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The Opioid Solution and HIV: From the Frying Pan Into the Fire

By Dave R.

February 1, 2013

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This article is Part One of a two-part piece. Read Part Two, "Opioid Dependency: What's It Got to Do With HIV?."

"Pain is experienced by people and families not by nerve endings." -- Dame Cicely Saunders

A nightmare for some and a godsend for others, some people become addicted to opioids because opioids have become their recreational drug of choice, while others become addicted because their pain symptoms are so severe that they have no choice. Either way, a problem has arisen which threatens social stability in whole communities, especially in North America, and makes authorities unsure which way to turn.

You may see this as a "far from my bed" phenomenon but as I will explain later, many people living with HIV find themselves involved with opioids before they know it and have to live with the consequences of this sort of treatment simply because there is no better way of treating their pain.

First some statistics to highlight the scale of the problem:

  • According to the US Institute of Addiction Medicine, in 2007, 23 million people over the age of 12 needed treatment for substance abuse in the USA.
  • Between 1992 and 2003, abuse of prescription drugs increased by 140%.
  • Given that Americans represent 5% of the world's population, 80% of the world's supply of opioids and 99% of the global availability of hydrocodone is used within the US borders.
  • Because opioids are legally available as prescription drugs, this availability has been matched by a 63% increase in opioid-related deaths between 1999 and 2004.
  • Many studies have shown that abuse or misuse of these drugs averages out at between 20% and 58% of people who have been prescribed opioids for chronic pain.
  • In 2005 it was established that almost 2 million Americans were opioid dependent but more alarmingly ...
  • Approximately 4.7 million teenagers and adults used opioids for non-medical purposes and ...
  • Over 32 million Americans reported having used them for non-medical purposes at least once in their lives.

Shocked yet? Actually these statistics were assembled before the current explosion in opioid addiction and abuse that has recently begun to hit the headlines across the western world. The figures, five years later in 2012, will be far higher; and the number of deaths and serious health problems resulting from both opioid prescription and the black market will now be alarmingly high. It's a problem that is almost unrecognised in its expanse, and a social time bomb that we still seem unwilling to acknowledge.

Still, why should this be relevant to people living with HIV? The answer is that many people with HIV are also chronic pain patients, something that is often overlooked when reading about the negative aspects of being positive.

According to The Well Project, many people with the virus have to manage chronic pain symptoms for the following reasons:

  • Peripheral neuropathy (between 25% and 40% of people with HIV) -- nerve damage with over 100 causes, amongst which are the virus itself, diabetes, cancer treatment, toxic medications and even high alcohol consumption.
  • Abdominal pain (26% ...) -- as a side effect of some HIV drugs; parasitical infection or bacteria; problems and irritability in the intestines, including irritable bowel syndrome; inflammation of the pancreas caused by some HIV meds; too much fat in the blood; or drinking; bladder or urinary tract infections and in women, uterus, cervix and ovary conditions.
  • Headaches and migraines (17% ...) -- from mild to severe brought about by a variety of causes including certain HIV drugs
  • Joint, muscle and bone pain (5% ...) -- can also be from mild to severe and be HIV-related to forms of arthritis, rheumatism, bone disease and bone density problems. It can also occur when using drugs for high cholesterol and especially hepatitis.
  • Herpes pain (5% ...) -- many people may see herpes as par for the course when you're sexually active but a cold sore, or sore on your genitals, represents its mildest form. If you've ever had shingles, you'll know that the pain can be excruciating and as the herpes virus can frequently re-occur, it's something that can plague your life if you have HIV.
  • Skin problems and rashes -- side effects of certain HIV medications or other drugs.
  • Chest pain caused by lung infections such as TB, bacterial pneumonia, or PCP pneumonia.
  • Mouth pain caused by ulcers or fungal infections.
  • Pain due to cancer in all its forms.
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According to pain.com, in 2005, 8% of HIV individuals were on long-term opioids (especially Oxycodone and Tramadol) for severe pain, which was more than double the non-HIV population. However, the good news is that the explosion in opioid use since then has not been paralleled in the HIV population. This is possibly because opioids are prescribed for valid reasons to HIV patients and there is less incidence of recreational opioid use which has worsened the problem in the general population.

Before everybody writes in to say that they're fine and have never had a problem with the virus or the medication, please be reassured that you are some of the lucky ones. Of course only a certain percentage of people living with HIV will suffer chronic pain in one form or another but a significant proportion of those will eventually have no option but to start taking opioids as the only painkillers that will help. It's not a choice; some pain is so severe that it just doesn't react to over-the-counter medications, or medications meant for other diseases. Opioids, if used properly, are a very effective solution. The problem is that they are not always used properly, as the statistics above clearly show.

Recreational use of opioids could also be said to be the result of psychological 'pain': fulfilling a need to escape from the harsh edges in life (it could also be simply the well-known search for a kick that has got out of hand). However, recreational drug use and the reasons for its popularity are really subjects for other articles. What we need to know to arm both ourselves and people we know with knowledge, is that it gets out of hand when people don't realise how quickly and easily they can become seriously addicted.

So, with the facts out of the way, it's perhaps useful to illustrate the problem by giving some examples of what opioid abuse and the authorities attempts to crack down on it have been doing to people.

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See Also
Ask Our Expert, David Fawcett, Ph.D., L.C.S.W., About Substance Use and HIV

 

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HIV, Neuropathy and More: Avoiding Becoming a Nervous Wreck


Dave R.

Dave R.

English but living since 1986 in Amsterdam, the Netherlands. HIV+ since 2004 and a neuropathy patient since 2007. I've seen quite a bit, done quite a bit and bought quite a few t-shirts if you know what I mean; but all that baggage makes me what I am today: a better person I believe, despite it all.

Arriving on TheBody.com, originally, was the end result of getting neuropathy as a side effect of the medication, or the virus, or both. I found it such a vague disease and discovered very little information that wasn't commercially tinged, or scientifically impenetrable, so I decided to create a daily Blog and a website where practical information, hints, tips and experiences for patients could be gathered together in one place.

However, I was also given the chance to write about other aspects of living with HIV and have now contributed more articles about those than about neuropathy. That said, neuropathy remains my 'core subject' although one which unfortunately dominates both my life and that of many other HIV-positive people.

I'm not a doctor or qualified medical expert, just someone with neuropathy and HIV who has spent the last few years researching the illness and trying to create information sources for people who want to know more.

I also have my own personal website and write for PositiveLite.com.


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