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High strength painkillers, known as opiates, represent the most widely prescribed class of medications in the United States. Typical examples include hydrocodone (Vicodin, Lortab, Norco, etc), oxycodone (Percocet, Tylox, Oxycontin, etc), fentanil (Fentanyl, Duragesic, Actiq, etc), morphine (MS Contin, Avinza, Oramorph), oxymorphone (Opana, Actavis, Impax), and methadone. Over the past decade, the number of prescriptions for the strongest opioids has increased nearly fourfold, with only limited evidence of their long term effectiveness or risks. Often prescribed for long term pain resulting from arthritis, back injuries, or other conditions; these medications can be highly habit forming and dangerous. Although much of the misuse is illegal, even prescribed use can lead to dependence and addiction.

Studies link narcotic painkillers to a variety of dangers, including drowsiness, nausea and vomiting, sleep apnea, sharply reduced hormone production, increased falls and hip fractures in the elderly, among others. The most extreme cases include fatal overdoses. In fact, overdosing of prescription pain killers during recreational use is now the leading cause of accidental death in the 25-40 year-old age group, a position previously held by traumatic injuries. In most instances, the source of the opiate is derived from a family member's or friend's prescription, taken either with or without that person's knowledge. Often times the abused opiate is crushed and then either snorted, smoked, or injected for an immediate "high".

"In 2010, an estimated 16,651 people died because of abuse and misuse of opioid drugs, which is an increase of more than 300 percent over the past decade. For each death, there is an additional 10 treatment admissions, 32 emergency department visits, and 825 nonmedical users of these drugs," according to Dr. Margaret Hamburg of the FDA. The agency is taking action "to combat the crisis of misuse, abuse, addiction, overdose, and death from these potent drugs that have harmed too many patients and devastated too many families and communities". The FDA is trying to find a balance between making these pain killers available for patients that really need them and reducing their abuse and misuse. New labeling has been instituted to make clear that addiction, abuse and misuse are possible even at recommended doses. Along with the risks of overdose and death, these drugs should only be used when other non-narcotic drugs have failed or aren't tolerated, or aren't strong enough to manage a patient's pain, the agency says.

Here at EmergeOrtho: Blue Ridge Region, we feel that high strength painkillers should be reserved for short term useless than 2 weeks, after surgery or after acute injuries, such as broken bones or torn ligaments. We do not advocate long term usage of these medications for typical musculoskeletal aches and pains or chronic conditions, which should be managed by exercise, activity modification, or other non-opiate pain relievers. Chronic use of opiates can lead to dependence and addiction- a compulsive use of a drug, adversely affecting the user's personal life or workplace. In addition, chronic opiate usage tends to make individuals more sensitive to pain, rather than less, adding further argument against chronic usage. In general, patients using chronic opiates have poorer outcomes following surgical procedures than those not using opiates beforehand.

In conclusion, it is best to limit the use of high strength pain relievers to short-term episodes of severe pain, when other less potent medications are not efficacious. Opioids should be taken only when absolutely necessary, with an effort made to discontinue these medications as soon as the pain improves or becomes manageable with less potent, non-opioid, medications. An effort to safeguard your prescriptions should be made in order to prevent diversion to family members or friends that may have access to your medicine cabinet. Despite best efforts, some individuals may require long term chronic pain medication for their condition. In these cases, a referral to a chronic pain management specialist or their family physician can be made, who will then determine medication appropriateness.