Opioid Abuse and Alternative Treatment Options

Opioid Abuse and Alternative Treatment Options

by Samantha Borenstein | Edited by Andrew Guo

While medications are incredibly useful tools, capable of both improving quality of life and thwarting death, they can also be misused or abused, resulting in irreversible damage.  Though prescription drug abuse has existed for decades, it has become especially problematic following the COVID-19 lockdowns, its effect especially pervasive among communities of recreational drug users and chronic pain patients, as well as emotionally distressed or depressed individuals.  Because opioids (used to treat pain or to relieve tension), anti-anxiety medications or sedatives, and stimulants (to improve concentration and alertness) have mind-altering effects on users, these categories of drugs are most commonly used illegally.  Medical professionals often undertreat or misdiagnose patients with complaints regarding pain, especially persistent pain, causing patients to turn to the black market or drug dealers in an effort to–in some small way–mitigate suffering.  Current stigmas against prescribing pain medications historically stem from the overprescription of opioid painkillers in the 1990s (before the addictiveness was well-documented), which led to its widespread abuse, but today, doctors do patients a disservice by making them turn to unsafe, illegal sources for pain relief. 

Studies have found that nearly half of all chronic pain patients exhibit signs of drug dependence; simultaneously, people who suffer from chronic pain account for more than sixty percent of opioid overdose deaths in the United States of America.  These separate realities have converged into an even larger issue – it has been documented that the combination of antidepressants and opioids is extremely dangerous, causing respiratory depression and shallow breathing. Abuse of opioids alone can have deleterious effects, including (but not limited to): fever, irritability, nausea, paranoia, impaired motor coordination, low blood pressure, coma, and poor breathing.  In fact, the CDC estimates that about 83,000 people died of opioid overdoses in 2021 alone, and largely attributes this to the proliferation of fentanyl in illegally-acquired drugs.

Because of these deaths, the unwillingness to over-prescribe opioids, and evidence of the limited long-term effect of opioids for pain relief, new treatment options are essential.  Massage, physical therapy, cognitive behavioral therapy, acupuncture, and meditation are some alternative treatments that doctors are recommending, but are not as immediately effective or impactful.  However, the scientific community is making strides in the area of pain management.  A recent study in the Journal of Neural Engineering found that the combination of electrical stimulation of the body and sound has potential for treating pain and sensory disorders.  The impetus for the study was the treatment of tinnitus (which can be thought of as a form of chronic ear pain) using music therapy.  The study investigated the somatosensory cortex (the center for receiving and modulating  sensory/pain information) in a guinea pig model, which had differentially activated neurons based on this stimulation combination.  Very few neurons were activated with sound alone, but the combination of electrical stimulation and sound affected almost every neuron investigated by the study.

While the study does not definitively show that this bimodal stimulation can effectively treat long-term, chronic pain in humans, it reveals a potential noninvasive approach to pain management.  Treatment that does not involve drug use is essential, especially with conditions like chronic pain, which often lead to drug abuse and depression.  Further, the equipment used to perform the treatment is relatively inexpensive, and readily accessible to patients if future studies yield more positive results.  The fact that this method has some precedent is also promising, given that another doctor, Dr. Medhat Mikhael, has been effectively using both electrical stimulation and music meditation with various chronic pain patients.

Alternative treatments for chronic pain are essential for preserving the quality of life and safety of patients.  Hopefully, in the near future, this will mitigate opioid deaths and improve trust and relationships between doctors and their patients, thereby decreasing reliance on the black market and illicit drugs.

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