To end the opioid crisis we must understand pain

For the first time in nearly 30 years, deaths from opioid overdoses decreased in 2018. We can't point to a single reason for the decline. But almost certainly it's due in part to changes in prescribing that have reduced the number of pills available.

The medical and dental clinics in the HealthPartners system alone have cut the number of opioid prescriptions by 50%. That translates to a whopping 7.7 million fewer pills.

While this is a good start, there are still too many people dying and too many people becoming addicted to this powerful narcotic painkiller. More than 1 in 5 deaths of teens and young adults are opioid-related, so it's clear that more is needed to raise awareness about the risk of opioid tolerance, addiction, extreme nerve sensitivity and better ways to treat pain.

One powerful message I send to my patients is that pain is normal for just about everyone each day. It's often tolerable and largely improves with time. I find that with reassurance, positive expectations, time, and instilling confidence, pain for most people improves and mostly goes away. With a severe injury, pain usually stops when the injury heals.

A fact largely overlooked is that opioids can actually increase pain over time. Other medications, such as the combination of acetaminophen and ibuprofen, are more effective. Opioids should be avoided.

Underused in the fight against opioids are consumer expectations and demand. We've seen consumer sentiment and behaviors change trends in the sale of sodas, organic food, craft beer, smoking, and drinking and driving. We can do the same with opioids by arming consumers with information that enables them to drive prescribing habits by asking for alternatives to opioids when they're recommended:

• Opioids reduce pain for about four hours, but they also block the brain's natural ability to release endorphins, pain-reducing chemicals. So when the opioids wear off, you feel more pain for up to three days.

• Opioids should only be used for end-of-life care and tissue damage from burns, frostbite or major trauma. People should avoid opioids for other reasons, such as back, neck or tooth pain, headache, a broken bone, a sprained ankle and hand surgery.

• For people with chronic pain, opioids treat the symptom but not the cause. Chronic pain is complicated, and there's no single solution. That's why our specialized pain clinics offer multiple treatments that address the many causes, including sleep, mental health, trauma, stress, exercise and physical therapy. HealthPartners Institute is also exploring integrative therapies such as yoga to reduce pain.

While we're making progress, I believe the goal should be a 90% reduction in the number of pills available. The more patients and consumers are informed, and the more they demand alternatives to opioids, the more successful we'll be in ending this terrible epidemic.

Bret C. Haake is a neurologist, vice president of medical affairs and chief medical officer at Regions Hospital, a part of HealthPartners.