Opioid misuse is common problem in rural communities

They’re meant to help, but extended use of prescription opioid pain medications can lead to serious addiction issues.
In conjunction with National Farm Safety and Health Week on Sept. 15-21, the Central States Center for Agricultural Safety and Health (CS-CASH) at the University of Nebraska Medical Center College of Public Health wants to use the week to address the issue of opioid abuse. CS-CASH has provided funding to Christine Chasek, Ph.D., associate professor at the University of Nebraska at Kearney, to help spread the word about opioid misuse in rural communities.
Dr. Chasek, who specializes in mental health and addictions, advises anyone receiving an opioid prescription to take caution in using it.
“In the past, when we thought about opioid use disorder, we thought more of illegal drugs,” Dr. Chasek said. “Now the majority of opioid use disorder cases begin with prescription drugs.”
An opioid use disorder is defined as a problematic pattern of opioid use that leads to serious impairment or distress. Persons diagnosed with this disorder exhibit at least two of these symptoms:

  • Substance is taken in larger amounts and for longer periods than intended.
  • User experiences persistent desire or unsuccessful effort to cut down or control use of the substance.
  • A great deal of the user’s time is spent in obtaining, using, or recovering from substance abuse.
  • Strong desire, craving or urge to use opioids.

Continued use of opioids typically leads to failure to fulfill major obligations at work, home or school Recurrent social and personal problems emerge and important social and/or occupational and recreational activities are reduced due to opioid use.
According to the Farm Bureau, an independent, non-governmental, voluntary organization governed by and representing farm and ranch families, 74% of farmers and farm workers are or have been directly impacted by opioid abuse, either by knowing someone, having a family member addicted, having taken an illegal opioid or having dealt with addiction themselves.
Some 77% of farmers and 76% of agricultural workers say it’s easy to obtain large amounts of prescription opioids/pain killers.
Since agriculture is Nebraska’s primary industry, injury rates are high. In 2017, the National Institute on Drug Abuse reported that Nebraska providers wrote 56.6 opioid prescriptions for every 100 persons. The average U.S. rate the same year was 58.7 prescriptions per 100 persons.
“People who receive an opioid prescription may not truly understand what the medication is,” Dr. Chasek said. “Recently, physicians have changed prescription patterns, and there are some opioid prescription laws that have changed, too. Still, if you receive a prescription for a pain medication, be diligent about using it according to your doctor’s instructions.”
It’s important to recognize whether or not a prescription is an opioid. Common opioid drug names include:

  • Hydrocodone (Hysingla, Zohydro ER, Lorcet, Lortab, Norco, Vicodin);
  • Hydromorphone (Dilaudid, Exalgo);
  • Meperidine (Demerol);
  • Methadone (Dolophine, Methadose); 
  • Oxycodone (OxyContin, Oxaydo); and
  • Codeine, Percocet and Roxicet.

 “These medications are prescribed for acute, short term pain,” Dr. Chasek said. “Typically they’re prescribed for five to seven days or less. If you use these drugs for long-term pain over a period of more than seven days, you’re at high risk for developing an addiction.”
When long-term pain solutions are necessary, Dr. Chasek advised relying on the expertise of pain specialists to identify an effective and safe treatment plan.
“Long-term pain treatment must be non-narcotic,” Dr. Chasek said. “Pain specialists have the necessary expertise and knowledge to develop a safe and effective treatment plan. Your primary care physician may be able to consult with a specialist if you don’t have ready access to that kind of care.”
She said primary indications that a person may be struggling with opioid addiction include extended use of a pain medication, continued or increasing pain, abnormal sleepiness or lack of focus, and changes in general behaviors.
“Look for depression, too,” Dr. Chasek said. “Ongoing pain makes you feel bad physically and emotionally and could lead to depression. If someone is irritable or seems to become cranky before it’s time to take their medication, those can all be red flags.”
Abnormal occurrence of accidents or unexplained injuries also could signal that an individual is physically and mentally impaired, she said, noting that opioids bind to receptors in the brain that tell the brain the body isn’t experiencing pain.
“Over time, your body is sensitized to the medication,” Dr. Chasek said. “You require more and more of the medication to relieve the pain, your body sensitizes to the higher dose, and it’s a vicious cycle. That’s why, if opioids don’t relieve the pain in a short time, you need to take a different approach to resolving the pain.”
If family members or friends suspect opioid abuse in an individual, Dr. Chasek said the best option is to respectfully and carefully approach them to offer support and help them recognize their opioid use disorder.
“If you see something, say something,” Dr. Chasek said. “We speak up because we care about people and want to help. Be respectful and kind rather than accusatory and defensive or angry.”
If necessary, obtain permission from a family member to consult their physician and determine if there’s a need to seek help. “We all need to work together to help each other respond to and overcome this epidemic,” she said.
Resources available:
A wealth of information about opioid addiction in America’s farm communities is available at this link, including links to the latest news and events related to opioid use in rural America.
Pharmacy Toolkit is an online resource to help health care providers talk to patients and caregivers about opioid use and opioid use disorder.
This site from the American Society of Anesthesiologists provides information about how opioids work, why people become addicted and how to avoid addiction issues.
This 21-page PDF includes: information about Nebraska’s legislative response to the opioid epidemic; prescription drug monitoring; reversing overdoses and calling for help; response from Nebraska’s state agencies; and state strategies and resources for those who need assistance with opioid addiction.
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