Despite the opioid crisis in America, there are many legitimate uses of prescription opioids. They can help people who, without them, would be in an incredible amount of pain. They can make surgeries bearable and injuries less of a burden.

Dr. Alan Heincker deals with these people every day. As an orthopedic surgeon at Phelps County Regional Medical Center, he prescribes opioids to help his patients deal with their pain.

“I usually tell people that I do not prescribe long term opioids, so I will usually give you opioids for a short time for an acute pain that you experience either from a surgery that I have done or performed or an acute fracture that you have. So, little old lady falls and breaks her arm, doesn’t need surgery, but has a bad injury, sometimes you need something a little bit more than an anti-inflammatory or Tylenol, and so they’ll get a opioid or narcotic pain medicine from me. If I do surgery, sometimes you get an opioid for that as well,” Dr. Heincker said.

Dr. Heincker rarely prescribes opioids for more than three months.

“We’re hoping that the cause of whatever pain you had is gone by then. For a fracture, it takes 6 to 8 weeks for it to heal, so most of the time, after a week or two, the worst of the pain is usually over. It still hurts, but most of the time you can control that with other means. Ice, things like that,” Dr. Heincker said.

There are cases when Dr. Heincker prescribes opioids for an extended period of time, like when there is a complication with surgery, but he has reservations about it.

“Very rarely is long term narcotic use the answer because what happens is you develop a tolerance to it, and you need more and more and more to treat the same amount of pain. And then we have more and more studies that show people that are on long term narcotics, if and when they need surgery or procedures, they have worse outcomes, so you’re gonna do worse automatically if you’re on chronic narcotics or opioids,” Dr. Heincker said.

While Dr. Heincker does see many patients that abuse opioids, he does not see many that are addicted to the high.

“I think it’s people who have pain and become dependent on it [opioids]. They think they need that to get through their day, otherwise they have more pain than their body can help fight off. I don’t think, at least in my practice, that many people are coming in because they’re just addicted to that high, that medication. Do I believe those people are out there? Absolutely. But, they’re not coming to our office and getting their medicines, they’re getting them from other people just like they would other illicit or illegal street drugs. They’re buying them from friends and things like that to get that feeling, that high,” Dr. Heincker said.

Dr. Heincker finds patients who have legitimate pain, but abuse opioids, very difficult to deal with.

“Pain medicines aren’t the long term answer, because you’re just going to need more and more and more in the future to deal with the same pain, and that’s not a good option. So, from my standpoint, I’ll usually say, ‘hey, you can either do a surgery, whether it’s with me or someone else, but the medicines aren’t the answer’. But sometimes you have someone that does have a legitimate pain. Back pain’s a big one. Sometimes people’s backs are too bad, they can’t do anything else with it. Or cancer pain, there’s nothing to do, it is what it is. Surgery is not an option, chemotherapy has already been done, and they have pain. Those people legitimately have a reason to get narcotic pain medicines, either from their cancer doctors, their oncologist, or there’s a pain management clinic that’s run by anesthesia doctors that usually deal with long term pain patients who give them pain meds,” Dr. Heincker said.

Heincker believes that eliminating the cause of pain is more important than simply eliminating the pain.

“[An opioid prescription] doesn’t do anything to fix the problem or do anything. It’s just letting you heal, whereas an anti-inflammatory like ibuprofen, aleve, something like that, that goes to decrease the inflammation which is the whole cause of the pain, and so hopefully that’ll help them out in the long run,” Dr. Heincker said.