The Opioid Epidemic

The Opioid Epidemic. New Heights Physical Therapy in Vancouver WA and Portland OR.

The Opioid Epidemic

According to the National Institute on Drug Abuse, more than 90 Americans die everyday from overdosing on opioids. There is a crisis in America right now where the addiction of opioids is on the rise. This shows that accessing drugs is easier than accessing help. The overdose of opioids – synthetic opioids, prescription painkillers, heroin – currently has a higher death toll than guns, car accidents, and HIV/AIDS.

History of the Opioid Epidemic

Starting in the 1990s, pharmaceutical companies began to see opportunities where they could push the use of prescription opioids without being honest about the safety and effectiveness of these drugs. With companies pushing to make more money, many doctors and patients fell for the scheme and did not believe the risks would outweigh the benefits. Doctors began to prescribe opioids for all kinds of pain management due to other drugs being less effective.

Currently, America is the leading prescriber in the world of opioid painkillers. Painkillers are a quick and convenient way for doctors to help pain management. Patients who experience acute pain are often prescribed opioids for far longer than they need because doctors do not want to receive complaints from prescribing too little.

The CDC wants patients to avoid prescription painkillers by seeking other treatment options. The best option for pain management is physical therapy. This will help the root of the pain and has far better results than drugs. There are other methods of treatment if physical therapy is not easily accessible. These can include alternative medicine and non-opioid painkillers such as ibuprofen.

Harder Opioid Drugs

Due to the excess prescription drugs, people aside from patients began getting their hands on them. This led  to heroin and synthetic opioids such as fentanyl. Heroin and synthetic opioids are much stronger than prescription opioids. The reasons people began doing these harder drugs varied. Some people lost access to pain pills, while others wanted to seek a stronger high.

Not all people who have a heroin or synthetic opioid addiction started on painkillers. Some may have started on heroin and began the use of pain pills after. Heroin has become much more easily accessible over the years due to prescription opioids becoming less common. This has given more people to the opportunity to try heroin.

With the rise of heroin and synthetic opioids, and the attempt to crackdown on prescription pain pills, the bigger picture needs to be looked at on how to fix this problem. Currently being addressed is the supply of opioids and how to reduce it, but if the supply is taken away, the nation will be full of people who still have an addiction. People who have an opioid problem need help. They need easier access to programs where their mental and physical health can be addressed.

It’s important to understand that someone with an opioid addiction cannot quit cold turkey. This is an addiction that needs a slow treatment to  avoid painful withdrawals. If someone is cut-off from prescription opioids, they will seek other ways to get high; this is where heroin and fentanyl come in. This crisis needs to be a combination of dwindling supply and easier access to treatment.

For further reading on the current opioid epidemic:

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

National Institute on Drug Abuse – Opioid Overdose Crisis

Healing 101

When we injure ourselves, whether it’s a broken bone, a sprained ankle or a simple skin cut, all of our tissues follow the same stages of healing; inflammation, repair and remodeling. The stages overlap, one stage flowing into another, with elements of different stages happening at the same time. How well the tissue heals depends on many factors including which tissue has been injured, how you manage pain and inflammation and how and when you start to use the tissues again.


Stages of Healing:


1. Inflammation: 

Inflammation seems to be the new buzzword in medicine and has been linked to all kinds of health issues. And it’s true that inflammation in the intestines from food sensitivities and in the joints from arthritis is destructive and should be managed. This is not the kind of inflammation we are talking about here. What we are referring to here is the inflammation that begins with injury and lasts anywhere from four days to three weeks. Immediately after an injury, the damaged tissue is bleeding and without oxygen. This activates your immune system, causing an inflammatory response in the injured tissue. A clot quickly forms and many different kinds of inflammatory cells are attracted to the injured tissue. Over the next several days, debris is removed and cells that are more anti-inflammatory in nature are attracted to the area. These cells will transform into the blood vessels and tissues of the healed injury. It is during this phase that many of the cells that you will need in the next two phases are attracted to the area, called in by the injury and inflammation.


2. Repair:

This phase begins as early as day four and lasts until about day 28. In this phase you begin to make the basic structure of tissue. Basic blood vessels form. You form a matrix, which is sort of like a gel. Into this gel you lay collagen, the fibers that provide structure. The gel gradually firms, trapping the collagen and beginning the healing of the tissue, closing the gap and reconnecting the edges of the injured tissue.


3. Remodeling:

Remodeling is the longest phase and can last as long as two years, depending on the tissue. During remodeling, the basic tissue formation that began in the repair phase is refined. The tissues gradually transform further into the tissue they are meant to be. The ratios of cells and vessels normalize. The collagen fibers become the type that normally occurs in that tissue, the fibers line up along the lines of the forces applied to the tissue and the structural strength of the tissue gradually improves.


Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) After an Injury

Non-steroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen, ibuprofen and aspirin (e.g. Tylenol, Advil, etc.), are often used after an injury to manage pain and inflammation. But many studies indicate that the use of NSAIDs in the inflammation phase impairs healing in the repair and remodeling phases. NSAIDs interrupt the inflammation phase by inhibiting certain enzymes. This interruption limits how many and which cells you have for use in the repair and remodeling phases. (Remember that many of the cells you will use during repair and remodeling are attracted to the area during the inflammation phase.) So you might want to minimize the use of or avoid using them altogether during the first one to two weeks after an injury. On the other hand, studies of NSAID use during the repair and remodeling phases indicate that use during these later phases is not detrimental to healing. In fact, NSAID use during repair and remodeling of ligaments and tendons may in fact improve the quality of the tissue and decrease formation of abnormal scars.

Using ice for inflammation and pain does not interrupt the inflammation phase in the way that NSAIDs do. Cold numbs sensation on the skin and constricts the vessels, decreasing the amount of fluid in the area temporarily, thus providing some relief of pain and inflammation.


Tension and Forces through the Healing Tissue

Providing the correct tension to the repairing tissue can assist healing and improve the final quality of the repair. How and when to apply tension through the healing tissue will depend on which tissue is involved and which phase of healing it is in. During the inflammation phase, correct movement will help reduce swelling and prevent abnormal scaring and loss of muscle mass. During the repair and remodeling phase, tissue specific tension will assist with proper bone formation and healing of muscle, ligament and tendon. It does this by providing the stimulus for reorientation of the collagen fibers in the proper direction and encouraging thicker, stronger collagen fibrils that can withstand greater forces. Knowing just how to do this properly is complicated, so get some help. Have your doctor and physical therapist guide you through the phases and tell you how and when to use the tissues, so you can recover from your injury strong and well healed.


Interested in learning more? Join us for our upcoming Healing 101 lecture on Thursday, September 21st at 6PM. Click here for more details. 

Welcome: A Place to Heal

By: Gema Sanchez, PT

It is written on entry mats all over the world. Welcome. You cross the threshold believing you are wanted there, that those who reside there do not mean you harm. That you are safe. But as many of us have experienced, it can be a false invitation when the welcome mat on the threshold is only for some, not all. This is the reality for many people in many places around the world who live where they are not welcome. They live in a stressful environment of hostility and fear, without refuge, always on guard. Even in their own communities.

The effect of stress on our lives and well-being has been the topic of many recent studies. Time and again, the researchers find that when we are stressed, we do not heal as well. When we are in a state of “fight or flight”, the resources of the body are reallocated to survival, and things like healing and digestion are put on the back burner. We flee, we survive, we live to fight another day and we hole up and lick our wounds. Only when we find our safe hidey hole does our body chemistry change and resources are reallocated to healing, our “rest and digest” state. Even now, when we are not running from predators who will kill us or constantly worrying about where our next meal will come from, our body biochemistry responds to stress in the same way as our ancient ancestors.

There are certain requirements for healing. We must be in the right biochemical state, to allow the allocation of resources to go to healing instead of survival. We must have the basic building blocks of cell regeneration that we get from our diet and environment such as vitamins, minerals, protein and fat. We need the steady, low level exercise that our ancestors had, walking and foraging all day, to keep our systems healthy and our brain biochemistry balanced. And we need rest and sleep, because it is during restful sleep that we repair and rebuild the damage done on any given day. But in order to rest, we must feel safe.

Which brings us back to welcome. Feeling safe, finding our hidey hole to heal. We recently put a sign in our front window. We welcome you. For centuries, there have been places of healing which are safe havens, neutral zones where the only time you are not welcome, is when you do not welcome others. Places where you can catch your breath and do not have to watch your back, because all agree to abide by the rules of that space and maintain the space as sacred, a place of healing. A place where all the descriptors do not matter, you are injured and this is a place to heal; that is all that matters. For those of us who reside here, who spent our days in the complicated and difficult task of healing, it means that we create a culture of welcome. We check our prejudices at the door, we view all humans as worthy and we create the safe space for healing to occur. We expect the same from those who come here, that they respect the space of healing for all. But we are always learning, and we need those who come here to help us learn and understand what is takes to heal, what it means to be truly welcome, how to embrace and welcome all, and what it takes to create a healing space. At a time and in a place where prejudice is condoned, where violence is accepted and where fear is commonplace, we have chosen to be a neutral zone, a safe haven, a place for healing. Welcome.

Top 5 Impediments to Healing

Top 5 Impediments to Healing. New Heights Physical Therapy in Vancouver WA and Portland OR.

When we become injured or sick, it is often in our nature to think there is a one-solution fix. We see our primary care physicians or our physical therapists in hopes that they alone will rid us of our ailments. However, this is not always possible and although our healthcare team plays a critical part in our healing process, there are often behaviors we practice outside the clinic that stand in the way of optimal recovery.

Here at New Heights, our PTs have identified a number of barriers that prevent optimal recovery. The top five were:

  • Poor nutrition
  • Inactivity or TOO MUCH activity
  • Poor hydration
  • Stress/Anxiety/Depression
  • Poor attitude

Other barriers include environmental toxins and lack of sleep. All play a part in our body’s ability to repair itself. Processed foods, pushing through pain and not giving our bodies enough time to heal can lead to chronic inflammation which in turn leads to degeneration and loss of function in the affected area. Factors such as chronic stress or anxiety cause our bodies to be in a constant state of tension, inhibiting the healing process.

Because our PTs recognize these and many other barriers, New Heights’ Portland Clinic is hosting wellness classes and lectures that focus on a holistic health approach. Every month, we invite experts from around the Portland-Metro area to come and share what they know. A majority of these offerings are free and open to both patients and the community.

This fall’s highlights:

  • Dr. Tyna Moore, ND, DC, will be leading a lecture about gut health and how the foods we eat can either promote or inhibit reactions such as inflammation
  • Dr. Kathy Alvarez, MD, will be speaking on stress management and the importance of understanding the effects stress has on the body
  • There will also be lectures on osteoporosis, concussion awareness, sports injury prevention, bike fittings and many others

In addition to the monthly lectures, weekly wellness classes have been developed to help relieve stress and promote healing. Our new yoga instructor, Heather Beckett, will be leading Yoga Steps every Monday, for those new to yoga or recovering from an injury. She will also be leading a Dynamic Yoga Flow class on Wednesdays for those ready for a bigger challenge. Furthermore, group acupuncture and CHILL classes provide more opportunity to de-stress, while MELT classes work to rehydrate to your connective tissue, reduce inflammation and increase joint mobility.

Our goal in providing these classes and lectures is to help build an awareness for the intricacies of our bodies and to recognize that in order to reach optimal health we must take care of multiple systems. Our hope is that you will take control of your health by joining us. For more information about our wellness classes and lectures visit our online wellness class schedule or call 971-339-3405.

References: U.S. News & World Report, American Psychological Association