Opiates on the Brain
As more than 65 people listened, Dr. Golden spoke about medications, the prescription drug epidemic, opiates and the brain and the “tremendous misunderstanding” about chronic pain patients and the prescribing of opiates.
Dr. Golden has a 30-year history in the private practice of medical oncology-hematology, and indicated that for cancer patients in the end states of life, opiates are a wonderful adjunct to a patient’s comfort care.
But for others in less critical conditions, he noted that more than 5,000 peer-reviewed citations say opiates do not work for Chronic Non-Cancer Pain, or CNCP. While he’s not an “anti-opiate” person particularly for acute, traumatic pain, sometimes patients are prescribed opiates, and the continued use is not indicated, he says.
He said he heard a statistic recently that 2 in 5 people are on prescription drugs, and that more people in the U.S. now are using opiates than are smoking.
“We want to medicate for function, not medicate feelings,” said Dr. Golden, who previously worked at the Betty Ford Center. “If those opiates allow somebody to get up and function, then they’re indicated. Start low and go slow.”
Those in chemical dependency treatment are trying to reach out to medical physicians to educate more about the dangerous combination of the use of opiates coupled with those using drugs such as Ativan, or Valium together with hydrocodone.
“All these medication together are providing dangerous cocktails and this is compounding the situation,” he says.
Drug poisoning deaths involving opioid analgesics have more than tripled in the past 10 years, he says. In 2014, he said, 47,055 overdose deaths were noted, with 28,647 attributed to opioids. From 2000 to 2014, there have been 500,000 accidental overdose deaths documented.
“What is the epidemic really,” he questioned. “There’s an epidemic of use. There’s an epidemic of misuse. There’s an epidemic of overdose, death, lack of benefit and adding to misery and disease burden. Opioids simply do not work for pain. They don’t work. They don’t work for pain beyond three months, that’s been clinically proven … There’s a large downside to opioids. They worse function and they worsen quality of life.”
“Well meaning” physicians prescribe opioids, because they don’t know what to do for issues such as non-cancer chronic pain, depression or other issues, Dr. Golden notes. Often, patients believe that their survival depends upon taking opiates and they will do almost anything to get them. But the problem, he said, is that opiates often worsen pain when taken for longer than three months.
Addictive disease, he said, is a neurologic-biological relapsing disease that’s fatal. With some 40 million Americans diagnosed with addiction, Dr. Golden suggests changes in treatment.
When patients come into Chemical Dependency Treatment, Dr. Golden said, “It would be so nice to say ‘You can’t leave for six months, because your brain has not healed.’ We need to keep them until their brain has healed -- because the disease wants them dead. And we cannot hold them. They have the right to leave. If it were possible to get patients to give up their liberty so they cannot leave, they would do so much better. Their brains are running the show. They get to go when they want. Every day, I don’t know who is going to show up, whether the patient is going to show up or the disease is going to show up. The tincture of time is what is the key. “