In today’s episode, Matt talks about news of opioid painkillers and what the history of opioid prescription means for you and your body.
Hey everybody, it’s Matt Hsu from Upright Health and welcome to episode twenty seven of the Upright Health Podcast. Today’s topic: What’s new with painkillers.
March 22nd, there’s an article here on NPR.org, which I will link to. It is titled, “FDA requires strong new safety warnings for opioids”. So opioids, in case you have not heard that word, that’s the new generally accepted word for opiates, which was the word that has been used to talk about drugs that block pain, and are basically related to things like morphine. Things like opium, which I’m sure you’ve probably heard of in relationship to opium poppy fields, and heroin, and all that stuff.
So, opioids were a huge hit when they started coming to markets for people with pain. I actually was on a trip last year, in 2015. I was staying at a cool little hotel in Turkey that had a little book exchange place. They just had a bunch of books in this nice little outdoor seating area. I was going through all these books that other travelers had left behind and I found this paperback that was talking about the latest developments in medical science. The book was published some time in the eighties. I forgot the exact date, but it was talking about how science had developed ways to treat chronic pain that were extremely effective, had no risk of addiction, or very little risk of addiction, and that doctors could now use to help you with any kind of chronic pain. I thought, “Oh that’s interesting”. So this book is basically talking about the advent of opiates.
The funny thing, unfortunately, is that there are a lot of parallels between the story here with opiates, and a story with a lot of different treatments. I wanted to highlight that, and emphasize the importance of being skeptical, and being as conservative with your body as you can. This is something that I talk about in regards to hip pain, and to the whole hip surgery explosion, and the explosion in various kinds of surgeries on your joints. It’s something that’s really relevant in this story. In this story that’s on NPR.org, they’re reporting that that FDA is now saying, “We need to have new safety warnings for opioids.” Basically, in the United States we’re at an epidemic. People are abusing prescription opioids because they “feel good”, and they are habit forming. The thing is, these pills are prescribed. Pills like oxycodone and hydrocodone. I can’t find the rest of the list here. Well, this actually mentions oxycodone, hydrocodone and morphine. These are intended for use every four to six hours for serious acute pain. Ninety percent of all opioid prescriptions are for these fast acting, or immediate release formulations. So think about this, if you’re in chronic pain, and I’ve definitely had people like this come to see me. You’re in chronic pain, and you’ve got to find a way to function.
So you need something that’s going to help you get through the day. Your physician says, “Well, we have this medicine. It’s a new medicine, it’s very strong, it’s very effective at blocking pain, and it works on your body on a receptor level. It blocks your ability to feel the pain, and you’ll be fine. Also, there’s not going to be any long term side effects. That’s an easy decision for you, as a patient, right? The doctor said, “Well yeah, there’s no big side effects to be super concerned about, and this is going to get you through the day.”, then it makes sense for you as a patient, as long as you trust your doctor, to do what your doctor said.
Unfortunately, what appears to be happening at least in the last several decades (I’m not going to make any grand generalizations across centuries of time, but at least in the last several decades that I’ve looked at and seen, experienced and learned about.), there seems to be an overly optimistic view of new treatments in the medical world, and that overly optimistic attitude tends to have a backlash. And so when you have a physician who is overly optimistic about some new treatment and they reassure you that, “This is going to work. It’s all great”. You as the patient, should probably be doing a little research on your own, and thinking about whether or not what you’re being told is actually the truth, and whether or not there’s enough data available for your doctor to make the recommendation that they’re making. That’s super difficult and requires a whole lot of time and effort on your part. I think it’s extremely important to keep in mind because the problem is the backlash. Nobody but you, has to deal with the consequences of the decision to follow the advice of somebody else. If I give you advice and you follow it, the effect of that decision is still primarily felt, by you. In cases where your decision affects your body, the person with the most incentive to make sure it’s a good choice, is you. Not me, not your doctor, nobody else.
Now, unfortunately, the results of the over optimism around opioids has been this huge epidemic of addiction. There are plenty of problems with being addicted. Obviously, your ability to function, suffers, when you are on and even when you are off the drug. There’s mood disturbances, and in this article they actually talk about. If you take aniti-depressants with opioids and migraine medications, which is possible, it can cause a potentially life threatening, central nervous system condition known as Serotonin Syndrome, which occurs when the body is overloaded with the brain chemical serotonin. Opioids are also known to increase the risk for rare but serious disorder of the adrenal glands known as adrenal insufficiency, and decrease levels of sex hormones. So that’s, not really a fun one to deal with either.
Basically, what they have found is that, the use of opiates is not such a great thing to help you with chronic pain or even lighter pain. Which is something that many people have been trying to talk about for a while, and in fact, there’s a physicians group that started putting out some videos and information for other physicians that talks about the over prescription of opioids and opiates. They’ve produced some pretty fantastic videos. I’m going to actually provide a link for one of their videos that they put out in 2011. It basically traces for you the pattern of being overly optimistic of medical data being skewed, or maybe not the data, but the interpretation of data being heavily skewed, and then strong recommendations made based on those skewed interpretations. So they actually, in this video that I’m going to share, they actually interview and feature this physician who use to be on the other end of the opioid debate. He was a thought leader; he was somebody who would go and present to other physicians and explain to them that, “Hey, these super strong painkillers are actually quite safe, and the risk of addiction in your patients is only going to be about one percent. There’s very little down side here. If you have somebody who has pain and they needed something strong, “Well we have these medications and they are safe, they are all good. Go ahead and prescribe them.” This physician now actually says, “Well, if I had known then what I know now, I definitely would not have been saying those things”.
In the beginning when things are new and fresh and there’s so much potential, it seems like there’s this common pattern where recommendations are made based on a limited amount of information. And then down the line, the backlash hits. It’s really tragic for people who have had pain, when there are different ways to deal with pain. Exercise, for one. Massage, for another. Acupuncture, all these different things are available to help people with muscular skeletal issues, but they’re not yet recognized as something that’s going to help. They are sort of being recognized now, but we’re kind of on the cusp of recognizing that maybe pain is not something to try to get way from so much, but it’s something that we need to understand better, in the context of how the human body functions.
The way western medical scientist’s kind of dealt with pain is, as a disease. I think that’s in general, a misguided direction. Pain in itself is not a disease. Pain is actually a sensation that your body is suppose to produce when something is going on. If I wake up every morning and hit myself in the head with a hammer, I’m going to feel pain when I’m hitting myself in the head with a hammer, and probably some residual pain thereafter. It would be completely wrong to say that the pain is a disease that I need to block and get rid of in order to get through my day. Where the blind spot is I think in medicine is, generally there’s no way for a physician to know what you are doing. Only you know what you are doing to your body everyday. And then it’s up to you to try to determine what the significance is of what you’re doing with your body every single day.
Recently, we’re starting to understand sitting on your butt all day is not treating your body very well, and does seem to lead to discomfort. I’ve used this metaphor before, but if I tied a tourniquet around my arm and kept it there for four days straight, it wouldn’t be surprising if my arm didn’t feel good. Now, is that in any way significantly different than sitting on your butt and sitting there day in day out for twenty years, with essentially a tourniquet around your hamstrings, and your glutes. I would argue that there is no significant difference there, and for us to simply assume that obvious physical activity doesn’t affect the body physically, is completely illogical. Just because we do something a lot, doesn’t mean it’s not something we need to consider.
Just want to summarize again, and close this episode. When you’re dealing with something, anything that’s bugging you, it’s really important to realize that you are the one who has the ultimate responsibly for the outcome. There are some things like infectious diseases, that you definitely need help with. There are some things like gunshot wounds, and pucks to the face that bust your face open, or you fall and you break your arm. These are all things that are sort of discrete. They are things that definitely need somebody’s help and intervention to make progress with.
In cases where there’s a potential life habit issue, it is not reasonable to assume that somebody else is going to be able to give you something that’s going to fix it. If somebody is offering you something to fix a problem, you need to consider the long term implications of what’s being suggested. You need to think of this long term, both into the future, and long term into the past. What I mean by that; I think long term into the future is pretty clear. Long term into the past, you need to realize or analyze just how much information is available from the past that allows the person who’s recommending this idea to you, to make this recommendation with certainty. With opioids and different kinds of surgeries, you have to think about the very limited time scope that’s available with hips surgery. For example, for hip impingement and hip pain, labral tears and all that. The actual scope of data is very short. That timeline of data is extremely short, and it’s only now we’re hitting that point in time where now, there’s enough data to actually say, “Maybe the justification for this doesn’t make sense”. It’s already been recommended very strongly and optimistically for the last fifteen years.
So again, I encourage you to take some stock of what you’re being told and recognize that the responsibility is on you for your body. If you know somebody who is being told to use opioids or you yourself are on opioids, definitely check with some kind of… If you or somebody you know is trying to get off of opioids, I know that can be a tough process and you should probably seek a little help and guidance on that. If you know somebody who is considering opioids to block pain, there’s definitely information out there that they should read before that starts. One video is actually this video that I will share. It would be very good to see because it’s information from physicians explaining why everyone was so gung-ho about these medications, and why it’s not so good anymore. It’s really an unfortunate story but, at least illustrative and hopefully something that everyone can learn from.
So that’s it for today’s episode. If you have questions you can always get in touch via UprightHealth.com, under the “Contact Us” page. There’s a place you can submit questions. Hopefully you found this helpful and enlightening. And I hope you remember that pain sucks, life shouldn’t.