Pain and Opioid Use Disorder
The Indian Health Service (IHS) works to promote safe and effective therapies to help patients and providers optimally manage pain and stop the inappropriate use of pain medications. Prolonged opioid prescribing at high doses or in combination with certain psychotropic medications and/or alcohol inevitably leads to dependence and overdose risk. Over the last decade, prescription drugs, especially opioid pain medications, have been increasingly implicated in drug overdose deaths. The CDC has identified addiction to prescription pain medication as the strongest risk factor for heroin addiction. Reducing and preventing opioid misuse is a national clinical and public health priority. IHS supports a a holistic, comprehensive, and interdisciplinary approach to address all facets of pain management while reducing medication misuse and diversion in our communities.
What Is Chronic Pain?
Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life. Chronic pain is persistent, typically 3 months or more, and exists beyond an expected time for healing. The cause of pain may not be removable or otherwise treated. It may occur despite generally accepted medical treatment.
What Are Opioids?
Opioids are illicit drugs, such as heroin, as well as some prescription medications used to treat pain. Examples of prescription opioids include: morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine. Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they minimize the body’s "reward centers" in the brain which can also trigger other systems of the body, such as those responsible for regulating mood, breathing, and blood pressure.
A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea, vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop.
Throughout the site, we refer to opioids, which are natural or synthetic derivatives of opium that act on the central nervous system to relieve pain. The term "opioid" is used to distinguish pain medications from illegal narcotics used to induce euphoria.
What is Dependence?
Dependence refers to the normal adaptive state that results in withdrawal symptoms if a medication is abruptly stopped or decreased.
What is Opioid Use Disorder?
The DSM-5 defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two out of 11 criteria within a 12-month period.
Opioid Use Disorder DSM V Diagnostic Criteria[PDF - 101 KB]
Appropriately prescribing opioid medications and managing chronic pain are critically important within the Indian Health Service. In February 2018, the IHS released the revised agency policy on Chronic Pain Management.
The information available on this site is intended for licensed health care professionals and adult patients. However, this site is not a substitute for clinical judgment and does not offer medical advice. Patients should consult their physicians or, in serious cases, contact emergency services. Health care professionals should confirm information available on this site with other sources.
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