These 10 Factors Linked To Increased Risk Of Opioid Overdose In Chronic Pain Patients

October 26, 2023 / Thomas Cohn, MD

Chronic pain patients who take opioids as part of their treatment plan always need to take steps to mitigate their risk of dependence or overdose, but that’s especially true for patients facing 10 specific factors, according to a new study out of Canada.

The study, published in the Canadian Medical Association Journal (CMAJ) and led by researchers at McMaster University, found that the risk of fatal and non-fatal opioid overdose by prescription medication increased up to sixfold in patients dealing with certain risk factors or predictors. To get a better understanding of some of the predictors of fatal and nonfatal overdoses in patients managing prescription medications, researchers looked at data from more than 24 million patients across Canada, the US and the United Kingdom. Researchers identified a total of 103 predictors, but 10 stood out from the rest because they showed a risk increase of two to six times compared to patients who didn’t have these factors.

According to the study, the 10 biggest predictors of fatal and nonfatal opioid overdose for patients taking prescription medication are:

High-dose opioids
Use of multiple pharmacies
Multiple opioid prescribers
Fentanyl prescription
Current substance use disorder
Depression
Bipolar disorder
Other mental illness
History of opioid overdose
Pancreatitis

The findings are important because they can help us map out chronic pain care and take different approaches in patients who may be considered high risk. For example, mental health screenings and questionnaires should absolutely become standard practice for patients dealing with a chronic pain condition. As we’ve said many times on the blog in the past, chronic pain is much more than just a physical issue. It also weighs heavily on your mind and your emotions, and if a doctor isn’t working to also control for these aspects, patients may end up depressed, anxious or facing other mental health issues that drastically increase their risk of overdose.

It’s also important that doctors work to provide a comprehensive treatment plan that involves more than just an opioid prescription. Opioids inherently become less effective as our body gets used to the medication, so patients may start to take larger doses to find the same level of relief. Needless to say, this greatly increases their risk of accidental overdose. Treatment tends to be more effective and patients can actually wean off opioids when they pursue other active techniques, like exercise, physical therapy, sleep improvements and better nutrition. Pain is rarely effectively managed through just one specific type of treatment, so find a provider who is willing to develop an individualized treatment plan to give you the best chance of overcoming your pain issue.

Whether you’re considered low-risk, high-risk or somewhere in between, we want to be your resource for overcoming a chronic pain condition. Nobody plans to become addicted to opioids, and it can happen to even the best of us, so be aware of the risk factors and connect with a provider who can help counter these potential predictors. For more information, or to set up an appointment with Dr. Cohn, give his office a call today at (952) 738-4580.

NIH Issues New Plan To Tackle Opioid Crisis

June 12, 2018 / Thomas Cohn, MD

Earlier today, the National Institutes of Health issued its new plan for taking on the opioid crisis in America. The plan is titled Helping to End Addiction Long-term, or HEAL. The plan has two main goals:

Fund projects that will help develop or facilitate treatments for opioid addiction and overdose.

Fund projects that are meant to improve the management of pain through research into how acute pain transitions to chronic pain, as well as research nonaddictive pain treatments.

“Like most other pioneering scientific initiatives, HEAL will focus on a range of objectives, from short-term goals to research priorities that will take longer to bear fruit,” the authors wrote. “Yet, all will be aimed at the same ultimate vision: a nation of people with far less disabling pain and opioid addiction.”

Treating Addiction and Overdose

For starters, researchers want to take a closer look at how we’re currently battling addiction and overdose. Through their research, they found that there are three main drugs prescribed to help wean people off of opioids. Researchers found that most people living with opioid addiction never get started on these treatments, and of those that do, half of them relapse within a year.

“Research to reformulate these medications to improve adherence, as well as to develop new, more flexible therapies, is needed to help those who have opioid use disorder,” the authors wrote.

The NIH also wants to fund efforts to create better drugs for reversing overdoses, especially among individuals who overdose on fentanyl. The current reversal drug is naloxone, and it isn’t as effective as experts want it to be when the overdoser has other drugs or alcohol in their system.

Treating Addiction Before It Starts

The second part of the initiative focuses on coming up with better pain treatment plans and stopping pain before it become chronic. This is what we’ve been championing for on the blog for years. We need to treat addiction at the source, and the underlying reason behind addiction is unaddressed pain. We need to find better ways to treat and manage pain conditions so they don’t progress to the point where opioids are needed.

Funding for both parts of the plan will come from a $500 million grant that Congress set aside for the NIH in the 2018 budget

Minnesota Researching Opioid Alternatives

October 19, 2017October 25, 2017 / Thomas Cohn, MD

Even if you’re not a chronic pain sufferer, you’ve probably heard about the “opioid crisis” here in America. Overdoses and accidental deaths from pain medications have skyrocketed in recent years, and things are only getting more divisive as we try to put an end to overdoses. There are too many competing interests working against one another. For example:

You have a government officials who are supported by money from big pharma.
You have big pharma, who is making a lot of money through the increase in prescription medications.
You have some overworked doctors who jump right to pain pills instead of taking more time to find solutions.
You have some chronic pain patients who take the idea of opioid regulation as a personal offense.

That’s simply too many interests pulling in too many directions, and chronic pain patients are suffering because of it. However, Minnesota has recently taken some tangible steps to look for alternatives to opioids.

Opioid Alternatives

Earlier this month, leading medical minds met in St. Paul to talk about some alternatives to pain management to help combat the opioid epidemic. They discussed a range of possibilities, including such options as:

Electrotherapy
Radio-frequency ablation
Cryogenics
Implantable spinal cord stimulators
Epidural injections
Medical gadgetry
Chemical compisitions
Physical therapy techniques

The goal of the meeting was to help lawmakers understand that they have the ability to influence how research funding can be allocated for some of these alternatives, and that the future of these pain management techniques are worth exploring.

Dr. Clarence Shannon, an anesthesiologist who works in the University of Minnesota Pain Clinic in Minneapolis, spoke about the summit and how it’s important to test out potential treatment options before jumping to opioids.

“It’s a stair-step approach that I like to use: nonsteroidals, anti-epileptics or neuropathic medications. We’ll try radio-frequency ablation if we can. We’ll do nerve blocks. And then we’ll move up to the things like the implantable devices,” Shannon said.

These alternatives aren’t perfect solutions, and while they do have some drawbacks, the downsides are much less threatening to a patient’s health than the negative consequences of opioids. Medical devices may cost more, may be more prone to malfunction and may require battery changes, but those downsides are worth it if they can protect us against opioid abuse and overdose.

A Good Start

The pain management summit was a good start, but we need to also focus on getting everybody on the same page. We need to the government to look at the bottom line in terms of lives saved and not dollars earned. We need to take the burden off doctors so they don’t feel the need to fall back on opioid prescriptions without first exhausting some other options. We need chronic pain patients to realize that searching for alternatives does not mean the government is going to come and take away their prescriptions that they are using responsibly to manage their pain.

We need to work together to find a solution, or we can’t expect anything to change. Hopefully Minnesota can be at the forefront of that change.

Signs of a Pain Medicine Overdose

October 9, 2013November 17, 2015 / Thomas Cohn, MD

All medications can cause problems when not taken correctly. Pain medications, even those sold over-the-counter, can have deadly consequences when overdosed. Having the right balance of medications for pain and not having significant side effects is the trick that a good pain physician will try to develop for a patient. It is always necessary to keep track of the patient’s medications, even nonprescription to monitor for adverse reactions. This article will discuss the signs of overdose for opioids, over-the-counter meds, and neuropathic medication.

Opioid Overdose

Narcotic/opioid medications have had the most publicity concerning overdose. These are the drugs like Percocet, Vicodin, Oxycodone, and Morphine. These drugs are powerful analgesics and are commonly given for severe pain. Side effects are common and include:

Upset stomach
Constipation
Nausea
A tired or “drugged” feeling

Signs of an overdose of opioid medications include:

Excessive tiredness & sleeping
Low pulse and blood pressure
Decreased breathing

Significant overdose may be treated with a medication called Narcan to reverse these effects. There is a push for all emergency responders to carry Narcan since overdose of these medications is becoming common due to drug abuse.

Neuropathic Medication Overdose

Neuropathic medications include many antidepressants (like amitriptyline, and Cymbalta), and seizure medications (such as gabapentin, Topamax, and Lyrica). These medications often have annoying side effects such as:

Dry mouth
Short term tiredness

If they cause significant changes like memory problems or worsening depression, talk to the physician about problems. Overdose with antidepressants such as amitriptyline can cause severe respiratory problems and needs to be treated with acute hospitalization.

Over the Counter Medication Overdose

Over-the-counter medications like acetaminophen and ibuprofen also have problems if overdosed. Anti-inflammatories like ibuprofen can cause ulcers and stomach bleeds in some people, even at normal doses, but these affects can be treated. Acetaminophen however is very dangerous if taken in to high of a dose. Taking 1.5 times the recommended amount can lead to liver failure and even death. If you have been taking too much acetaminophen the eyes and skin can turn yellow indicating liver damage, and must be treated promptly by a physician.

Pain medicines can be very helpful in managing symptoms. Like all drugs, they need to be taken only as directed. Make sure your physician knows all the medications that you are taking. Additionally, be sure to talk to your doctor about whether you can eat certain foods, or drink alcohol with your medication. If side effects of a medication are a problem, talk to the doctor before stopping the medication, sometimes these drugs need to be tapered off or just changed slightly to be helpful.