Opioids and Bleeding Disorders

It is recognized in the bleeding disorders community that opioid聽medications can be a helpful addition to the treatment plan聽for patients experiencing refractory acute pain, as well as聽for those with long-standing chronic pain 聽resulting from joint聽disease. Opioids as a class of drugs are used for many types of聽pain. According to the Centers for Disease Control and Prevention聽in 2012, healthcare providers wrote 259 million prescriptions聽for opioids, a number that had actually leveled off聽after decades of escalation. This leveling off is likely due to聽increasing awareness of opioid abuse, underscored by the fact聽that each day 46 people die from an overdose of prescription聽painkillers in the US (CDC). Clearly, despite being a highly effective聽medication class, awareness of the potential for harm聽needs to be discussed.

Opioid medications work by attaching to opioid receptors in聽the brain, reducing the perception of pain. A subsequent effect聽is the release of dopamine, which is well known to be linked聽to feelings of pleasure. This connection is likely a major reason聽that opioids as a class have a high potential for abuse. To聽understand the nuances of opioid abuse, it is critical to understand聽the differences between tolerance, physical dependence,
and addiction.

Opioids have a distinct place in the treatment of patients with聽hemophilia who are experiencing severe acute pain or chronic聽pain and are unresponsive to non-steroidal anti-inflammatory聽drugs (NSAIDs). Because of the biochemical processes that聽take place when opioids are administered, varying degrees of聽tolerance and physical dependence can be expected over time聽with chronic exposure. Physicians, particularly pain experts,聽are well versed in navigating these effects safely with patients聽who require opioid therapy, however this requires that the patient聽and the prescribing physician develop a plan for appropriate聽opioid use that is closely followed. Certain patients are聽at a much higher risk of developing addiction and physicians聽should be aware of these risk factors. Patients displaying addictive聽tendencies should undergo a multidisciplinary evaluation聽with their primary hemophilia physician, a mental health聽expert, and an addiction specialist.


鈥 A need for a greater amount of a drug to maintain the聽therapeutic effect with the loss of efficacy over time.

Dependence (Physical)

鈥 Neurochemical changes in the body require continued聽use of the substance. Withdrawal syndrome occurs if聽the medication is discontinued, the dose is substantially聽decreased, or an antagonist is administered.

Addiction (Psychological Dependence)

鈥 A psychiatric disorder characterized by continued compulsive聽use of a substance despite harm to the patient.聽Effects from the use of the medication are desired and聽reinforce continued use.

Learn more by reading聽the Winter 2015 edition of聽Dateline: Federation. This edition includes perspectives of this issue by 5 different community members of the bleeding disorders community.

If you or a loved one need help, the聽Substance Abuse and Mental Health Administration’s (SAMHSA) National Helpline聽聽is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders.

Erika Mora is a Clinical Pharmacist Specialist聽practicing in inpatient hematology聽and oncology at the University of Michigan聽CS Mott Children鈥檚 Hospital in Ann聽Arbor, Michigan. Mora graduated with her聽PharmD degree from the University of聽Georgia and completed post-graduate聽residencies at Northeast Georgia Health System and Mayo聽Clinic. She has been in her current position for six years.

Sign up for E-mails, Dateline Magazine, and other ways to stay connected.