New survey shows that relatively few legitimate users of opioid medications are getting the information they need to keep their medications safe.
For some people with ongoing or chronic pain, opioids (medications such as oxycodone or hydrocodone) can make the difference between disability and the ability to function at near-normal levels. For those with acute pain, such as pain after surgery or injury, sound pain management with opioids can speed healing and recovery.
Yet opioids are powerful medications and carry risks when they are not used properly. According to the Centers for Disease Control (CDC), the number of U.S. poisoning deaths involving any opioid analgesic (e.g., oxycodone, methadone, or hydrocodone) more than tripled from 1999 to 2007, from 4,041 to 14,459, accounting for 36% of the 40,059 total poisoning deaths in 2007. Opioid poisoning now causes more deaths than either heroin or cocaine.
Those who use opioids properly, under a prescriber's care, need to understand how to take, store, and dispose of their medications to keep themselves safe and keep their medications out of the hands of potential abusers. Yet a recent survey conducted by the American Chronic Pain Association (ACPA) indicates that relatively few of those receiving opioid prescriptions are given sufficient education about the drugs to ensure safe use.
Use of Opioid Agreements
Only 28% of patients were asked to sign an opioid agreement. Opioid agreements explain the risks and responsibilities involved in using opioids. They set the ground rules, facilitate patient counseling on expected benefits and side effects, explain safe storage and disposal, and are meant to protect both the patient and prescriber. Of those asked to sign one, 10% received no counseling and 45% had less than 15 minutes to discuss it with the health care professional.
Using a Single Pharmacy
Using a single pharmacy for all prescriptions is a good way to ensure that a new medication will not interact with those already being taken. Only 21% were told to do this by their clinician, but 86% reported that they did in fact use only one pharmacy.
Fear of Addiction
Worries about the possibility of addiction are common among those using opioids legitimately. Nineteen percent report that they are very concerned about addiction and another 34% say they are somewhat concerned. "The risk of addiction when opioids are used legitimately under a professional's care are modest," notes Penney Cowan, founder and executive director of the American Chronic Pain Association, "yet many fear taking medications that may help them reach a higher level of function. It's important that individuals discuss their concerns with their provider openly. A candid discussion can help your provider determine if you have clinical factors that put you at a higher risk for possible addiction to opioid medications."
Storage and Disposal
Diversion, the theft or resale of opioids for recreational use, is the most common way these drugs get into the hands of those for whom they are not intended. Yet just 14% of those surveyed keep their opioids in a lock box or other locked location. Nearly 25% store their medication in the medicine cabinet. "Securing your medicines is the best way to avoid having them taken by casual visitors, workers, of even teens who don't understand the risks," said Cowan. "We suggest people treat these drugs the same way they would a stack of $100 bills; keep track of how many you have and keep them where they can't be easily found by others. And most important, never share your medication with others. The dose that safely reduces your pain can be deadly for someone else."
When it comes to disposal, the Food and Drug Administration recommends that unused opioids be flushed down the toilet. This will keep them from being stolen from the trash or accidentally used at a future date. Yet the study shows that 34% save their unused medications in case of future pain. Only 7% flush them away as recommended.
"Opioids can be an important part of an overall pain management strategy. But they are powerful drugs and must be treated with care, " Cowan concludes. "Our study indicates that we still have much work to do to ensure that individuals who can benefit from opioids know how to take them, store them, and dispose of them properly. Even one unintentional death is one too many."
American Chronic Pain Association