Weighing the costs against the benefits of opioids
January 1, 2020
Editor's note: This story appears in the Senior Voice Health and Fitness section, Jan. 2020, however the text is incomplete, due to a layout error. We apologize for the error and here it is in its entirety.
Tylenol with codeine makes my occasional migraines bearable. I use them sparingly, always cognizant of the dangers of opioids. More than that, I am beyond grateful that I don’t have to endure the chronic pain that can be a real problem for our age group. Which is worse, the pain or the cure?
Opioids weren’t always reviled. The powerful class of painkillers was first discovered in1804, when German pharmacist Friedrich Serturner’s painstaking research isolated morphine as a sleep-inducing molecule found in tarry poppy seed juice. His discovery created an amazing new pharmacological tool in pain management.
Opioids make recovery bearable for surgery patients and normal life possible for the estimated 20% to 30% of Americans who suffer chronic pain. Opioids are “the cardinal feature of a diverse spectrum of diseases, including arthritis, migraine, cancer, metabolic disorders and neuropathies,” according to the National Institutes of Health. They include legal medications such as oxycodone, fentanyl, codeine and morphine.
The dark side of opioids is their side effects, over-prescription, and black-market versions, including heroin. Dr. Anna Lembke, medical director of Stanford Hospital’s Addiction Medicine department, calls it one of the worst drug epidemics in U.S. history. She urges attention to the role of Big Pharma, the medicalization of poverty, and the neuroscience of addiction.
The National Institutes of Health (NIH) calls out the side effects of opioids in arcane medical language. There are opioids’ analgesic tolerance (diminished pain-relieving effects), hyperalgesia (increased pain sensitivity), and drug dependence. Basically, you need more and more to provide the same effect against pain, but escalating the dosage puts patients at risk for dependence and other medical issues.
Paradoxically, many patients also develop an increased pain sensitivity using opioids, causing an excruciating cycle of pain. The Center for Disease Control and Prevention statistics show the devastating result: 2.1 million Americans suffer from opioid substance use disorder; 44 deaths per day are attributed to opioid overdose.
Drug overdoses are now the leading cause of death for Americans under age 50, with two-thirds of those caused by opioids, according to the CDC. The follow-on to drug addiction in the young population is drug-addicted newborns. Sara Murray, a West Virginia nurse who founded a facility for drug-addicted babies and mothers, says, “We have generational addiction. It was their mother’s normal. It was their grandmothers’ normal. And now, it’s their normal.”
Families who believe they have dodged this particular societal bullet are mistaken. Evidence has emerged from sources as diverse as the Federal Reserve and the CDC. The Feds report that opioid addiction, “may be shrinking the number of job applicants” by keeping otherwise able-bodied people out of the workforce. The CDC estimates opioid abuse costs the U.S. about $78 billion a year in medical expenses, lost productivity, and prison costs. Employers report significant problems finding applicants who don’t fail drug tests.
No easy answers
The core of any solution will need to recognize that, until there are better ways to deal with physical pain, opioids will keep their place in the medicine cabinet. The NIH recognizes chronic pain as a major disability and among the most common forms of chronic illness afflicting individuals younger than 60. Potential solutions also have to account for the breadth of reasons people come to this powerful drug class.
When you tally up the devastation of opioids, you have to add an asterisk for their indirect benefit to patients in need of organ donation. Nearly one in eleven organ donors is a drug overdose victim. Opioid overdoses were the fourth most common cause of death for donors of 16,000 hearts transplanted in a study by The Annals of Thoracic Surgery.
The study noted that, “hearts removed from overdose death donors (ODD), who often tend to be younger and healthier, provide ‘favorable heart donor quality’ and as-good-or-better outcomes than organs harvested from donors who died from other causes.”
My 20-year-old niece’s organs and tissue saved many lives, but these blessings seem small consolation for her life cut short by opioids.