Michael Frost, MD, FACP, FASAM
The opioid epidemic has now reached levels that only a few years ago were unimaginable. With nearly 2.5 million Americans suffering from opioid use disorder1 (OUD) and more people dying from overdose than from motor vehicle accidents according to the Centers for Disease Control and Prevention (CDC)2, the urgent need for awareness and dialogue around the problem has never been greater. The risk of addiction and fatal overdose associated with opioids is increasingly better understood by the medical community and the general public alike. What remains most often misunderstood is the role that opioid withdrawal plays in the opioid epidemic. Frequently overlooked, opioid withdrawal can present a significant challenge not only for those suffering from OUD but also for the millions who are prescribed opioid medications for the treatment of chronic pain.
Opioid withdrawal is a recognized medical condition that can develop when opioids of any kind are stopped abruptly. This occurs not just in situations where drugs are abused but more often is seen when opioid pain medications are taken as prescribed for long periods and then discontinued. Withdrawal results in significant physical discomfort and although rare, can be fatal. The management of withdrawal alone is not considered sufficient treatment for OUD; however, fear and avoidance of withdrawal represent a major reason why many individuals suffering with OUD delay seeking treatment for their addiction. Stressing the need for an array of effective treatment options, inadequately managed opioid withdrawal is often stated as a reason for individuals to return to misuse or leave treatment facilities before completing a program.
In those who take prescribed opioids for pain, withdrawal as a result of an interruption or cessation of their medication can be an unexpected source of physical and mental distress. Nearly 1 in 5 people diagnosed with non-cancer pain are prescribed opioids with primary care providers accounting for almost half of the opioid prescribing3. There is however, a considerable gap between the comfort that healthcare providers have in prescribing opioids and their comfort and ability to identify and appropriately treat opioid withdrawal. Few providers are educated on the risks of opioid withdrawal and even fewer are trained to properly address it. While several effective treatments are currently available, these are often restricted to use by specially trained providers and can be limited in the clinical settings where they may be offered. In some cases, this lack of access to treatment leaves individuals with pain and anxiety and for some, the compulsion to seek out relief in the form of illicit opioids.
In order to adequately address opioid withdrawal and the role it plays in the complex landscape of the opioid epidemic, efforts must be made to raise awareness about withdrawal as a driver of prolonged opioid use in the arenas of both substance use and chronic pain. Provider education on the risks, identification and treatment of opioid withdrawal is vital, as is the continued development of more and newer treatments. These and other initiatives could play an important part in addressing the overall opioid crisis.
To learn more about opioid withdrawal, please visit OpioidWithdrawalSyndrome.com.
Michael P. Frost, M.D., FACP, FASAM, an addiction specialist at Frost Medical Group, is affiliated with US WorldMeds, LLC.
1 NIDA. “Effective Treatments for Opioid Addiction.” National Institute on Drug Abuse, 1 Nov. 2016, https://www.drugabuse.gov/effective-treatments-opioid-addiction-0. Accessed 21 Mar. 2018.
2 Ahmad FB, Bastian B. Quarterly provisional estimates for selected indicators of mortality, 2016-Quarter 2, 2017. National Vital Statistics System, Vital Statistics Rapid Release Program. 2017. National Center for Health Statistics.
3 Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010. Medical Care 2013; 51(10): 870-878. http://dx.doi.org/10.1097/MLR.0b013e3182a95d86