-By Tucker Woods
Tucker Woods, DO
As we begin a new year, we continue the fight against an old problem: the opioid crisis.
While tremendous strides have been made to put a dent in opioid deaths, we still have a long way to go. The CDC reports that there were an estimated 107,622 drug overdose deaths in the United States in 2021. That is a 15 percent increase from the prior year.
To me, these are not just statistics. Throughout my career as an ER physician, I have seen far too many lives lost to addiction. Fighting the opioid epidemic has become a passion of mine and I plan to continue that fight as the new chair of the emergency department and associate medical director of Lenox Health Greenwich Village (LHGV).
While the facility is already well equipped to treat those in the throes of addiction and withdrawal, our Emergency Department is also very focused on preventing one from developing an addiction at the root by treating patients in pain with more effective and non-addictive opioid alternatives.
During the ‘90s, healthcare providers prescribed an excessive number of opioids to patients who were experiencing pain. Opioids provided quick relief to those with injuries, illness and chronic pain. Now, with a better understanding of the negative effects of opioids, the healthcare industry realizes how these often well-intended decisions were potentially deadly. Traditional opioids like morphine, oxycodone, and fentanyl raise dopamine levels in the brain to unnatural levels. When this is done repeatedly (a 30-day prescription, for example), the opioids will strengthen the pleasure/reward part of the brain called the nucleus accumbens and this part of the brain overpowers the part of your brain in charge of keeping you safe — the frontal lobe.
The frontal lobe area of your brain controls executive functioning, decision making, rationale thinking and judgement. The repeated use of opioids causes unnatural dopamine levels in the pleasure-reward area of the brain and sends signals that “this feels good; let’s do more,” and the mind begins to develop habits and cravings that become more escalated and serious over time. In other words, when you become addicted to opioids, your brain has becomes “rewired”. Taking the drug soon becomes absolutely necessary to prevent withdrawal. When the addiction becomes severe, the decision to obtain more opioids, rather than participate in usual life activities, becomes the sole focus as a consequence of your brain being “rewired” and you developing opioid use disorder (aka addiction to opioids).
As the addiction becomes stronger, and prescription opioids are no longer available or becomes too expense, many turn to more illicit alternatives, like heroin & fentanyl, to raise those dopamine levels and prevent painful withdrawal.
The dangers of chronic opioid use are now well documented. It is now abundantly clear that we need pain management options that won’t put a patient at risk of developing addiction. Physicians and researchers have discovered better medication options that provide the same — or even more effective — pain relief as opioids, minus its addictive qualities. For example, in lieu of morphine or hydromorphone, which are commonly used to treat acute pain from kidney stones, we can prescribe acetaminophen, IV fluids, an intravenous anti-inflammatory called ketorolac and a medication called tamsulosin, which helps in the passage of kidney stones. Another interesting ER treatment option we’ve discovered to be even more effective than opioids for kidney stone pain is intravenous lidocaine, a drug that’s traditionally used to treat a dangerous heart rhythm called “V-Tach”. Under my leadership, the LHGV emergency department will be adding more “tools to its toolbox” and use innovative methods to treat other common conditions like musculoskeletal pain, lower back pain and headaches.
By working as an ER doctor for over 2 decades, I have had a front row seat to addiction.
I have seen so many lives ruined and lost to addiction and it has been a sobering experience. I hope that we have a future world where we can put this epidemic behind us. Non-addictive opioid alternatives is one piece of that puzzle and can lead to an enhanced patient experience.
Throughout my career, I have had many patients who say they want to forgo pain medication because of their fear of opioids, and I have to say those fears are warranted.
Opioids can lead anyone down a dark and deadly path; no one is immune to addiction.
However, it is my pleasure to inform patients in our emergency department that they do not have to forgo pain under our care. We have alternatives to opioids. They can rest assured we care for our patients’ wellbeing during their ER visit and we will set them up to succeed long after.
Tucker Woods, DO is the chair of the emergency department and associate medical director of Lenox Health Greenwich Village.