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The Opioid Paradox

These pain pills can provide relief, but for some people, they bring other kinds of problems.

Timothy Gower

If you have ever been in severe, nonstop pain, there’s a good chance you’ve taken an opioid for relief. Maybe a doctor gave you a prescription for these potent pain killers after you underwent surgery or had a tooth pulled. Or perhaps it was to ease intolerable chronic pain that just wouldn’t go away. These drugs are very good at stifling acute pain, and for some people they are an important part of arthritis management. But for many others, opioids can become a kind of trap: a potentially dangerous drug that wreaks havoc on daily life, but that can’t be stopped easily.

Maybe you have been taking an opioid for pain, and you’d like to get off it. Maybe you’ve even tried. You’re not alone. Stopping or tapering these powerful medications isn’t easy and there’s no clear path to success, but it can be done. Here are the stories of several people who gave up opioids, why it was important for them and what it took.

A TRADEOFF

Batya Blimes Lemier had used opioids to relieve her aching back and neck for over two decades. She has ankylosing spondylitis, a form of inflammatory arthritis, and initially the medications allowed her to maintain a busy schedule as the co-owner of a helicopter service. “I couldn’t get on a plane or go to my next meeting unless I took an opioid,” says Batya, 59, of Scottsdale, Arizona.

But chronic use of prescription opioids has many potential downsides. “They change your body, and they change your spirit,” says Batya, who used a variety of opioids, including morphine and fentanyl skin patches. For starters, the medications gave her gastrointestinal problems, a common side effect. But the drugs also frequently left her feeling dull-witted and less outgoing than she always had been. She believes that opioids clouded her judgment, too.

“Opioids work for pain,” she says, “but I didn’t like what I was giving up.”

In 2016, Batya decided that she was done with the drugs once and for all. She previously had attempted to taper off them several times, but the results were always the same: She developed withdrawal symptoms, such as loss of appetite, nausea, diarrhea and insomnia, and inevitably ended up in a hospital emergency room – only to be discharged with a prescription for more opioids.

She finally quit taking opioids by working closely with specialists at an integrative medicine center at the Mayo Clinic in Scottsdale, where she learned to use meditation, breathing exercises and biofeedback to manage pain in addition to the biologic drug she uses to control her ankylosing spondylitis. Some days her pain levels rise enough to keep her from social commitments or doing volunteer work for the Spondylitis Association of America and other groups. “But my baseline attitude, happiness and spirit is at 100 percent,” she says. “That’s what I got back.”

WIDELY USED FOR ARTHRITIS

Many people, like Batya, find that opioids work for arthritis pain. About 15 percent of people with osteoarthritis (OA) severe enough to require joint replacement use them every day, according to a study presented at the American College of Rheumatology’s annual meeting in 2017. And 40 percent of rheumatoid arthritis (RA) patients in a typical rheumatology practice in the United States use opioids regularly, according to a 2017 study published in Arthritis & Rheumatology.

But also like Batya, many have trouble with side effects, which some users find intolerable, and try to quit opioids. And recently, some people who take these drugs to control arthritis pain are being urged – or even forced – to give them up by doctors concerned about the epidemic of opioid abuse in the United States. Roughly 115 Americans die of an opioid overdose every day, and 40 percent of those deaths involve prescription medications, according to the Centers for Disease Control and Prevention, which has encouraged physicians to limit use of the drugs. Insurers and pharmacies are placing restrictions on access to opioids, too.

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March/April 2019

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