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A better way to handle opioids

January 6, 2019

The prescribers of opioids are partially responsible for the current opioid crisis. We are remiss in explaining to the patient when it is time to stop any opioid, she or he will have withdrawal symptoms. It takes time for the body to adjust to not having opioids in the system, whether the drug is taken for a few days or a longer period.

Withdrawal symptoms include: muscle aches or twitching, restlessness, anxiety, tears, runny nose, sweating, inability to sleep, frequent yawning, itching or feelings of insects crawling on the skin. These may be mild or severe, depending on how long opioids are used.

These symptoms may not be understood as withdrawal, but believed to be pain from the original injury, procedure or surgery. The patient may request more of the opioid, and the provider, unaware the patient is suffering withdrawal rather than the original pain, prescribes the drug again. This can begin a cascade of patient requests and provider prescribing leading to addiction. If the provider refuses an additional prescription, the need for the drug can be great enough that the patient now seeks the drug illegally on the street.

Instruction and education to patients about how to wean oneself off these drugs can be a time-consuming process for both the provider and patient. There is always a question of patient understanding, and no way to monitor patient compliance.

A preferred solution would be to dispense opioids in punch-out blister (bubble) packs so that the dosage decreases on a daily basis. This packaging, already in use with other drugs, in one- or two-week dosages, would allow prescribers a better idea of patient use, and whether a second prescription is required. It is less likely that there would be unused portions kept for later use, hoarded, given to someone else, or show up for sale on the street.

This solution puts the larger burden on the pharmacological industry. It would change opioid manufacturing and packaging. Dispensing these packs and providing explanations to the patients would be easier for pharmacists.

Pain is well-controlled with opioid drugs. As medical professionals, we can begin to be better about instructing patients in opioid use and take responsibility to encourage the pharmacological industry to change opioid prescribing and dispensing.

Suzanne D. Schutze is a registered nurse living in Taos.

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