Articles the Physician-Patient Alliance for Health & Safety (PPAHS) have been reading the week of July 9, 2018 ask us to consider 3 ways we need to change our perception of opioids, pain medications, and other sedatives
There is No Absolute Safety When Using an Opioid
In an interview with Christopher G. Gharibo, MD, a pain specialist and the director of pain medicine at NYU Langone Health, Dr. Gharibo discusses the use of opioids and pain medications. He cautions, “what we need to keep in mind is that there is no absolute safety in many of the medicines that we prescribe, whether it is an opioid or a nonopioid.”
To improve the safety when using opioids, he suggests a number of measures, including these two:
- Individualize Treatment – “This is a category—that is clearly effective—that needs to be individualized to the patient, and that needs to be kept in check in terms of the dosing that’s provided to the patient, the pill counts, and the combination therapy that’s provided.”
- Be Prepared for An Adverse Event – “What can also be available when opioids are prescribed—especially in the chronic setting—is a take-home naloxone. Now this comes in a variety of different forms. Whatever the form is, it needs to be easy to administer, and it needs to be reliably administered to reverse the effects of the opioid. Now that’s not so simple. I think it also concomitantly requires education of the patient as well as the caretaker for the patient. … This is something that is relatively low-cost and can make a huge difference in the ultimate outcome.”
To read the complete interview with Dr. Gharibo, please go to Pain Medicine News.
Opioids Aren’t necessarily the Culprit
Much has been discussed about the role of opioids in deaths. However, a recent study found that 82.5% of opioid-related overdose deaths in 2016 involved either fentanyl or heroin.
This is not to suggest that caution should not be used when prescribing or using opioids, but merely to point out that it is often opioid use in combination with other substances that is deadly.
Under General Anesthesia May Not Mean “Out Cold”
Being under general anesthesia is often thought to be when the patient is “out cold.” However, recent research suggests that brain activity and responses to stimuli may persist. Harry Scheinin, MD, PhD, one of the project leaders, commented on the results:
“I don’t think it’s bad that brains are working more than we had previously thought and that anesthesia would resemble sleep more than we had previously thought. But there still is this problem of unintended awareness, so we need better ways to measure really objectively the level of sleep, especially when we are using these muscle relaxants because we are then putting the patients into a situation where they can’t show ‘hey, I’m awake.’”