5 Myths About Opioids That I Believed, Until I Needed Them

By Crystal Lindell

I had been enduring debilitating pain for months by the time I was given my first hydrocodone prescription for chronic pain in 2013.

At the time, I didn’t even know that hydrocodone was an opioid.

I had only heard of Vicodin being an opioid, and that was only because I lived near the Wisconsin border, where there are lots of Packer fans. The news that former Green Bay quarterback Brett Favre had to go to rehab for his Vicodin use was part of the local conversation.

But I had no idea that hydrocodone was the active ingredient in Vicodin.

It’s been over a decade now, and I have come to rely on opioids to manage the chronic pain I have in my right ribs, which is technically called “intercostal neuralgia.”

Before I needed opioids for pain relief, I used to buy into a lot of common cultural myths about them. Below is a look at what I used to believe, and how my views eventually shifted.

Myth #1: Only People Who ‘Misuse’ Opioids Have Physical Withdrawal

When I got my first hydrocodone prescription, I didn’t know it was a controlled substance with strict limits on how often you can get refills. And I definitely didn’t know that I would go through withdrawal if I stopped taking them abruptly.

My doctor prescribed 10mg pills and the label said: “Take 1-2 every 4-6 hours.”

So, that’s exactly what I did: Two pills every four to six hours.

My pain was (and still is) intense, but at the time I was still trying to keep pace with my pre-chronic pain lifestyle, which meant doing everything possible to push the pain away so that I could work and have a somewhat normal life.

But that meant that I ran out of my prescription early – something I was not aware was even a problem. When the doctor’s office said I would need to wait a couple days for a refill, I didn’t think it would be a big deal. Surely, I could easily ride out a couple of days without hydrocodone, no problem. After all, I had been taking them as prescribed.

Yeah. That’s not what happened. Turns out you actually cannot go from 40 to 80 mg of hydrocodone a day to zero.

I naively went to work that day, and still remember the trauma of spending the entire shift in the bathroom with diarrhea, nausea, horrible flu-like aches, and an odd feeling of anxiety.

Turns out, anyone can go through withdrawal from opioids. There is no magic spell that doctors can cast to give you immunity from it, just because you’re taking opioids exactly as prescribed. Your body doesn’t know the difference.

And that physical withdrawal is also not indicative that you have “a problem.”

In fact, it’s one of the reasons I think the entire conversation around addiction is often more nuanced than people want to admit. Taking a dose to combat withdrawal is often labeled as “misuse” – even though anyone can have withdrawal. 

And anyone who’s been through it knows that you’ll do almost anything to make it stop.

Myth #2: The Best Way to Stop Using Opioids Is Quitting Cold Turkey

There’s a common myth that the best way to stop using an addictive substance is to go cold turkey. That’s usually not true for things like nicotine and alcohol, and it’s also not true for opioids.

I used to believe in the common framing for this. That if you stopped using opioids cold turkey, made it through 72 hours of withdrawal, and then took just one dose, it would reset the whole process. You’d have to go through withdrawal all over again.

That’s not true. In fact, taking a dose after going longer than usual without one is often part of the tapering process that works best for getting off opioids. 

Ideally, you taper off slowly by lowering the amount you’re taking each day. So, if you’re on 40mg of hydrocodone a day, the best way to stop using it is to take 35mg daily for a week or so, then 30 mg, and so on until you get down to zero.

That’s the best way to reach success long-term and actually get off the medication, if that is your goal.

If you’re looking for more realistic tips on how to stop taking opioids, see “A Survival Guide for Opioid Withdrawal” that I wrote for PNN with my partner a few years ago. You can trust the advice because we learned it ourselves the hard way.

Myth #3: Opioid Doses Last as Long as Manufacturers Claim

I was eventually prescribed extended-release morphine pills for my chronic pain, and was told that each one should last a full eight hours. I was also told that hydrocodone should last four to six hours.

Unfortunately, neither of those things are true. So-called “extended release” morphine lasts about four hours, while the short-acting hydrocodone can stop working in just two or three hours.

So, it’s not wise to take another dose whenever your pain comes back. If you do that, you’ll end up running out of your prescription early every month.

Instead, you should expect to go through periods throughout the day when your pain starts to come back – and then you have to count down until your next dose.

Myth #4: Even One Dose of an Opioid Creates a High Risk of Addiction

Before I started taking opioids, I honestly believed the myth that just one 10mg dose of Vicodin could result in life-long addiction.

In reality, that’s nearly impossible. In fact, even among patients who take opioids long-term, the rate of addiction is still incredibly low. Estimates vary widely, but according to experts who have studied it, people who take opioids over long periods have addiction rates of 1 to 3 percent.   

Opioids are often framed as being so addictive that anyone can get hooked, so any exposure to them is dangerous and risky. In reality, low-dose opioids are incredibly safe, and most patients taking prescription opioids never develop an addiction to them

Myth #5: If Someone Is ‘Really’ in Pain, Doctors Will Prescribe Opioids

I am a little ashamed to admit this, but I used to think of a Vicodin prescription as an indicator of whether or not someone’s pain was actually severe.

If a doctor prescribed Vicodin to someone, that meant they were in “real” pain.

Boy, was I wrong.

While dealing with pain myself, I quickly learned that doctors will often ignore severe pain in patients because they don’t want to deal with the hassle of prescribing a controlled substance. That reluctance has only gotten worse since 2013. Much worse.

These days, doctors withhold opioid medication from post-op patients, cancer patients, palliative care patients, and even hospice patients. All of them are still in very real pain though.

Whether or not a doctor validates your pain with an opioid prescription has no bearing on how severe your pain actually is.

There’s a lot of misinformation about opioids and these are just some of the common myths perpetuated about them. While it’s understandable to believe them if you’ve actually never needed opioids, I encourage everyone to keep an open mind. After all, if you wait until you or a loved one needs opioids to see the truth, it may be too late.

11 Myths About the Opioid Epidemic

By Pat Anson, PNN Editor

If you’re a journalist, researcher or student interested in learning more about the opioid epidemic – or a patient or healthcare provider just trying to make sense of it -- a revealing new analysis debunks many of the myths and falsehoods being told about opioid pain medication.

“Misperceptions about the Opioid Epidemic: Exploring the Facts” was recently published in the journal Pain Management Nursing. Unlike most articles in medical journals, this one is not hidden behind a paywall – so the comprehensive and heavily footnoted research is available to everyone for free.

Co-authors Cathy Carlson, PhD, a professor at Northern Illinois School of Nursing, and June Oliver, APRN, a clinical nurse pain specialist at Swedish Covenant Hospital in Chicago, worked on the article for over four years, compiling research on 11 common myths about opioids that are repeated ad nauseam by the media, politicians, law enforcement and others.   

“We identified many more than this, but you have to put a limit on how long an article can be, so we narrowed them down to what we thought were the most important ones,” Carlson told PNN. “What concerned us is that this is all being presented by politicians and other important entities. It's just perpetuating the fear and sensationalizing it.”

Misperception #1 is the number of deaths attributed to opioid medication. The next time you see a statistic reported like “more than 63,600 people died of drug overdoses” in 2017, you should recognize that thousands of deaths were counted multiple times.  That’s because the Centers for Disease Control and Prevention doesn’t count “deaths” – it counts the number of drugs involved in overdose deaths.

The actual number of Americans who died from opioid overdoses in 2017 was not 63,000 – but about 49,000.

“If a person died of fentanyl, heroin and prescription opioids, that’s three deaths. We went from one person that actually died to three deaths counted in the categories because they put one under each,” explained Carlson. “It’s never known which drug they actually died from. So, we can never say prescription opioids caused the death. We can only say they were present at the time of death.”

Another myth is that more Americans die from opioid overdoses than in motor vehicle accidents, a claim first made by the National Safety Council (NSC) that’s been widely repeated in the media.  

“The opioid crisis in the United States has become so grim that Americans are now likelier to die of an overdose than in a vehicle crash,” The New York Times reported.

Carlson and Oliver say the NSC used a “confusing mismatch of statistical categories” to inflate the overdose numbers and make them more “attention grabbing.”

What are the actual facts? Nearly 30,000 Americans died in motor vehicle accidents in 2014, but the number of prescription opioid deaths was about half that.

“It doesn’t make as good of a story if you include it. We do believe it is purposely misleading,” says Carlson. “It’s the change theory. They have this need for change and they’re supplying it with statistics that sensationalize the issue.”

CDC’s Anti-Opioid Bias

Some of the other myths debunked by Carlson and Oliver include claims that the U.S. is the biggest consumer of opioids; that long-term use of opioid medication is not supported by evidence; that prescription opioids often lead to heroin use; and that statistics published by CDC are of high quality.

“We have a lot of issues with data collection. It’s not the CDC’s fault, they can only use what’s given to them. And states vary considerably in their accuracy in keeping statistics for overdose deaths,” Carlson said. “We’d like to see better data collection, especially through state and county medical examiners, so the statistics reported by the CDC are more accurate.”

But the CDC is not held blameless for the cascade of misinformation. Carlson says the agency has an anti-opioid bias that is repeated in many of its studies and policy statements.

“If you read what they do publish, they obviously have a viewpoint. It’s not a neutral viewpoint that gives you both good and bad. They are pushing you in a certain direction,” she said.

The CDC’s controversial 2016 opioid guideline – intended only for primary care physicians treating non-cancer pain – has been implemented as policy or law in dozens of states.

“I’m disappointed in what has occurred with CDC guidelines. Many people question the guidelines and that they weren’t always based on evidence,” Carlson said. “They were meant for primary care providers, not for pain management specialists, not for surgeons, and they’re making them apply to everyone. They are supposed to be guidelines. There are always people out on the Bell Curve and they don’t take that into consideration either.”

Carlson says Americans should be cautiously skeptical about much of the information they’re getting about the opioid crisis.  

“We’re mostly asking for discernment. To be aware of what you’re reading,” she said. “We want you to think about these statistics and look at the glaring gaps and reporting of statistics.”

Living in the Real World of Pain Care

By Ann Marie Gaudon, PNN Columnist

For years now, chronic pain patients in Canada and elsewhere have heard nothing but disingenuous and downright nonsensical information about opioid medication.

It’s beginning to feel like a cheese grater scraping on my very real nerves. No facts or just wrong facts from the government, regulators and the media. Are all of these players living in an alternate reality?

Rewind back to June 2, when pain patient and advocate Paul arranged a meeting between several physicians and pain patients. You can find out the whole story, as Paul told it to me, on this YouTube video. The sole doctor attending the meeting had one objective: To present (via PowerPoint no less) how “responsible and non-biased” leaders and physicians are when it comes to pain patients.

Indeed, the College of Physicians and Surgeons of Ontario put out “A Message to Patients Living with Chronic Non-Cancer Pain.” It tells us it is “never appropriate to abandon a patient on long-term opioid therapy or abruptly cut off or threaten to cut off a patient’s medication” and that “patients taking prescribed opioids should not be stigmatized.”

In its guideline for accepting new patients, the college also tells us that “physicians must accept new patients in a manner that is fair, transparent and respectful…”

However, doctors live in their own reality, far apart from their college. In the real world of pain care where I reside, doctors everywhere and every day: 

• Refuse to prescribe opioid medication for their patients

• Abandon pain patients altogether because they need opioid medication

• Drastically taper opioid medication against their patients’ wills and to the detriment of their health and quality of life

• Stigmatize and discriminate against patients, who are labeled as addicted and in need of treatment

• Refuse to accept new pain patients if they need opioid medication 

This picture of a doctor's window in Ontario reflects that reality:

What we experience in the real world doesn’t have any relation to what we are being told. I recently listened to a fascinating interview with Pulitzer Prize-winning journalist and author Christopher Hedges, who spoke about a “post-truth phenomena.”

“The facts don’t matter, we’re bombarded with lies…. Once facts are interchangeable with opinions, then it becomes an Alice in Wonderland kind of experience where nothing makes sense,” said Hedges

We are now living that experience, complete with mythology. The myth about pain patients is that they are cared for by an ethical medical establishment according to their own unique needs, and also recognized as valuable citizens deserving of human rights by a responsible government.

Mythologies were created by ancient peoples trying to make sense of the world. If you live in an alternate reality, you would need to create these narratives so that your distorted reality made sense to you.

For those of us whose bodies are pained and whose minds remain firmly planted on this earth, the myths about opioids are misrepresentations at best, pure hypocrisy and deceit at worst.

Sometimes peoples of the past got it wrong, but sometimes they got it right. Seventeenth century philosophers used the fundamental nature of knowledge and their reality to make sense of the world. Voltaire cautioned us not to take the myths too seriously.

"Those who can make you believe absurdities, can make you commit atrocities."

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for 33 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

10 Myths About the Opioid Crisis

By Roger Chriss, Columnist

There is no shortage of false statements being made about opioids. As the overdose crisis worsens, old and debunked claims reappear, while new claims rise up alongside them. Pundits, politicians and even physicians are perpetuating them, despite all evidence to the contrary.

So let’s set the record straight in order to promote an informed dialog about opioid medication, chronic pain, and the opioid crisis.

Myth 1: America has 5% of the world’s population but uses 80% of the world’s opioids.

Numerous politicians, such as Missouri Sen. Claire McCaskill and former New Jersey Gov. Chris Christie, as well as many journalists, have made this statement. It is demonstrably false.

In fact, the U.S. only uses about 30% of the world’s opioid supply. That estimate includes the addiction treatment drugs methadone and buprenorphine, both of which are opioids.

Myth 2: 80% of heroin addicts began by abusing prescription opioids.

This myth is pernicious because it is based on a kernel of truth. The number is correct but the implication is wrong. Only 4 to 6% of people who misuse prescription opioids go on to use heroin. And the number of people who start heroin without taking prescription opioids first has been rising in the past year.

Myth 3: Addiction starts with a prescription.

This claim persists despite decades of data to the contrary. A 2010 study found that only one-third of 1% of chronic pain patients without a history of substance abuse became addicted to opioids during treatment. Most abuse begins when people take medication that was not prescribed to them, using pills that were stolen, purchased illegally, or obtained from friends and family members.  

Myth 4: Opioid use leads to pain sensitization or ‘opioid induced hyperalgesia.’

Addiction treatment specialists like to repeat the claim that long-term opioid use makes patients hypersensitive to pain. But hyperalgesia is poorly understood and often confused with opioid tolerance. One study found that chronic pain patients on opioids had no difference in pain sensitivity when compared to patients on non-opioid treatments.    

Myth 5: Opioid overdoses are killing 64,000 people per year.

Nearly 64,000 Americans died from drug overdoses last year, according to the CDC, so that part is true. But opioids were involved in only about two-thirds of those deaths – and most of those overdoses involved heroin and illicit fentanyl.

Myth 6: Reduced opioid prescribing will end the overdose crisis.

Reduced prescribing is clearly not working.The number of opioid prescriptions has been in steady decline since 2010, yet fatal overdoses have risen sharply ever since.

Myth 7: Medical cannabis will cure the opioid crisis.

This is a recurring myth, made popular again in 2017. Unfortunately, not only does the recent data show that medical cannabis is not helping in states where it is legal, the underlying assumption of this myth is that chronic pain care is driving the opioid crisis. This is not the case.

Myth 8: Banning opioid medication will fix the opioid crisis.

This was put forth again early in 2017 by New Hampshire attorney Cecie Hartigan. Setting aside the problem of banning illegal drugs like heroin and fentanyl analogues (they are already banned), opioids are simply too medically useful to give up. Moreover, prior experience with drug bans, from Prohibition to the current overdose crisis, shows that bans do not stop misuse or addiction.

Myth 9: There are lots of ways to treat chronic pain

This myth has become increasingly popular as states, medical facilities, and health insurers pursue policies to reduce opioid prescribing. Although some of these methods, from physical therapy to spinal cord stimulators, may prove helpful, that misses the fundamental point. Chronic pain disorders are so horrible that all effective options, including opioid therapy, need to be on the table.

Myth 10: Opioids are ineffective for chronic pain.

This is the biggest myth of all. There is an abundance of high-quality research showing that opioids can be effective for some forms of chronic pain. Here’s a partial list of recent studies:

• Benefits and Risks of Opioids in Arthritis Management

• Opioids for chronic pain: new evidence, new strategies, safe prescribing

• The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

• Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Adding to these studies is a recent review in Medscape, in which Charles Argoff, MD, a professor of neurology at Albany Medical College, said that “in multiple guidelines and in multiple communications, we have a sense that chronic opioid therapy can be effective."

New myths appear regularly, but these persist despite all efforts to counter them. Like an ear-worm or viral meme, they cannot be eliminated. The only defense is knowledge.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.