who have become hooked – you’re not alone and there is hope. It is estimated that in the United States, about 4 million people have reported non-medial use of prescription pain relievers. Every year, there are appallingly about 17,000 deaths secondary to opioids.

And approximately 3 million persons in the United States have a current or past opioid-use disorder. These people are all subjected to ample health problems, disabilities and early death.

Behavioral modification can go a long way in reducing opioid dependency and drug-seeking behavior. Motivational interviewing is essential to promoting an impetus to change, adherence to a treatment program, reward incentives and education. In addition, supports such as Alcoholics Anonymous and Narcotics Anonymous (NA) are extremely valuable in terms of providing a support network and nonjudgmental community of peers.

This is a huge problem. But the good news is that doctors like to problem-solve and work with others toward common goals. It might mean reshuffling what’s in our toolbox and asking patients to get on board with trying novel techniques – but the rewards will be worth it!


Image Courtesy of iStock

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