Q&A: Prescription Painkillers

Why are painkillers all over the news right now?

Laura Bitts, MD, answers common questions.

Q: Why are painkillers all over the news right now?

After two decades of increasing use of OxyContin, Percocet, Vicodin and other opioid pain medicines in the United States, new studies are finding that these drugs are associated with far more harm — including addiction, accidental overdose and death — than previously understood. In Oregon, the majority of drug-overdose deaths are now linked to prescription opioids. In light of what we know now, the medical community is reexamining how we treat pain and updating the guidelines for prescribing these drugs.

Q: What if I need opioids for my pain?

When prescribing any medication, our goal is always to make sure that the benefits to you outweigh the risks. Short-term use of opioids can be helpful for acute pain, and the guidelines don’t prevent doctors from prescribing them when appropriate. But the research to date has found no good evidence that opioids improve pain or function when used long term. On the other hand, they pose significant risks for harm. If you’ve been on opioids for a while, this is a good opportunity for you and your doctor to take a fresh look at your medications to see if there are safer treatments that might make your life better.

Q: What are the risks of these medications?

In addition to the risks of addiction and overdose, opioids can have far-reaching effects on your body and brain. They may cause or worsen depression, sleep problems, cardiovascular disease and low testosterone. They may reduce your ability to function socially or at work. And for many people, they actually increase sensitivity to pain.

Q: How addictive are they?

Very. Some people — particularly those with a history of depression, trauma, or addiction to alcohol or other substances — are at especially high risk. But because of the way opioids affect the brain, anyone can become addicted to them. One study found that 47 percent of people on opioids for 30 days will still be on them three years later. Addiction is a serious health issue, not a personal failing, that can and should be treated.

Q: What are the alternatives for managing pain?

There are many — your doctor can help you explore the approaches that might work best for you depending on your individual pain issues. Three that work very well for many people are non-opioid pain medications, physical therapy and cognitive behavioral therapy. These approaches help many people safely manage their pain, reduce or eliminate their need for opioids, function better in their work and activities, and reclaim their lives. It’s well worth a conversation with your doctor.

Laura Bitts, MD., is the medical director of The Portland Clinic – South, where she sees patients. Dr. Bitts helped lead the development of The Portland Clinic’s opioid treatment plan.