Maybe you’ve heard and maybe you haven’t but America is in the midst of an opioid crisis. Opioid use and abuse is rampant. Millions of Americans are affected. You might think of opioids as illegal drugs like heroin and black-market morphine. True, these are opioids, but the real crisis has to do with opioids (narcotics) you get from your healthcare providers through legitimate prescriptions. Oxycontin, oxycodone, morphine, fentanyl, hydromorphone, hydrocodone, codeine — ring any bells?

How do opioids work?

Many think opioids treat pain — not exactly. They only block your brain from perceiving pain. They don’t actually treat what is causing the pain. This becomes problematic for nagging orthopedic injuries involving hands, wrists, elbows, shoulders, knees, ankles, the neck, spine, and back.

Here’s a common scenario:

You injure your shoulder at work. Your job requires you to use your arms/shoulders at work (lifting, hammering, sorting, pushing, pulling, holding, driving, whatever).

The injury is probably some kind of tear or strain on the rotator cuff of the shoulder. What you likely need is ice, rest, anti-inflammatory medication, and perhaps physical therapy to strengthen the muscles of the rotator cuff so it can heal and to prevent the injury from happening again.

But we live in a quick-fix society, so maybe you ask for narcotics (opioids). When you take your narcotics, you can no longer perceive the pain, so you go right back to work and each day injure, and re-injure, the same shoulder. As the injury worsens, the pain becomes worse.

Now, you’ll need more narcotics to control the pain—all so that you can go to work the next day and worsen the shoulder injury again. Next thing you know, the pain is intense because you’ve injured your shoulder beyond what conservative measures can treat.

You want more narcotics so you can keep working. The opioid dose has to increase and presto, you’re part of the opioid crisis. What happens then? In the case of your shoulder, you’re going to be headed to surgery to either repair or completely reconstruct your shoulder.

And guess what? Your provider is going to have to wean you off the high-dose narcotics, get you on anti-inflammatories (that actually treat the source of the pain), rest the injury from aggravating factors, and get you into physical therapy so you can actually heal. Isn’t that interesting? That’s the same therapy you should have agreed to in the first place.

Don’t get me wrong…

Narcotics are necessary and appropriate for things in the acute (short-term) setting like broken bones or coming out of surgery. But for chronic pain? Unless you have cancer or are in a hospice situation, you really have to think twice about narcotics.

Side effects?

Most people are familiar with at least some of the side effects of narcotics: nausea, vomiting, constipation, sleepiness, foggy thinking, fainting, decreased sexual drive, seizures, and headaches, to name a few. And there is a danger for anyone to become addicted to any narcotic, but there are other, worrisome side effects.

Narcotics make your breathing slow and in some people, it can actually stop. If this happens at night or when you are alone, you’ll likely die.

The incidence of this happening is higher if you already have lung disease or smoke, or if you use narcotics with other cerebral (brain) depressants like alcohol, sleeping medicine, or certain anti-anxiety medicines, like benzodiazepines (Xanax®, Valium ®, lorazepam, clonazepam, etc.)

One thing you may not be aware of has to do with kids in the home. Most toddlers and teens don’t have prescriptions for narcotics at home. But if your bottle of narcotics is accessible, this can become an avenue for inadvertent narcotic overdose (young kids), purposeful narcotic overdose (teens trying to ‘get high’ or commit suicide), or a target for thieves — other family members, care givers, and ‘friends’ are usually the culprits — sometimes to take the medicine themselves, sometimes to sell the medicine, or sometimes to give to other friends who may or may not be addicted.

What should you expect now?

Many healthcare providers in our area are starting to make changes in the way they are prescribing narcotics. You may notice differences from your primary care provider, the local urgent care centers, and the ER at the various hospitals.

You might start seeing urgent care centers and ERs giving fewer (yet still appropriate to treat your pain) supplies of narcotics for acute injuries. Your primary care provider might start replacing some of the more worrisome narcotics you take with safer narcotic alternatives.

They might hold discussions with you about weaning down from the current dosages you take. They may stop providing chronic pain management themselves and refer you to local pain specialists in an effort to increase your ability to function with better pain control.

Depending on your situation, they might start a process to get you off narcotics for good. Talk to your primary care provider. He or she will know if it is best for you to get off your narcotics completely, taper your dose down to safer levels, change your medication, or continue your current narcotic dosing.

Mark T. Horrocks, M.D., serves as the Chief Medical Officer for Health West and their eight locations in Southeast Idaho. He is from Pocatello and is a U.S. Air Force veteran.