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GIFFORD-JONES: With opioids, less is usually better

Most readers agree with Dr. Gifford-Jones that terminally ill patients should have easier access to heroin to relieve them of their pain.
Many North Americans are taking medicines for the long run when they’re only intended for the short run. This can have a huge impact on well-being. - 123RF Stock Photo

What will be your 2019 New Year’s resolution? Losing weight? Finally deciding to get off the couch and get more exercise?

Hopefully to convince yourself smoking means 20 years less life? These are all healthy ways to start the year. But I’d like to add another New Year’s resolution. Many North Americans are taking medicines for the long run when they’re only intended for the short run. This can have a huge impact on well-being.

The January Reports on Health claims that one-third of Americans over the age of 55 take too many medications. Michael Steinman, an expert on aging and professor of medicine at the University of California, San Francisco, says: “Some medicines are more effective and safest when you use them for a specific and limited period of time.”

So, what are some of the major drugs being taken too long, and what can happen when they are?

Dr. W. Gifford-Jones
Dr. W. Gifford-Jones

Most readers don’t need Professor Steinman or me to tell them there’s a raging lethal epidemic of opioid drugs. Chad M. Brummett, associate professor of anesthesiology at the University of Michigan, says this addiction can happen in as little as seven days.

A study by Brummett, published in the Journal of the American Medical Association Surgery, says, “six per cent of patients prescribed an opioid drug after surgery for minor procedures are still taking them six months later.” And, according to the Centers for Disease Control and Prevention, taking an opioid for longer than three months increases addiction risk 15 times.

This information should be posted on the front door of every doctor’s office. Patients should stop being wimps after minor surgery and use commonsense about this potent painkiller. Experts say opioids should be the last resort for chronic or minor pain, but if prescribed, it should be a low dose for a short period of time. And that doctors should suggest other pain options such as Advil, Motrin and Aleve.

It’s also hard to believe that 14 per cent of those between 65 to 80 years of age use either prescription or over-the-counter sleeping aids. Dr. Raj Dasgupta, assistant professor of medicine at the University of Southern California, reports these medications have greater effect on older people making them more susceptible to confusion and memory problems. They also double the risk of falls and hip fractures in the elderly.

Authorities claim the better solution is referral to a sleep therapist. This is easier said than done, as many communities don’t have such caregivers to calm the mind. And I’ve found in practice that sleep labs, even after numerous tests, still can’t solve this trouble. I’ve helped some patients by telling them to get up earlier in the morning, be active throughout the day and read a book until they fall asleep.

Society also needs a wakeup call when 17 million North Americans require daily heartburn drugs such as Nexium, Prevacid and Prilosec. Dr. Nicholas Shaheen, chief of gastroenterology at the University of North Carolina, reports “doctors start patients on these drugs and do not advise stopping them even when symptoms get better.”

Taking these drugs for a year or more increases the risk of heart attack, dementia and bone fractures. Moreover, a study published in the Journal of the American Society of Nephrology in 2016, showed that patients on heartburn drugs for five years had a 28 per cent higher risk of developing chronic kidney disease.

The solution necessitates playing the same song over and over to get the message across. Namely, it’s prudent to take the lowest effective dose for the shortest period of time. This means tapering off slowly when symptoms subside. Or switch to a less potent drug at this time, such as Tums, Pepcid or Zantac.

Are you feeling congested and using an over-the-counter decongestant spray? Sprays shrink nasal tissue quickly and are less likely than oral decongestants to increase blood pressure. But they should be used for only three days in a row. Studies show many people use them daily for a year. This can result in dependency on them which can also increase heart rate.

All the best for 2019 and remember that with drugs less is usually better.

Dr. W. Gifford-Jones is a syndicated columnist whose medical column appears in The Guardian every Tuesday. Check out his website, docgiff.com, which provides easy access to past columns and medical tips. For comments, readers are invited to email him at info@docgiff.com. He can also be found on Twitter @GiffordJonesMD.

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