By Dr. Mercola
Opioids kill patients more frequently than any other medication used for nonfatal conditions,1 yet disturbing statistics reveal more than one-third of American adults were prescribed these dangerous drugs in 2015.2 Even more shocking, opioid overdoses are now the leading cause of death for Americans under the age of 50.3
More than half of all opioid prescriptions in the U.S. are also issued to patients suffering from anxiety and depression,4 despite the fact that this increases their risk for addiction. Overall, studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain.5
While back pain is one of the most common reasons for receiving a prescription for a narcotic pain reliever,6 a surprising number of people — especially teens and young adults — receive these potent drugs from their dentist. Women are also increasingly being prescribed opioids during pregnancy and after delivery,7 creating addicts in the womb and destroying families by creating drug-dependent mothers and infants.
Of the 1.1 million pregnant women enrolled in Medicaid in 2007, nearly one-quarter of them filled a prescription for an opioid drug.8 Not surprisingly, statistics9 reveal a disconcerting rise in neonatal abstinence syndrome (NAS). Between 2000 and 2009, the prevalence of NAS increased from 1.2 to nearly 3.4 per 1,000 live births.
1 in 3 American Adults Prescribed Opioids Every Year!
According to Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse in Bethesda, Maryland, 38 percent of adults (about 92 million people) in the U.S. were prescribed an opioid drug in 2015.10,11,12,13 Women, people over the age of 49 and those without college degrees were most likely to receive a prescription, and the unemployed, uninsured and adults with an annual family income below $50,000 had the highest prevalence of opioid misuse and addiction.
An estimated 5 percent of adults (11.5 million people) misused the drugs, and nearly 1 percent (some 1.9 million people) reported addiction. Interestingly, while women are prescribed opioids more frequently than men, men have a higher rate of misuse — 13 percent compared to 9 percent respectively. Of those misusing the drug:
- 41 percent reported getting leftover medication from family or friends14,15
- 64 percent said their use of the drug was motivated by need for physical pain relief
- 11 percent said they took the pills to relax or get high
According to Compton:16
"Overall, the results indicate that the medical profession is doing a poor job of appropriately prescribing opioid painkillers. Even though the rates have leveled off, we have a long way to go in improving medical care so these are not as overprescribed as they are currently … [T]here are a lot of leftover medications. In many cases, physicians could write smaller prescriptions, or avoid them completely for those who benefit from ibuprofen or acetaminophen."
Nearly 70,000 Physicians Were PAID to Prescribe Opioids
A recent paper17 hints at one of the reasons why opioids are still so vastly overprescribed. Between 2013 and 2015 alone, 68,177 physicians received in excess of $46 million in payments from drug companies marketing narcotic pain relievers.18 In all, that amounts to 1 out of every 12 doctors in the U.S. As noted by pediatrician Scott Hadland, who led the study, "The next step is to understand these links between payments and prescribing practices and overdose deaths."
Conventional Pain Management Needs Radical Overhaul
Dr. Karen Lasser, associate professor of medicine and public health at the Boston University School of Medicine's Clinical Addiction Research & Education (CARE) Unit, told CBS News pain management needs significant revision:19
"Doctors need to adopt a stepped-care approach to pain management. With this approach, doctors would first try to manage pain using nondrug means — such as physical therapy, yoga or acupuncture — or prescribe milder pain medications, including aspirin, ibuprofen or acetaminophen.
There would be guidelines for all the medications you should try before you get to opioids. In addition, patients should have to sign an opioid treatment agreement outlining the risks and benefits of such therapy, so they understand the potential for addiction."
Oral Surgeons and Dentists Are Major Opioid Prescribers
Oral surgeons and dentists, in particular, need to reconsider their prescribing habits. Each year, about 3 million Americans, most under the age of 25, have their wisdom teeth removed, and most if not all receive a prescription for opioids. This, despite research20,21 showing a combination of ibuprofen and acetaminophen actually works better than opioids for the treatment of pain following wisdom tooth extractions.
As noted by The New York Times,22 "dentists and oral surgeons are by far the major prescribers of opioids for people ages 10 to 19," and even short-term use is associated with future opioid misuse and addiction among teens and young adults.
In fact, children who receive an opioid have a 1 in 3 chance of "lifetime illicit use." According to recent research,23 of the people who received a mere 12-day supply of an opioid, 1 in 4 were still taking the drug one year later, and that includes all age groups. Children and teens are at higher risk for continued use once they're exposed.24
Overdose Deaths Continue to Climb
While you certainly hear more about the dangers of opioids these days, growing awareness has yet to impact death statistics. According to the latest data from the National Center for Health Statistics, more Americans died from opioid overdoses in the first nine months of 2016 than in the first nine months of 2015. When broken down into quarters, you can see the death toll from drug overdoses steadily climbing, quarter by quarter.25
|✓ First quarter of 2015: 16.3 overdose deaths for every 100,000 people|
|✓ Second quarter of 2015: 16.2 overdose deaths per 100,000|
|✓ Third quarter of 2015: 16.7 overdose deaths per 100,000|
|✓ First quarter of 2016: 18.9 overdose deaths per 100,000|
|✓ Second quarter of 2016: 19.3 overdose deaths per 100,000|
|✓ Third quarter of 2016: 19.9 drug overdose deaths per 100,000|
Other recent research drives home the severity of the problem, showing opioid deaths have been significantly underestimated. According to this report,26 published in the American Journal of Preventive Medicine, mortality statistics involving drug overdoses from 2008 through 2014 underestimated opioid-related deaths by 24 percent. Overdose deaths involving heroin was underestimated by 22 percent.
Spike in Fatal Car Crashes Linked to Opioid Use
Overdose deaths are not the only problem associated with skyrocketing opioid use. It's also causing people to die on our roadways. Statistics reveal driving under the influence of drugs now causes more fatal car crashes than drunken driving.
According to a report27,28,29 compiled by the Governors Highway Safety Association and the Foundation for Advancing Alcohol Responsibility, prescription and/or illegal drugs were involved in 43 percent of fatal car crashes in 2015, while 37 percent involved illegal amounts of alcohol.
Another recent report30 found drivers killed in car crashes while under the influence of opioids specifically rose seven-fold between 1995 and 2015. Among male drivers killed, the prevalence of prescription narcotics in their system increased from 1 percent in 1995 to 5 percent in 2015. Among women, narcotic pain relievers were implicated in 1 percent in 1995 and 7 percent in 2015.
According to lead author Stanford Chihuri, staff associate in the department of anesthesiology at the College of Physicians and Surgeons at Columbia University Medical Center in New York, "The significant increase in proportion of drivers who test positive for prescription pain medications is an urgent public health concern.31 "
Co-author Dr. Guohua Li, professor of epidemiology at Columbia's Mailman School of Public Health, added,32 "The opioid epidemic has been defined primarily by the counts of overdose fatalities. Our study suggests that increases in opioid consumption may carry adverse health consequences far beyond overdose morbidity and mortality."
Avoid Driving Under the Influence of Narcotics
It's important to realize that illegal drugs are far from the only drugs capable of impairing your judgment behind the wheel. Hundreds of medications can impair your driving ability, including some sold over-the-counter. Opioids are certainly part of that list. Drugs — both prescription and illegal — in combination with alcohol is particularly risky.
So, please, if you absolutely must take a prescription painkiller, carefully assess your ability to drive safely. Ideally, let someone else drive. And, if you know someone who is using an opioid, remember that just as with alcohol, "friends don't let friends drive impaired."
President Trump Declares State of Emergency
In related news, a government opioid commission recently called for President Trump to declare a state of emergency to force Congress to fund strategies to curtail and treat opioid addiction.33,34,35
The commission is chaired by New Jersey Gov. Chris Christie. Other members include Charlie Baker, governor of Massachusetts, North Carolina Gov. Roy Cooper, former U.S. Rep. Patrick Kennedy and Bertha Madra, a psychobiology professor at Harvard Medical School. In their White House report, the commission states:36
"According to the Centers for Disease Control (CDC) … 142 Americans die every day from a drug overdose … The opioid epidemic we are facing is unparalleled. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined. In fact, between 1999 and 2015, more than 560,000 people in this country died due to drug overdoses — this is a death toll larger than the entire population of Atlanta …
In 2015, nearly two-thirds of drug overdoses were linked to opioids like Percocet, OxyContin, heroin, and fentanyl … [H]ere is the grim reality: Americans consume more opioids than any other country in the world. In fact, in 2015, the amount of opioids prescribed in the U.S. was enough for every American to be medicated around the clock for three weeks.
Since 1999, the number of opioid overdoses in America have quadrupled … Not coincidentally, in that same period, the amount of prescription opioids … quadrupled as well. This massive increase in prescribing has occurred despite the fact that there has not been an overall change in the amount of pain Americans have reported in that time period.
We have an enormous problem that is often not beginning on street corners; it is starting in doctor's offices and hospitals in every state in our nation."
President Trump declared the opioid epidemic a national emergency on August 10, saying, "The opioid crisis is an emergency … It is a serious problem, the likes of which we have never had … We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis."37
Pain and Hopelessness Fuel Opioid Crisis
According to recent research, half of all Americans are living with chronic illness,38 and many addiction specialists believe pain and hopelessness are driving the opioid crisis in the U.S. As noted in The Washington Post:39
"Fatal overdoses from prescription opioids have quadrupled since 1999 and heroin overdoses have gone up about six-fold since 2001. But other drugs also play a role. A Post analysis of federal health data found that white women are five times as likely as white men, for example, to be prescribed drugs for anxiety in tandem with painkillers, a potentially deadly combination.
Meanwhile, the suicide rate among middle-aged white women has risen in parallel with prescriptions for often-ineffective psychiatric drugs. Both have roughly doubled since 1999 … According to federal health officials, nearly 1 in 4 white women ages 50 to 64 are [sic] being treated with antidepressants. Binge drinking is also on the rise, as women close the gap with heavier-drinking white males."
Limiting the availability of opioids and making overdose-reversal drugs (naloxone) and treatment for drug addiction more readily available are certainly part of the answer. But it's not enough. We have to take a much deeper look at the root of the problem. What is causing all this physical and emotional pain in the first place?
Clearly, the U.S. health care system is blatantly ineffective at treating chronic health problems. Whether ill health is promoting hopelessness or the other way around is difficult to ascertain, but the two appear to be closely intertwined and need to be addressed together. Somehow or another, we need to refocus our efforts to create lives worth living, and improve access to and information about basic disease prevention, such as healthy foods and foundational health-promoting lifestyle strategies.
Nondrug Solutions for Pain Relief
It's important to realize that in addition to the risk of addiction, opioids can also severely impair your health by suppressing your immune function. In fact, several studies show that one primary risk for HIV and AIDS is opiate exposure.40,41,42,43 In cancer patients, opiates have a tendency to produce a rapid decline in health as the drug causes their immune system to falter.
So please remember, opiates are highly immunosuppressive drugs that raise your risk of any number of diseases, as your immune system is your frontline defense against all disease. It's particularly important to avoid opioids when trying to address long-term chronic pain, as your body will create a tolerance to the drug.
Over time, you may require greater doses at more frequent intervals to achieve the same pain relief. This is a recipe for disaster and could have lethal consequences. Following is information about nondrug remedies, dietary changes and bodywork interventions that can help you manage your pain.
✓ Eliminate or radically reduce most grains and sugars from your diet
Avoiding grains and sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses.
✓ Take a high-quality, animal-based omega-3 fat
Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, by manipulating prostaglandins.) Good sources include wild caught Alaskan salmon, sardines and anchovies, which are all high in healthy omega-3s while being low in contaminants such as mercury. As for supplements, my favorite is krill oil, as it has a number of benefits superior to fish oil.
✓ Optimize your sun exposure and production of vitamin D
Optimize your vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain. Sun exposure also has anti-inflammatory and pain relieving effects that are unrelated to vitamin D production, and these benefits cannot be obtained from a vitamin D supplement.
✓ Medical cannabis
Medical marijuana has a long history as a natural analgesic and is now legal in 29 U.S. states. You can learn more about the laws in your state on medicalmarijuana.procon.org.44
Kratom (Mitragyna speciose) is another plant remedy that has become a popular opioid substitute.45 In August, the U.S. Drug Enforcement Administration issued a notice saying it was planning to ban kratom and list it as a Schedule 1 controlled substance. However, following massive outrage from kratom users who say opioids are their only alternative, the agency reversed its decision.46
Kratom is likely safer than an opioid for someone in serious and chronic pain. However, it's important to recognize that it is a psychoactive substance and should not be used carelessly. There's very little research showing how to use it safely and effectively, and it may have a very different effect from one person to the next.
Also, while it may be useful for weaning people off opioids, kratom is in itself addictive. So, while it appears to be a far safer alternative to opioids, it's still a powerful and potentially addictive substance. So please, do your own research before trying it.
✓ Emotional Freedom Techniques (EFT)
EFT is a drug-free approach for pain management of all kinds. EFT borrows from the principles of acupuncture in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, and negative emotions that may be exacerbating your physical pain. By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain.
✓ K-Laser, class 4 laser therapy
If you suffer pain from an injury, arthritis or other inflammation-based pain, I'd strongly encourage you to try K-Laser therapy. It can be an excellent choice for many painful conditions, including acute injuries. By addressing the underlying cause of the pain, you will no longer need to rely on painkillers.
K-Laser is a class 4 infrared laser therapy treatment that helps reduce pain, reduce inflammation and enhance tissue healing — both in hard and soft tissues, including muscles, ligaments or even bones. The infrared wavelengths used in the K-Laser allow for targeting specific areas of your body and can penetrate deeply into the body to reach areas such as your spine and hip.
Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain such as low back pain.
Qualified chiropractic, osteopathic and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate health care training, which lasts between four to six years. These health experts have comprehensive training in musculoskeletal management.
Research has discovered a "clear and robust" effect of acupuncture in the treatment of back, neck and shoulder pain, and osteoarthritis and headaches.
✓ Physical therapy
Physical therapy has been shown to be as good as surgery for painful conditions such as torn cartilage and arthritis.
✓ Foundation training
Foundation training is an innovative method developed by Dr. Eric Goodman to treat his own chronic low back pain. It's an excellent alternative to painkillers and surgery, as it actually addresses the cause of the problem.
A systematic review and meta-analysis published in the journal Pain Medicine included 60 high-quality and seven low-quality studies that looked into the use of massage for various types of pain, including muscle and bone pain, headaches, deep internal pain, fibromyalgia pain and spinal cord pain.47
The review revealed massage therapy relieves pain better than getting no treatment at all. When compared to other pain treatments like acupuncture and physical therapy, massage therapy still proved beneficial and had few side effects. In addition to relieving pain, massage therapy also improved anxiety and health-related quality of life.
✓ Mind-body methods
Methods such as hot and cold packs, aquatic therapy, yoga, cognitive behavioral therapy48 and various mind-body techniques, including meditation and mindfulness training can also result in astonishing pain relief without drugs.
For example, among volunteers who had never meditated before, those who attended four 20-minute classes to learn a meditation technique called focused attention (a form of mindfulness meditation) experienced significant pain relief — a 40 percent reduction in pain intensity and a 57 percent reduction in pain unpleasantness.49
Walking barefoot on the earth may also provide a certain measure of pain relief by combating inflammation.
Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and you may need 8 milligrams (mg) or more per day to achieve this benefit.
This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. A past study also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.50
Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients.
This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful.
✓ Cetyl myristoleate (CMO)
This oil, found in fish and dairy butter, acts as a joint lubricant and anti-inflammatory. I have used this for myself to relieve ganglion cysts and carpal tunnel syndrome. I used a topical preparation for this.
✓ Evening primrose, black currant and borage oils
These contain the essential fatty acid gamma-linolenic acid (GLA), which is particularly useful for treating arthritic pain.
✓ Cayenne cream
Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
✓ Low-dose naltrexone (LDN)
Naltrexone is an opiate antagonist, originally developed in the early 1960s for the treatment of opioid addiction. When taken at very low doses (LDN, available only by prescription), it triggers endorphin production, which can boost your immune function and ease pain.