Although most Americans say they would prefer being treated with something other than an opioid medication to relieve pain after surgery, few of them talk to their health care provider about it, according to the results of a survey released Tuesday by the Mayo Clinic.
The survey also found that many Americans have some stunning misconceptions about opioid addiction, including beliefs that the greatest danger is to people living in urban areas and that that they themselves are not personally at risk.
“It’s important that the public understand that there’s a risk with taking these medications, and that it’s not just a risk for everyone else,” said Dr. Helen Gazelka, a pain specialist and chair of Mayo Clinic’s Opioid Stewardship Program, in an interview with MinnPost. “Anyone who takes an opioid can be at risk of an addiction.”
Indeed, health officials estimate that about one in four patients prescribed opioids for chronic pain will go on to misuse the drugs, and about one in 10 will become addicted to them.
The United States is in the midst of a national opioid crisis, in which prescription opioid medications have played a major role. In 2016, opioid overdoses claimed more than 42,000 deaths — more than any other year on record, according to the Department of Health and Human Services.
About 40 percent of those deaths involved a prescription opioid.
A reluctance to ask questions
The new survey is the latest in the Mayo Clinic National Health Checkup series, “a kind of litmus test we do of Americans’ understandings and perhaps even their opinions about matters in health care,” explained Gazelka. The survey on attitudes regarding opioids was conducted in July and involved a nationally representative sample of 1,270 adults living across the U.S.
Of the people surveyed, 94 percent said they would opt for an alternative treatment — such as physical therapy, over-the-counter pain relievers, acupuncture or medical marijuana — to avoid opioid pain medications. Most (34 percent) cited fear of addiction as the main reason for wanting to forgo the opioids.
But only a quarter of the respondents said they had actually discussed such alternatives with their health care provider when the need came up.
“In spite of how good of advocates we’ve become for ourselves and how much we Google things to look them up, patients still sometimes have a reluctance to question their provider,” said Gazelka.
The survey also found that a significant proportion of Americans harbor several misunderstandings about opioids and the opioid crisis.
A large majority (67 percent) said, for example, that they were confident that they would not become addicted to opioids if prescribed the drugs for the treatment of chronic pain. Yet, although it’s true that not everyone who takes opioid pain medications becomes addicted, experts say there is no way to tell who will get hooked.
“I think there may be a human tendency to think that it might happen to someone else, but not to me,” said Gazelka. “But that’s certainly not true. “There’s a risk of addiction for everyone who uses opioids. Some people may be at higher risk, but there’s certainly a risk for everyone.”
Another misconception uncovered by the survey has to do with where the opioid crisis is occurring. When asked where the people most at risk for becoming addicted to opioids live, the largest proportion of the survey’s respondents (37 percent) said urban areas.
Yet the reality is that small towns and rural areas have been hit even harder than cities by the crisis. In 2017, the Centers for Disease Control and Prevention (CDC) announced that the rates of deaths from drug overdoses in rural areas had surpassed those in urban areas.
Acute vs. chronic pain
The survey also found that most Americans (79 percent) believe that opioids are primarily intended for the treatment of chronic pain. Thirty-one percent of the survey’s respondents said they had used prescription opioids for that purpose.
Yet, as the Mayo Clinic points out on its website, research has shown that opioids are most effective for acute, or short-term, pain from a traumatic injury, such as a broken bone or surgery. In those cases, the drugs are supposed to be used at the lowest dose possible and for only a few days.
Studies have also found that patients who take opioids for chronic pain become tolerant to the drugs over time, diminishing their effectiveness. Patients then need ever-increasing doses of the drugs to achieve the same amount of pain relief — a situation that can lead to dependence and addiction.
“Many times chronic pain patients will find that opioids simply don’t work as well anymore, and they really do need other options for their pain management,” said Gazelka. “They often feel better when they get off of the opioids.”
In addition, the survey found that Americans are not following safe practices when disposing of their unused opioid medications. Only one in four of the respondents said they had received instructions from their health care provider or pharmacist about what to do with leftover pills, and about the same low percentage said they had participated in a drug-disposal program.
Some of the survey’s respondents said they had flushed unused opioids down the toilet (17 percent) or had tossed them in the garbage (17 percent). Most (30 percent) said, however, they had kept leftover pills in their home medicine cabinet — a dangerous practice because the drugs might then get into the hands of young children or someone who is already addicted to them.
The safest way to dispose of unused opioid medications — or other prescription drugs — is to drop them off at one of the sites approved for such collections by the Drug Enforcement Administration (DEA).
The DEA also sponsors a “National Prescription Drug Take-Back Day” twice a year. The next one is this Saturday, Oct. 27. You can find a collection site near you by simply plugging your ZIP code into the NEA’s website.
“That’s a great way for people to dispose of unused medications,” said Gazelka.
FMI: You can read more about this and other Mayo Clinic National Health Checkup surveys on the Mayo Clinic’s website.