Author: Dr. Norman Johnson, CEO
I do not think anyone would disagree that the number of deaths from opioids has reached catastrophic proportions. Here is a question for you to consider. What kills more people, opioids or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen and naproxen? At first glance, this may seem like a silly question. The truth is the death rates from these two classes of drugs are very close. There are approximately 16,000-20,000 deaths a year from NSAIDs alone.
I recently had an opportunity to tour a large portion of our 280 jails throughout the seventeen state area in which we operate. I have discovered that ibuprofen and naproxen are the drugs of choice for simple pain. This includes headaches, twisted ankles, general body aches and pains, arthritis, and any other generalized non-serious pain. I have seen NSAIDS ordered for 120 days for things such as osteoarthritis. The goal of this article is to encourage you, your facility, and your medical team to stop using NSAIDS as your drug of choice for simple pain. You should be using acetaminophen (Tylenol®).
Nonsteroidal anti-inflammatory drugs reduce inflammation and control pain. The pain controlling effects in a non-inflammatory pain such as a twisted ankle or headache are about the same with ibuprofen as it is with Tylenol®. In my opinion, the reason people go to the ibuprofen or naproxen drugs is because they are more heavily marketed by the pharmaceutical industry.
Common over the counter names include: ibuprofen (Advil®), naproxen (Aleve®), and aspirin (Bayer®). Prescription brands include: celecoxib (Celebrex®), diclofenac (Voltaren®), etodolac (Lodine®), fenoprefen (Nalfon®), indomethacin (Indocin®), ketoprofen (Orudis®, Oruvail®), ketorolac (Toradol®), oxaprozin (Daypro®), nabumetone (Relafen®), sulindac (Clinoril®), tolmetin (Tolectin®), and refecoxib (Vioxx®).
Because these drugs are over the counter, most people do not consider the serious side effects that are possible with these agents. This includes but is not limited to: gastrointestinal bleeding, peptic ulcer formation, perforated ulcer, exaggerations of asthma, worsening of congestive heart failure, elevation of blood pressure, fluid retention, edema, hearing loss, miscarriage, allergic reactions, and death.
I am concerned about the use of these agents in our jail system as we have experienced multiple cases of perforated peptic ulcer disease. While I cannot say that these are directly related to NSAID use, it is clear we need to reduce the use of NSAIDS drastically within our system.
A few years ago, I was touring two prisons in Illinois. One was a 2,200 bed, medium-security prison that was averaging 240 upper GI endoscopies per year. They were using nonsteroidal drugs as their standard non-serious pain drug of choice. A larger facility a 3,500 bed, maximum-security facility, was only doing three upper GI endoscopies per year and their drug of choice for non-serious pain was acetaminophen (Tylenol®). I believe the evidence is clear. There appears to be a direct relationship between the use of NSAIDs and gastric pain in these two populations. I want to emphasize we need to stop using these as our standard pain medicine.
There is a clear indication for ibuprofen and NSAID drugs. In my opinion, this includes dental pain, female pelvic pain, gout, and any joint pain which is warm upon examination (has an inflammatory component). If you believe that you need to give a nonsteroidal drug for pain, for example dental pain, the proper dose would be 400-600mg, not 800mg. 800mg is an anti-inflammatory dose. The side effect profile of nonsteroidal drugs is higher with higher doses. If you use 800mg, you get all of the side effects but no further pain relief than you would with 600mg.
In conclusion, my goal is to have you stop using nonsteroidal anti-inflammatory drugs as the pain pills of choice for non-serious pain. I recommend you use acetaminophen (Tylenol®). When you feel you need an NSAID drug for pain and if possible go no higher than 600mg. If you have a serious inflammatory disorder, such as gout, and you have an acute flare, the dose would be 800mg of ibuprofen, three times daily. That is a very high dose, but it has a very good anti-inflammatory component.
I am recommending you decrease your use of NSAIDs such as ibuprofen.