We’re in the midst of an opioid epidemic. Opioids include heroin as well as Vicodin, Percocet, Oxycontin, morphine and fentanyl. The associated “epidemic” means that an abnormally high number of Americans meet criteria for opioid use disorder (OUD) and are dying from overdoses at record numbers.
The criteria for OUD include taking opioids in larger amounts or over a longer period of time than intended; intense cravings for or desire to use opioids; continued use of opioids despite persistent or recurrent social, interpersonal, legal or occupational problems; and withdrawal symptoms such as nausea, diarrhea, pain and agitation when the pills are not taken.
It may help to understand how we got here when considering that in 2012 alone, 259 million opioid prescriptions were written by U.S. prescribers — that’s enough for every American adult to have his or her very own bottle of pain pills.
Deaths by opioids have outpaced deaths by more traditional killers, such as heart disease, car accidents and guns, making this epidemic the first medical system-derived epidemic in human history.
Conventional/Traditional Treatment of OUD
Treatment of OUD is first concerned with the management of acute withdrawal symptoms, which typically last between one and three weeks, and then the longer, more protracted post-acute withdrawal symptoms (PAWS), which can last a year or longer. This is largely achieved with a combination of medications such as buprenorphine and naltrexone; group, individual and family counseling; and peer support. While some medications can be extremely helpful in managing symptoms, the choice of intervention, regimen and duration of therapy are important considerations in providing individualized care to patients.
Naturopathic medicine can be very beneficial in gently assisting the body back into equilibrium once the opioids have been reduced or removed. The longer an individual uses opioids, the greater the likelihood he or she will have to deal with one or more downstream effects of the opioids on body systems. These include bowel dysfunction — of which constipation is the most prevalent; insomnia; nausea and vomiting; and low testosterone in men and women and low estrogen levels in women, causing reduced sexual function, decreased libido, infertility, mood disorders, osteopenia and osteoporosis. Overnight sleep studies, therapeutic nutrition and hormone replacement strategies may all be useful in returning the body to balance after opioids.
Complementary and alternative modalities such as massage therapy, aromatherapy and acupuncture have proven efficacy in the adjunct treatment of pain, anxiety, insomnia, poor appetite and depression. These treatments also commonly add to patients’ overall sense of well-being, which is an all-important ally for patients dealing with acute and post-acute withdrawal symptoms.
Medically-supervised cannabis is another tool providing tangible benefits for opioid-dependent individuals. Cannabis is particularly useful in providing symptomatic relief in patients undergoing acute withdrawal. Acute withdrawal symptoms such as body aches, insomnia, anxiety and agitation, nausea and vomiting, lack of appetite and more can occur every time the opioid dose is reduced and almost certainly occurs once opioid use has been stopped altogether. Cannabis’ greatest benefit in treating post-acute withdrawal symptoms is in decreasing cravings, which are the No. 1 predictor of relapse. It also helps with other post-acute withdrawal such as insomnia, anxiety and increased sensitivity to stress.
Ravi Chandiramani, N.D. is the medical director and co-founder of Blue Door Therapeutics, an outpatient opioid treatment center that combines the use of medical cannabis with traditional medicine, alternative and naturopathic therapeutics as an exit strategy for opioid dependence; his holistic approach to the treatment of substance use disorders has been refined over a decade of direct clinical experience with more than 1,000 patients