Opioid addiction has reached epidemic levels in the United States. It is estimated that there are currently 2.1 million people addicted to prescription opioid pain medications and an additional 467,000 addicted to heroin at this time. The problem of opioid addiction is a complicated and widespread one, affecting communities all over the country and individuals from every economic demographic. But what, exactly, does this have to do with orthopaedics? 

It is widely acknowledged that addiction can drastically weaken the immune system, but many people are unaware that addiction can also have negative effects on the skeletal system. Heroin and opioid addiction in particular can cause damage to both bone and mineral metabolism, leading to orthopaedic problems in the long term.

How Addiction Effects the Skeletal System

One of the biggest problems faced by the recovering addict is managing their health, and any health problems they have inflicted upon themselves during their period of addiction. Drug abuse affects bone density, leading to Osteoporosis that can require orthopedic surgery and treatment to control: this is as a result of the malnutrition that so often co-presents with drug addiction and the subsequent cravings for foods rich in carbohydrates and saturated fat that so many former addicts report experiencing. Individuals who are addicted to both cocaine and methamphetamine in particular tend to go for long periods of time between meals and choose to eat low quality foods when they do eat. Osteoarthritis (the most commonly diagnosed and experienced form of arthritis in the United States) is also commonly associated with consuming a poor diet that does not contain a extensive balance of nutrients, vitamins and minerals, which can in turn reduce the body’s natural ability to repair itself and lead to arthritis and arthritis-type pain in the joints. Vitamin C is one of the nutrients most integral to joint repair, and research has shown that this is a nutrient often lacking in individuals experiencing chronically stressful situations, such as situations involving drug use.

Although not directly related to drug use, spinal health can also be reduced in those that have spent considerable amounts of time struggling with drug addiction. Poor spinal health is most commonly caused by slouching and not holding the correct postural position, but when an individual is using certain drugs (in particular stimulants) it is impossible to hold the correct and relaxed postural position because chronic muscle tension is a side effect of the substance misuse. If the substance misuse is chronic then these issues weaken the spine’s supporting muscles and cause them to deteriorate over time, increasing the likelihood that you will cause damage or injury to your spine in the course of your normal everyday routine.

Treating Drug Users or Former Drug Users Who Present With Orthopaedic Pain

The treatment of drug users and former drug users who present with orthopaedic pain is a frequent concern for specialists in the field and proposes a unique challenge. This is because the opioids that are so often prescribed for this kind of pain, and which we know to be most effective, simply aren’t suitable in this situation. Pain control and pain management cannot be aggressive (unless the patient is in an end of life situation, regardless of their addiction status) but it remains integral to minimise your patient’s pain as much as possible. Physical therapy can prove useful in these situations, and many postural problems can be improved with strengthening exercises, as well as with medication. A recent report published in The Journal of  the American Academy of Orthopaedic Surgeons asserted that orthopaedic surgeons have historically prescribed opioids at a high rate. This makes sense, given that orthopaedic injuries and surgeries can be very painful and opioids pose one of our most effective forms of pain relief but it also means that those same surgeons need to think outside the box when addiction is a treatment factor, in order to provide the very best level of care for their patients.

Resources

“America’s addiction to opioids: heroin and prescription drug abuse”, National Institute on Drug Abusehttps://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse

“Understanding addiction: the orthopaedic surgical perspective to a significant problem”, Pub Medhttps://www.ncbi.nlm.nih.gov/pubmed/18486857  

“How to Stop Cravings: 7 tips from an expert”, Recovery.org, http://www.recovery.org/pro/articles/how-to-stop-cravings-7-tips-from-an-addiction-expert/

“Successful pain management for the recovering addicted patient”, The Primary Care Companionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC315480/

“Challenges of treating chronic pain in people with opioid dependence”, Partnership for Drug Free Kidshttps://drugfree.org/learn/drug-and-alcohol-news/challenges-of-treating-chronic-pain-in-people-with-opioid-dependence/

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