Will I Get Addicted to Opioids from My Restless Legs Syndrome (RLS) Treatment?
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- čas přidán 27. 01. 2024
- Opioids are a consensus treatment for moderate to severe restless legs syndrome (RLS) when first-line approaches are insufficient. However, many patients with RLS are worried about getting addicted to opioids or they won't be able to get off them once they start.@andyberkowskimd of ReLACS Health assesses the risks of opioid use disorder this week's video.
For more detail on addiction risk with opioids for RLS, read this blog post:
www.relacshealth.com/blog/will-i-get-addicted-to-opioids-from-my-restless-legs-syndrome
This video addresses the following aspects of opioid addiction when it comes to RLS:
- What is opioid use disorder?
- What is the difference between abuse and dependence?
- Why are those with RLS different than those who use opioids for chronic pain or recreational use?
- Are those with RLS at lower risk for abuse or dependence?
- What are different types of dependence?
- What does the National RLS Opioid Registry say about risks of abuse or dependence?
- What strategies do clinicians use to mitigate the risks of opioid use disorder in RLS?
- Why are opioids potentially dangerous to use for treatment?
- What makes the benefits outweigh the risks for those with RLS specifically?
In case you were wondering about other adverse effects from opioids, this blog presents 10 of the most common adverse effects to watch out for when initiating treatment with opioids for RLS:
www.relacshealth.com/blog/10-of-the-most-common-side-effects-of-opioids-for-restless-legs-syndrome
In the wake of the opioid crisis in the US, the medical field has swung far to the other side in terms of comfort with prescribing of opioids. To read in detail why doctors are unwilling to prescribe opioids for RLS, read A ReLACSing Blog #21: www.relacshealth.com/blog/why...
This is the 2023 publication from the National RLS Opioid Registry:
www.neurology.org/doi/10.1212...
After a thorough evaluation, an experienced clinician may suggest an opioid medication a person struggling with RLS may be recommended to start on an opioid. For any treatment, the benefits of the treatment must outweigh the risks or side effects to start in the first place. If one moves forward with opioid therapy for this condition, it is important to be aware of these common side effects: respiratory depression (shallow breathing or the inability to breathe at all), abuse (taking the drug to get high or for purposes not intended with treatment), dependence (reliance on the medication to be taken daily or withdrawal symptoms may occur), nausea & itching, constipation, symptoms of depressed mood, low testosterone, dental problems from buprenorphine, and heart conduction problems from methadone. These are discussed in more detail in this video.
As always, the most important thing with any treatment, even if adverse effects do occur, is to report these and make changes under the strict guidance of a licensed medical professional.
These videos are for general medical information, but those who live in or near Michigan, Ohio, or Florida can hire @andyberkowskimd of ReLACS Health for consultation regarding treatment of RLS as well as any sleep disorder that requires a little more time and expertise. Go to www.relacshealth.com/ for more information.
Why is my insurance denying my Belbuca? It’s the only thing that works. My neurologist has to code it as severe chronic leg pain. Im fighting my insurance and don’t know how to convince them to understand RLS .
I've been part of the RLS Registry I think since the beginning. Five years now? You touched on a couple questions I've had regarding methadone. Can I develop a tolerance? I've been taking it since 2017, 5 - 10 mgs at bedtime, and feel it is not quite as effective now. Also, is there any evidence of augmentation? Typically I'll take 5 mgs, hoping that's enough. But sometimes, I get a sensation that feels like augmentation through my chest, back and arms. So then I'll usually take another 5 mgs. Never more than that. I stopped taking melatonin and OTC sleep aids after reading they can make RLS worse. Though methadone is a blessing and works 80 percent of the time, at 68 years of age, I still battle RLS in a variety of ways. Thank you again for your great videos.
You are welcome. To answer the tolerance question and some of the more detail you desire, there is a three-part blog on this topic for you!:
www.relacshealth.com/blog/will-i-get-addicted-to-opioids-from-my-restless-legs-syndrome
Thanks for your time Dr. Only thing that works for my RLS is opioids specifically Percocet however it takes 20mg to even help quell the RLS. Bummer part is that I have had several failed back surgeries and have peripheral neuropathy which I also treat with Percocet. I’ve augmented on requip and praxomole. Because my Dr is afraid to go above the 90MME “guidelines” I’m not allowed to also add bupernorphine which would be advantageous
Depending on the source, oxycodone 20 mg is about 30 mg morphine equivalents (MME). Buprenorphine has unique properties so it is hard to determine the relative morphine equivalent but certainly most of those with RLS do not require more than 50 MME (cutoff by DEA for a high dose) with any drug and probably the buprenorphine doses for most people are less than 50 MME equivalent if one could accurately calculate this. With all the opioids, the dose matters and for RLS it is much lower than in pain conditions.
Thanks for the reply. I appreciate your efforts in addressing RLS which to me is hell.
@@evrtglnyou’ll need a higher dose for buprenorpgine , methadone is much more effective since it doesn’t have any naloxone.
I was on bupe and had to change to methadone and my rls is so bad I’m on 90 mg
What is your opinion Doctor on Stellate ganglion block?
I'm not sure these have been studied, but I am wary of nerve procedures for a condition that occurs in the brain and not the nerves.
Thank you for this presentation. I wonder how many times over it will need to be repeated until professionals and lay people will get it. There are circumstances where opioid use and subsequent dependence is an acceptable form of treatment. Until something is developed to replace the current drugs that create augmentation, the weaning process will be torture and there's no reward for going through the torture except more pain from the RLS. Opioids have to be found as an acceptable substitute. Some wonderfully brilliant physicians, PA's and NP's just aren't "getting it" in so many ways. I finally figured out that Requip 4mg, 3 times daily wasn't going to make my RLS better. My providers response was, "We'll just have you come off of it, start with one 4mg dose." You who know, know.
"There are circumstances where opioid use and subsequent dependence is an acceptable form of treatment."
No there aren't. you're just on the hamster wheel now and you'll require higher and higher doses to stay on it. You've been turned into a lifelong customer of the pharmaceutical industry. It sucks for you, but just think of the big bonuses your doctor is getting for pimping his patients to pfizer. A little advice, stop taking the pills for a week and give kratom a shot. it will not only help with the rls, it will help with the addiction your doctor has lured you into. If it doesn't work for you then you can always go back to the pills.