Prescribing more opioids than needed can be dangerous

A recent study at Johns Hopkins Hospital in Baltimore, MD, has found that most orthopedic surgery patients go home with far more opioid pain pills than they need – some times as many as 80 pills too many. And it’s not uncommon for other types of patients to be overprescribed. So what’s wrong with having some unused opioids in the house? That is, besides the extra cost to the patient and/or the insurance company? Isn’t it more convenient than having to call the doctor to get a refill and go back to the pharmacy? Well, no, it isn’t better. Prescribing more opioids than needed opens the door to some common and serious problems.

1. Opioids make me feel good

Some patients are at risk of continuing to take opioids after the legitimate need for pain relief has passed. They do this because they “like” how it makes them feel. Having a dozen or several dozen extra pills in the house can be for some people an open invitation to experimentation and eventual addiction. There are thousands of former pain patients who first became addicted taking legitimate, doctor-prescribed opioids.

2. Risk of overdose

Overdose can happen whether or not you have more opioids on hand than you need. People can always take more pills or take them more often than the doctor or the label says. Tragically, this sometimes happens. But there’s another reason people might overdose just because they saved unused pills. When pain from surgery or accident is too intense, some patients simply increase their dose a little. If it hurts even more, they increase it again. And again the week after that. And again. Eventually they heal, stop taking the opioids and put the leftovers away. But something else also happened. By gradually increasing their dosage over several weeks they increased their tolerance for opioids. Bodies can adjust gradually to dosages that are higher than normal people can tolerate when just starting out. Now, a year or two later, they experience some new pain and remember those opioids in the cabinet. They also remember how much they were taking at the end of their treatment, after they’d built up that tolerance. But in the time since then, their body has gone back to normal. They are no longer protected by the tolerance. So they take that huge dose – not the original starting dose – and succumb to a life-threatening overdose.

3. Risk of diversion

Countless thousands of patients every year leave millions of unused opioid pills in medicine cabinets or in plain view on counters. This adds to the risk of “Diversion” – the medical and legal term for “diverting” legally prescribed drugs to another person for illicit use. A high number of prescription opioid and heroin addicts say they got their first pills from a family member or a friend. They were given to them to treat some painful condition. Then the worst happened: They liked a little too much how good those pills made them feel. Lending or gifting prescription meds is a proven bad idea. And it’s always easier to do when you have lots of extras in the house. They’re also easier to steal – another popular way to divert drugs.

4. I need them because it still hurts

Many patients fall victim to “opioid induced hyperalgesia” – a fancy term for a fairly common condition when opioids begin to cause pain . Opioids can cause bodies to become more sensitive to painful stimuli. Now the patient is in even more pain than before – surgery plus hyperalgesia pain – or the patient doesn’t know that the pain from the surgery is actually gone and it’s the hyperalgesia that’s hurting. In either case, the patient takes more opioids – and often at a higher dose. Opioid induced hyperalgesia leads countless people into physical dependence and addiction. And it happens more frequently when there are dozens of extra pills in the house. Patients just keep taking them instead of calling the doctor to report that their pain still hasn’t gone away or it's hurting even more. Had they called, the doctor would have suspected hyperalgesia and treated the patient accordingly – avoiding dependence or addiction.

How to dispose of unwanted opioids (and other medicines)

Go to this FDA webpage to read everything you need to know about how to dispose of those leftover opioids and other medications in your medicine cabinet.

Surgeons don’t know how much to prescribe

The Hopkins’ study concluded that more research is needed into how much painkiller patients really need, and the results need to be conveyed to the prescribing surgeons. They have little to go on, the study said, so they overprescribe to minimize patient complaints about pain control.

If you or someone you care for has a problem with opioids and pain control, or dependence or addiction to opioids or any other substance, don’t hesitate to call Novus Medical Detox Center. We are the experts, and we’re always here to help.