An effective alternative to opioids for many

As the opioid epidemic spreads, Texas is taking important steps, from improved monitoring of prescription painkillers to expanded programs to treat addiction.

But as a doctor who regularly sees patients suffering from chronic pain, I don’t believe this crisis can be solved until we educate more physicians and the public about real alternatives to these addictive pills.

In 2016, Texas had 1,376 opioid-related overdose deaths, according to Dr. John Hellerstedt, the state’s health commissioner, who shared the data at a U.S. Department of Health and Human Services summit at UT Southwestern Medical Center in Dallas.

Deaths tied to prescription painkillers have started to decline in Texas, but heroin overdoses and overall opioid-related fatalities are up. About 80 percent of heroin users report using prescription painkillers. Fentanyl is entering the country illegally, along with more potent opioids.

When I entered the field 30 years ago, opioids could not be prescribed in Texas to anyone who might be a habitual user. That began to change in the early 1990s after the Legislature passed the Intractable Pain Treatment Act to provide relief to terminal cancer patients. It allowed doctors to prescribe opioids at whatever dosages they deemed necessary.

Early assumptions about the drugs — that addiction rates would be low and benefits would extend over the long term — turned out to be wrong. Opioids are very addictive, their effectiveness waning as people habituate to the medication. But the convenience of offering quick relief won over doctors, and our pill culture appeals to patients. The medical community should have known better.

There’s no scientific data showing opioids effectively treat chronic pain. There is a better solution. Interdisciplinary pain management programs — combining physical therapy, stress management and therapies including acupuncture or non-opioid drugs with analgesic effects — have proved more effective and less risky.

A study of patients who went through the UT Southwestern pain management program found their median pain score reduced by 35 percent over a year; about half were able to stop using opioids.

This approach is not for everybody, and opioids remain an effective solution for handling acute pain caused by an injury or major chest surgery, or during hospice care. But millions need to get off the pills. About 16 million Americans take opioids chronically — five times higher per capita than some industrialized countries.

A law passed by the Texas Legislature last year requiring pharmacists to more quickly report sales of controlled substances will help physicians better track opioid history before writing a prescription. But this crisis is likely to get worse before it gets better.

If you have chronic pain and are on opioids, try a pain-management program and taper off the drugs, or at least reduce your dosage. If you’re in chronic pain and not on opioids, try nondrug alternatives first.

Dr. Carl Noe is medical director at the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center. This article first appeared in the Texas Tribune.