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Opioids, Opiates and Other Options

Bottle of opioids.

October 21, 2019

When the Sumerians of southwest Asia wrote about the "joy plant" in 3400 B.C., they weren't just happy to gaze upon the striking red flowers. This is the earliest known reference to the opium poppy, and the Sumerians discovered that the milky fluid dripping from the plant's broken seed pods had narcotic effects when dried and consumed.

Opium and its naturally derived pharmaceutical cousins, morphine and codeine, are collectively known as "opiates." As scientists discovered how to produce synthetic opiates, which include the drugs hydrocodone, oxycodone and fentanyl, the class of drugs known as "opioids" developed.

Opioids vs. opiates

"Opioids work on the same pain receptors as opiates," says Dawood Sayed, MD, who specializes in pain management at The University of Kansas Health System. Meanwhile, he adds, "narcotics" typically refer to illegal substances.

"When a physician prescribes an opioid, it's not referred to as a narcotic," he notes. "Methamphetamine is a narcotic; synthetic fentanyl sold on the streets is a narcotic; but a drug prescribed by a doctor for pain control is not a narcotic."

Dr. Sayed and his colleagues only prescribe opiates under strict conditions, including pain related to cancer, an acute injury or surgical recovery.

"We do not use opiates unnecessarily," he said. "But many people suffer from poorly treated pain and many are being weaned off opioids and need to have their pain properly managed. Their first step should be to see a board-certified pain management specialist. We maximize pain management strategies, usually without using opioids or opiates."

People who have chronic pain have options other than opioids … A pain management specialist can offer new treatments that can improve your quality of life without drug dependence. – Dawood Sayed, MD

Pain management

Targeted drug delivery

For example, a patient with chronic back pain may benefit from targeted drug delivery. Physicians implant a medication pump in the abdomen or back. The pump infuses medication through a very thin tube directly into the patient's spinal fluid. This medication may or may not include an opioid, depending on the individual's specific condition. However, if physicians deploy an opioid through this method, it binds directly to the pain receptors at the site instead of being delivered through the bloodstream.

"These targeted systems allow us to choose the best drug for the pain without the side effects and dependence that occur when someone takes the drug orally or by injection," Dr. Sayed said. "And by hitting the pain receptors directly, we need only a tiny fraction of the amount we would need to give by mouth to see the same level of pain relief. There's no risk of abuse when the physician is measuring these very specific doses."

Targeted drug delivery is an option for an increasing number of patients, including those who have cancer-related pain, have failed to experience relief with other treatments, and want or need a nonsurgical option.

Options in pain relief

Another newer treatment available to manage chronic low back pain is the Intracept® procedure. The University of Kansas Health System was one of the first hospitals in the world to offer this treatment, which was commercially launched in April 2018. "The chief indication for this procedure is degenerative disc disease or pain that emanates from the lumbar discs between the vertebrae. This is a very common source of pain and has historically been one of the most challenging types to treat," Dr. Sayed says.

Intracept targets a nerve within the vertebrae that creates sensation in the discs. Under X-ray guidance, the physician accesses the nerve and cauterizes it. With the nerve destroyed, the pain is eradicated without the use of drugs.

"People who have chronic pain have options other than opioids," Dr. Sayed says. "Technologies in interventional pain management are quickly developing. A pain management specialist can offer new treatments that can improve your quality of life without drug dependence.

For comprehensive pain management care, call 913-588-1227.

Choosing the right treatment requires a comprehensive evaluation. For some people, a combination of approaches might be recommended for longer-lasting pain relief. If you are enrolled in a managed care plan, your treatment at The University of Kansas Health System may be covered by insurance. Before scheduling an initial appointment, call your health plan/insurance company and ask if you have access to our services.

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