Alternatives To Opioids
By D. S. Mitchell & Trevor K. McNeil
Definitions: *Opiate and opioid are often used interchangeably although that interchange of usage is not precisely accurate. The following would be more correct:
Opiate: A drug (such as morphine, codeine or heroin) containing or derived from opium or the opium poppy, used to alleviate pain, or induce sleep or euphoria.
Opioid: A synthetic or semi-synthetic drug producing an opium-like effect, often prescribed for the alleviation of moderate to severe pain; a prescription painkiller in the opiate class.
Balancing Act
With drugs, even those considered alternatives to opioids, there is always a risk. Even a “safe” drug such as caffeine. Caffeine is regularly consumed by children, and has had documented negative effects. The same goes for nicotine, deemed for the most part “safe” except when smoked by children. Some of those effects include paranoia, muscle spasms and heart arrhythmia’s. The question becomes how much of a risk is there; and are the positive effects worth the negative risks?
Mesopotamia
It was in Mesopotamia over 3,500 years ago that farmers in the Southwestern section of the region began extracting the seeds from opium poppies and ingesting them for pain, digestive disorders, sleep and a blissful euphoria. The once wild poppy soon was cultivated for its medicinal properties and its use spread across the world. With no alternatives to opioids, addiction accompanied the spread of opium.
Painkillers Are Controversial
One of the more complicated areas of medicine has been in painkillers. Historically, everything from alcohol administered by mouth, to ether administered by inhalation has been used to reduce or block pain. Particularly in the context of surgery. The surgical suite has limited ability to use alternatives to opioids.
Take Home Medication
Prescription painkiller addiction was long a silent addiction. Over the last two decades, prescription painkiller addiction has become the most common and the most deadly addiction(s) in America. Prescription drug addiction deaths have far outpaced “street drugs” like heroin in overdose deaths in the United States. It has become so serious it is being called a “crisis,” “epidemic” and a “national emergency.” We, as a nation, have to find alternatives to opioids.
Opium Chemistry
One of the most common and successful drugs used for pain-relief is opium. As previously noted, Opium and its related drugs are called opiates while synthetic versions are called opioids. These medications are some of the most effective painkillers on the planet but also the most addictive. Doctors have looked for alternatives to opioids because of these addictive properties.
Success
Sadly, they are also incredibly addictive. It is most effective in the clinical setting for acute, short-term pain. Unfortunately, these medications have moved from the clinical setting to the doctor’s prescription pad and the street chemist’s lab. The unparalleled success of such medications has led to an alarming spike in abuse. With abuse has come an increase in overdoses leading to unprecedented death counts leading to the search for alternatives to opioids.
Searching For A Non-addictive Painkiller
Beginning in the late nineteenth century until today, chemists have searched for non-addictive alternatives to opioids. Unfortunately, science has done a pretty good job finding pain relieving compounds, but the non-addictive part of the mission has been elusive and seemingly impossible.
It’s Not Just Opiates and Opioids
In some ways I feel the search for non-addictive alternatives to opioids is a lost cause. Human nature seeks addiction. There are food addictions, nicotine addictions, caffeine addictions, Benadryl addictions, nasal spray addictions. These “addictions” may seem inconsequential when talking about opioid and opiates, but there seems to be a ‘core need’ for most of humanity to seek a sense of well-being using whatever vehicle that will satisfy their need. Each person identifies the catalyst of that “feel good” sensation usually reasonably early on in life, usually no later than age 25.
Definitions
With regard to alternatives to opioids, you either love weed, or you don’t. Downer’s are either a do, or a don’t. Booze is a buddy, or a rare interlude. You either embrace chocolate eclairs, or you give them a pass. Each of us, are aware of our personal triggers and most of us have some semblance of control over our behavior. It is probably important at this point to identify the differences between bad habits and addictions.
Bad Habits
A habit is a settled or regular tendency or practice, especially one that is hard to give up. The habit in fact, may have a provable harmful effect over time; such as cigarette smoking. I’m sure everyone has heard the confronted smoker say, “everyone’s gotta die some time.” There is a sign of finality in that comment. The “habit” is greater than their power or desire to change the behavior. The same holds true for opioids. Patients don’t look for alternatives to opioids until some life circumstance forces them to look for an alternative.
Rationalization and Justification
This is how many people address their behaviors by rationalization and justification. It is important that an individual can honestly identify their relationship between a substance such as chocolate, or cigarette smoking; and decide how harmful or disruptive that habit is to the life they want to live. Usually the need for opioids zips right by the habit stage which brings back to the need for alternatives to opioids.
Addiction
So, we can see that a bad habit can eventually lead to death, as with a cigarette smoker who dies 20 years before their time because of their “cigarette habit.” Experts define addiction as a “disease” in which a person finds themselves unable to stop using a substance such as heroin, or engaging in a behavior such as gambling. This is despite the immediate and observable harm that the addiction is having on the person’s life and relationships. Because of their highly addictive properties there is a need for people to seek alternatives to opioids or any other addiction that is destroying their lives.
Oblivious To The Obvious
In cases of addiction, the need to take part in the “high” provided by the substance or behavior is more important than their job, their family, their health and even their very lives. The negative effects are not delayed and in fact are often immediately observable. Yet, many people continue the activity oblivious to the obvious and don’t seek out alternatives to opioids.
Back To Alternatives
Once we understand that human beings are naturally inclined to fall into addictive behaviors redirecting such behaviors becomes essential. The need for alternatives to opioids is essential for society to end such behaviors. Opiate/opioid dependence is a major public health problem associated with transmission of deadly diseases such as HIV and Hepatitis, lawless activity, unintended overdose, hospital and emergency room admissions and death. The economic cost of the opioid epidemic to the U.S. economy from 2001-2017 topped $1 trillion dollars. The cost in human suffering is immeasurable.
Substituting Methadone
Methadone is a long-acting man-made compound used for chronic pain and management of drug withdrawal. Methadone is routinely the drug of choice for heroin withdrawal and subsequent long-term maintenance. Using Methadone to withdraw from heroin is simply replacement of a fast-acting narcotic by a long-lasting synthetic narcotic with its own habit-forming properties. Since it is also an opioid it obviously doesn’t offer an alternative to opioids.
Why One Over Another?
In fact, Methadone is just switching from a drug taken in back rooms and alleyways for one taken in a clinic setting. The suggestion here being that if you take away the sleazy ritual of the street drug’s preparation and use; and supply the junkie with a longer acting version of his dope administered in a sterile medical setting usage goes down. At least overdoses are dramatically reduced; but still, there are no pain relievers for severe pain that are not addictive.
Weed Out
Cannabis use is still illegal in many parts of the United States. The first state to legalize medical cannabis for medical treatment was California in 1996. Sixteen years later, Washington and Colorado fully legalized cannabis by state referendum. In Canada and the UK, the medical system is administered by the government. Cannabis is used for pain relief resulting from such disease conditions as cancer and multiple-sclerosis and may have a future as an alternative to opioids.
Effects
While the conclusions were somewhat mixed, there was a strong indication that moderate use of cannabis, particularly in spray, pill and vaporized form, provided positive effects on chronic muscle pain; particularly from spasm, as well as greatly reducing chemo-induced nausea. All of which could make cannabis one of a number of viable alternatives to opioids in jurisdictions in which it is now legal.
Clinics
So, the alternative to addiction is to replace one bad behavior with another more healthy addiction. In many cases addictions are treated with more “acceptable” drugs, dispensed by doctors and nurses, i.e. the Methadone Clinic. For others it will be a trip to rehab. In many cases, more than one trip will be necessary and the failure rate is astronomical. There is a real need for alternatives to opioids.
Some Sobering Tactics
Without alternatives to opioids, there are only four principle types of rehab available.
1) Inpatient treatment is where an addict receives a rigorous medication and counseling immersion during schedule an average 30-day hospital stay.
2) Residential treatment programs are aimed at changing the addicts lifestyle through 70-day programs that focus on community, where peer counselors replace medical staff. These programs often last 230 days.
3) Detox programs rely on medications to ease transition from using and are combined with psycho-social treatments. Such programs commonly last six months.
4) Outpatient/drug free counseling is a rehab format that allows addicts to stay in their own homes and does not use medication during the transition process.
What Statistics Say
Statistics show that there is a strong need for alternatives to opioids because rehab is pretty much a failure. Check out the numbers.
- Inpatient treatment. 73% complete treatment. 21% remain sober for 5 years.
- Residential treatment. 51% of addicts complete treatment. 21% remain sober for 5 years.
- Detox. 33% of addicts complete treatment and 17% remain sober after 5 years.
- Outpatient/drug-free. 43% complete treatment and 18% remain sober after 5 years.
Conclusion
After rehab some addicts rely on yoga, acupuncture, pressure points, running, biking or other physical alternatives to “replace” the high from their preferred drug and become their alternatives to opioids. The struggle to stay clean is a difficult one. Whatever method the recovering addict uses, hopefully they will find success. There is no “cure-all” for addiction. I’m sure any addict will confirm the struggle for sobriety is a daily, hourly second-by-second fight. Take a minute, hug a friend who is struggling with food issues, cigarette smoking or opioid addiction. Everyone does better when they know people care about them.
