Sunday, July 29, 2018

Withdrawing from Opiates - Part 2 of 2.

(Read Part 1 at this link.)

After 1-2 weeks of taking opiate analgesics our bodies develop tolerance and become dependent on them. This means that it might be very uncomfortable to suddenly discontinue the use of opiates. There are several key concepts to helping withdraw comfortably from opiates.

Prevention of withdrawal symptoms:

Before we discuss strategies for withdrawing from opiates, let’s discuss how to help to mitigate the inevitable onset of tolerance and dependence to begin with.

If your doctor feels that you will need to be prescribed opiates for longer than 1-2 weeks, then ask that they prescribe a long acting opiate right from the start. Long acting opiates smooth out the highs and lows of the medication in your system which decreases the development of tolerance and abuse. With short acting opiates the body gets a high dose and then quickly switches to a lower dose after just a few hours. Your pain level with increase with each low that occurs, potentially making you feel like you need a higher and higher dose to keep you comfortable. In this case you don’t need a higher dose but a formulation that smooths out the highs and lows, so you stay in a steady state of pain relief over time. This also makes it much easier to withdraw when it is time to discontinue the use of opiates.

Sunday, July 22, 2018

The Opioid Crisis – the problems of tolerance, physical dependence and hyperalgesia. Part 1 of 2.

The news is full of stories about the addictive potential of opioids and deadly opioid overdoses. What seems to be missing in the news stories is the subtler issue of separating out the concept of true addiction from the tolerance, physical dependence and hyperalgesia that develop over time, for patients who take opiate analgesics.

Our body naturally makes opioid like compounds. If we use man made opioids (opiate analgesics) our body gradually decreases the creation of natural opioids and we start to need a greater and greater dose to get the original pain-relieving benefit. This is called opiate tolerance. In other words, we start to tolerate the artificial dose of opiates  Inevitably, if you start to rely on pharmaceutical opiates you will start to feel the need for more pharmaceutical opiates to get the same effect. It's easy to understand how this might lead to a dangerous spiral of increasing opiate use which may ultimately become life threatening. Once you have developed tolerance to opiates your body becomes dependent on the artificial medicine to replace your normal production. This is called physical dependence. Once you have developed physical dependence on opiates withdrawal of the opiate medication will cause unpleasant physical symptoms. Physical dependence to opiates may be confused with addiction. Just because patients may be unable to wean themselves off the opiates at the end of their treatment may not mean that they have somehow become an “addict”.