It is recognized in the bleeding disorders community that opioidÂ medications can be a helpful addition to the treatment planÂ for patients experiencing refractory acute pain, as well asÂ for those with long-standing chronic pain Â resulting from jointÂ disease. Opioids as a class of drugs are used for many types ofÂ pain. According to the Centers for Disease Control and PreventionÂ in 2012, healthcare providers wrote 259 million prescriptionsÂ for opioids, a number that had actually leveled offÂ after decades of escalation. This leveling off is likely due toÂ increasing awareness of opioid abuse, underscored by the factÂ that each day 46 people die from an overdose of prescriptionÂ painkillers in the US (CDC). Clearly, despite being a highly effectiveÂ medication class, awareness of the potential for harmÂ needs to be discussed.
Opioid medications work by attaching to opioid receptors inÂ the brain, reducing the perception of pain. A subsequent effectÂ is the release of dopamine, which is well known to be linkedÂ to feelings of pleasure. This connection is likely a major reasonÂ that opioids as a class have a high potential for abuse. ToÂ understand the nuances of opioid abuse, it is critical to understandÂ the differences between tolerance, physical dependence,
Opioids have a distinct place in the treatment of patients withÂ hemophilia who are experiencing severe acute pain or chronicÂ pain and are unresponsive to non-steroidal anti-inflammatoryÂ drugs (NSAIDs). Because of the biochemical processes thatÂ take place when opioids are administered, varying degrees ofÂ tolerance and physical dependence can be expected over timeÂ with chronic exposure. Physicians, particularly pain experts,Â are well versed in navigating these effects safely with patientsÂ who require opioid therapy, however this requires that the patientÂ and the prescribing physician develop a plan for appropriateÂ opioid use that is closely followed. Certain patients areÂ at a much higher risk of developing addiction and physiciansÂ should be aware of these risk factors. Patients displaying addictiveÂ tendencies should undergo a multidisciplinary evaluationÂ with their primary hemophilia physician, a mental healthÂ expert, and an addiction specialist.
â€¢ A need for a greater amount of a drug to maintain theÂ therapeutic effect with the loss of efficacy over time.
â€¢ Neurochemical changes in the body require continuedÂ use of the substance. Withdrawal syndrome occurs ifÂ the medication is discontinued, the dose is substantiallyÂ decreased, or an antagonist is administered.
Addiction (Psychological Dependence)
â€¢ A psychiatric disorder characterized by continued compulsiveÂ use of a substance despite harm to the patient.Â Effects from the use of the medication are desired andÂ reinforce continued use.
Learn more by readingÂ the Winter 2015 edition ofÂ 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, theÂ Substance Abuse and Mental Health Administration’s (SAMHSA) National HelplineÂ Â 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 SpecialistÂ practicing in inpatient hematologyÂ and oncology at the University of MichiganÂ CS Mott Children’s Hospital in AnnÂ Arbor, Michigan. Mora graduated with herÂ PharmD degree from the University ofÂ Georgia and completed post-graduateÂ residencies at Northeast Georgia Health System and MayoÂ Clinic. She has been in her current position for six years.