What is a safer alternative to opioids? As concerns about addiction, overdose and overuse of opioids rise, many doctors are looking to alternatives to standard opioid therapy, especially for chronic pain. Many states now have laws prohibiting doctors from prescribing more than a seven-day supply of any opioid-containing medication at once for patients not being treated for chronic pain. Other states and providers use the MME system to limit amounts of opioids prescribed for chronic pain. MME stands for milligrams of morphine equivalent. Regulatory agencies use this formula to restrict the amount of any opioid that may be dispensed as expressed in total daily milligrams. For example, morphine always has a conversion factor of 1. Oxycodone’s MME conversion factor is 1.5. If a prescriber had an MME limit of 90, this would translate into a maximum oxycodone daily dosage of 60 milligrams, most likely taken as four of the 15mg tablets every four to six hours for that day. The amount of tablets dispensed for the month would depend on their strength. Hydrocodone’s MME in this case would be 90. Methadone’s would be 20 or 4 of the 5-milligram tablets, although many doctors not specialists in pain management hesitate or refuse to prescribe methadone at all. It’s a tricky, very powerful medication with an incomplete cross-tolerance profile and unpredictable effects. However, doctors experienced with it like to prescribe it because it’s a truly superior analgesic with a greatly reduced tendency to cause euphoria. In fact, it’s sometimes referred to as “heroin without the high.”
Problems with Opioids
Aside from the obvious short-term problems with opioids, such as addiction, overdose, sedation, mood changes and constipation, there are long-term effects, too. These may include reduced immune system function, edema, loss of libido, sexual dysfunction and weakened bones. Although some of the initial side effects of opioids tend to decrease with time, constipation typically does not. It may sound like a minor problem, but constipation induced by opioids can be severe and even life-threatening. The problem occurs because the body has opioid receptors in the stomach and digestive system as well as the brain. Opioids bind to these receptors in the gut and limit their function. Constipation results, and it’s typically not responsive to standard remedies.
Alternatives to Opioid Therapy
There are a number of non-drug therapies that may be effective for pain:
- Cognitive behavioral therapy (CBT)
Acupuncture may be particularly effective because it’s thought to work by inducing the body to release more of its own endorphins, which are pain-killing compounds produced by the brain. You cannot become addicted to your own endorphins. Acupressure and certain types of massage may also work in the same way. Exercise is also thought to cause the release of endorphins. Chiropractic may relieve pain by adjusting the positions of certain body parts. Yoga may work similarly. Aromatherapy using certain essential oils may relieve pain by activating certain parts of the brain directly through the nasal pathways. These methods won’t work for everyone or for all kinds of pain, but they’re worth a try. They are unlikely to cause any harm.
Ketamine, a dissociative anesthetic used for veterinary and human anesthesia for about the past 50 years, has a new application in the treatment of chronic pain and also depression. Ketamine is administered by infusion or by a nasal spray only under direct medical supervision. It’s not prescribed and taken at home. After the drug is given, the patient is observed in a medical setting for most of the day. Side effects are common and significant:
- Vividly terrifying dreams
- Screaming and crying
- Feelings of being disconnected from one’s body
- Possible bladder damage
- Paranoid behavior
Despite the side effects, many patients have reported that the drug has greatly reduced their pain and depression symptoms. Improvement typically is seen after a few days. Ketamine is thought to rewire the brain to relieve pain and depression.
Another powerful non-opioid group of pain relievers are the NSAIDs or non-steroidal anti-inflammatory drugs:
These medications work to reduce the inflammation often causing the pain. They do have side effects and are not suitable for everyone, but they are a non-addictive opioid alternative. Acetaminophen, brand name Tylenol, is not an NSAID. However, it may also be an effective opioid alternative in some cases.
For More Information
If you’re trying to find opioid treatment and would like more information, just call us anytime at 844-903-2111. Our professional counselors are trained to answer any kind of substance abuse question you may have. We’re here to offer hope and help. We look forward to helping you.