Opioid prescribing drops for first time in 2 decades

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Opioid Prescribing Drops for First Time in Two Decades

INDIANAPOLIS, Ind. – There is a decline in the amount of opioid pain pills prescribed in about two decades. A study published by IMS Health points to more oversight and tougher enforcement as a couple of the contributing factors.

However, patients like Fern Decker, who legitimately need pain medication, are having a difficult time obtaining it.

SEE ALSO: Overdoses from legal drugs are exploding — and a new plan to curb the crisis reveals one big flaw in our approach

"I can't even walk a half a block and I can't even lift pots and pans," said Decker.

Decker describes her pain in vivid detail.

"It feels like you are getting stabbed in the back when I turn certain ways or walk," said Decker.

She recently had back surgery and was initially prescribed 15 milligrams of the opioid Oxycontin. Despite following her doctor's orders and not abusing her prescription, her dosage was cut to five milligrams. Decker is now in constant pain and has no way of reliving it.

"As my doctor put it, the pendulum has swung back," said Decker.

That pendulum shows a shift in opioid prescribing.

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Opioid prescribing drops for first time in 2 decades

Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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"We still have a problem of people starting off with prescriptions and ending up on heroin," said addictions counselor Scott Watson with Heartland Intervention.

Watson says the decrease can be credited to tighter prescribing guidelines introduced in 2014 and countless examples of doctors behaving badly, like William Hedrick, a former central Indiana pain doctor linked to several overdose deaths of his patients.

"There is a small population that is not able to get the pain medication they want and need," said Watson.

Watson is talking about people like Decker. Doctors have grown so afraid of law enforcement that they are hesitant to prescribe opioids. Even those who are in desperate need of pain pills are being overlooked.

"The government has got to lighten up for people like me that really need the pain medication," said Decker.

While opioid prescribing has declined, the same study shows that overdose deaths have not declined.

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