Opioids – A Surgeon’s Perspective
Oh dear, where can I start when talking about opiates! There has been a deluge of media coverage in recent months regarding the ‘epidemic’ of addiction to medically prescribed opioids. Here in Australia there have been recent changes to legislation making codeine (eg. Panadeine) unavailable as an over-the-counter medication in pharmacies. This is a highly emotive issue, as it seems like a balancing act between two hot-button topics - pain and addiction. It is an issue which seems to be in the zeitgeist at present. I read two novels during my last holiday (Harry Bosch and Jack Reacher), and both had plots involving the criminal underworld that revolve around the medically prescribed opiate industry.
The problem of opiate addiction is very real, and needs to be taken seriously. The fastest growing group of addictions in western society are medically prescribed opiates. This is not because they are a new form of medication – opiates have been around a long time. There seems to be a complex cyclical pattern of restrictions being increased then decreased as our health systems struggle with the consequences of these powerful medications.
As an orthopaedic surgeon who does a lot of hip and knee joint replacements, I have many patients with high levels of pain in the early post-op period, and I will often prescribe opiates in this situation. They can be a fantastic option for relieving severe, acute pain. They are also capable of transporting the patient to another world – a world of euphoria, or disconnectedness, or elephants flying on the ceiling, or large spiders crawling through the window (all things my patients have told me about). But the risk of addiction is very real. Take care that you don’t stay on them any longer than you need to. Opiates can affect your insight, and can change the way you experience pain. If taken over an extended period for a persistent or chronic pain problem, opiates actually tend to increase your pain!
If you or someone close to you is having trouble getting off opiate medications, please seek expert help. Talk with your GP, Surgeon or visit: freshstart.org.au
Dr Mark Hurworth, Orthopaedic Surgeon