I’ve been given opioids after surgery to take at home. What do I need to know?
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Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.
These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.
However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.
Which types of opioids are most common?
The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).
In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.
Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.
Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.
Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.
Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.
Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.
Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.
But there are also risks
As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.
Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.
But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.
Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.
Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.
Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.
This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.
How to mimimise the risks
Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).
These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.
Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.
However, if you do need opioids, there are some ways to make sure you use them safely and effectively:
- ask for immediate-release rather than slow-release opioids to lower your risk of side effects
- do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
- as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
- before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
If you’re concerned about side effects
If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:
- constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
- drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
- weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.
If you’re having trouble stopping opioids
Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.
You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.
How about leftover opioids?
After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.
Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.
For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.
Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The How Not to Die Cookbook – by Dr. Michael Greger
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We’ve previously reviewed Dr. Greger’s “How Not To Die”, which is excellent and/but very science-dense.
This book is different, in that the science is referenced and explained throughout, but the focus is the recipes, and how to prepare delicious healthy food in accordance with the principles laid out in How Not To Die.
It also follows “Dr Greger’s Daily Dozen“, that is to say, the 12 specific things he advises we make sure to have every day, and thus helps us to include them in an easy, no-fuss fashion.
The recipes themselves are by Robin Robertson, and/but with plenty of notes by Dr Greger; they clearly collaborated closely in creating them.
The ingredients are all things one can find in any well-stocked supermarket, so unless you live in a food desert, you can make these things easily.
And yes, the foods are delicious too.
Bottom line: if you’re interested in cooking according to perhaps the most science-based dietary system out there, then this book is a top-tier choice.
Click here to check out The How Not To Die Cookbook, and live well!
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Colloidal Gold’s Impressive Claims
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All That Glitters…
Today we’ll be examining colloidal gold supplementation.
This issue of 10almonds brought to you by the writer suddenly getting lots of advertisements for this supplement. It’s not a new thing though, and has been around in one form or another since pretty much forever.
Colloidal gold is…
- Gold, as in the yellow metal
- Colloidal, as in “very tiny insoluble particles dispersed though another substance (such as water)”
What are the claims made for it?
Honestly, just about everything is claimed for it. But to go with some popular claims:
- Reduces inflammation
- Supports skin health
- Boosts immune function
- Combats aging
- Improves cognitive function
So, what does the science say?
Does it do those things?
The short and oversimplified answer is: no
However, there is a little bit of tangential merit, so we’re going to talk about the science of it, and how the leap gets made between what the science says and what the advertisements say.
First… What makes gold so special, in general? Historically, three things:
- It’s quite rare
- It’s quite shiny
- It’s quite unreactive
- The first is about supply and demand, so that’s not very important to us in this article.
- The second is an aesthetic quality, which actually will have a little bit of relevance, but not much.
- The third has been important historically (because it meant that shiny gold stayed shiny, because it didn’t tarnish), and now also important industrially too, as gold can be used in many processes where we basically need for nothing to happen (i.e., a very inert component is needed)
That third quality—its unreactivity—has become important in medicine.
When scientists need a way to deliver something (without the delivering object getting eaten by the body’s “eat everything” tendencies), or otherwise not interact chemically with anything around, gold is an excellent choice.
Hence gold teeth, and gold fillings, by the way. They’re not just for the bling factor; they were developed because of their unreactivity and thus safety.
So, what about those health claims we mentioned above?
Here be science (creative interpretations not included)
The most-backed-by-science claim from that list is “reduces inflammation”.
Websites selling colloidal gold cite studies such as:
Gold nanoparticles reduce inflammation in cerebral microvessels of mice with sepsis
A promising title!The results of the study showed:
❝20 nm cit-AuNP treatment reduced leukocyte and platelet adhesion to cerebral blood vessels, prevented BBB failure, reduced TNF- concentration in brain, and ICAM-1 expression both in circulating polymorphonuclear (PMN) leukocytes and cerebral blood vessels of mice with sepsis. Furthermore, 20 nm cit-AuNP did not interfere with the antibiotic effect on the survival rate of mice with sepsis.❞
That “20 nm cit-AuNP” means “20 nm citrate-covered gold nanoparticles”
So it is not so much the antioxidant powers of gold being tested here, as the antioxidant powers of citrate, a known antioxidant. The gold was the carrying agent, whose mass and unreactivity allowed it to get where it needed to be.
The paper does say the words “Gold nanoparticles have been demonstrated to own important anti-inflammatory properties“ in the abstract, but does not elaborate on that, reference it, or indicate how.
Websites selling colloidal gold also cite papers such as:
Anti-inflammatory effect of gold nanoparticles supported on metal oxides
Another promising title! However the abstract mentions:
❝The effect was dependent on the MOx NPs chemical nature
[…]
The effect of Au/TiO2 NPs was not related to Au NPs size❞
MOx NPs = mineral oxide nanoparticles. In this case, the gold was a little more than a carrying agent, though, because the gold is described and explained as being a catalytic agent (i.e., its presence helps the attached mineral oxides react more quickly).
We said that was the most-backed claim, and as you can see, it has some basis but is rather tenuous since the gold by itself won’t do anything; it just helps the mineral oxides.
Next best-backed claim builds from that, which is “supports skin health”.
Sometimes colloidal gold is sold as a facial tonic. By itself it’ll distribute (inert) gold nanoparticles across your skin, and may “give you a healthy glow”, because that’s what happens when you put shiny wet stuff on your face.
Healthwise, if the facial tonic also contains some of the minerals we mentioned above, then it may have an antioxidant effect. But again, no minerals, no effect.
The claim that it “combats aging” is really a tag-on to the “antioxidant” claim.
As for the “supports immune health” claim… Websites selling colloid gold cite studies such as:
To keep things brief: gold can fight infectious diseases in much the same way that forks can fight hunger. It’s an inert carrying agent.
As for “improves cognitive function”? The only paper we could find cited was that mouse sepsis study again, this time with the website saying “researchers found that rats treated with colloidal gold showed improved spatial memory and learning ability“ whereas the paper cited absolutely did not claim that, not remotely, not even anything close to that. It wasn’t even rats, it was mice, and they did not test their memory or learning.
Is it safe?
Colloidal gold supplementation is considered very safe, precisely because gold is one of the least chemically reactive substances you could possibly consume. It is special precisely because it so rarely does anything.
However, impurities could be introduced in the production process, and the production process often involves incredibly harsh reagents to get the gold ions, and if any of those reagents are left in the solution, well, gold is safe but sodium borohydride and chloroauric acid aren’t!
Where can I get some?
In the unlikely event that our research review has given you an urge to try it, here’s an example product on Amazon
Take care!
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Night School – by Dr. Richard Wiseman
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Sleep is a largely neglected part of health for most people. Compared to factors like food and exercise, it’s something that experientially we’re mostly not present for! Little wonder then that we also often feel like it’s outside of our control.
While Dr. Wiseman does cover the usual advices with regard to getting good sleep, this book has a lot more than that.
Assuming that they go beyond the above, resources about sleep can usually be divided into one of two categories:
- Hard science: lots about brainwaves, sleep phases, circadian rhythms, melatonin production, etc… But nothing very inspiring!
- Fantastical whimsy: lots about dreams, spiritualism, and not a scientific source to be found… Nothing very concrete!
This book does better.
We get the science and the wonder. When it comes to lucid dreaming, sleep-learning, sleep hypnosis, or a miraculously reduced need for sleep, everything comes with copious scientific sources or not at all. Dr. Wiseman is well-known in his field for brining scientific skepticism to paranormal claims, by the way—so it’s nice to read how he can do this without losing his sense of wonder. Think of him as the Carl Sagan of sleep, perhaps.
Style-wise, the book is pop-science and easy-reading. Unsurprising, for a professional public educator and science-popularizer.
Structurally, the main part of the book is divided into lessons. Each of these come with background science and principles first, then a problem that we might want to solve, then exercises to do, to get the thing we want. It’s at once a textbook and an instruction manual.
Bottom line: this is a very inspiring book with a lot of science. Whether you’re looking to measurably boost your working memory or heal trauma through dreams, this book has everything.
Click here to check out Night School and learn what your brain can do!
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What Would a Second Trump Presidency Look Like for Health Care?
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On the presidential campaign trail, former President Donald Trump is, once again, promising to repeal and replace the Affordable Care Act — a nebulous goal that became one of his administration’s splashiest policy failures.
“We’re going to fight for much better health care than Obamacare. Obamacare is a catastrophe,” Trump said at a campaign stop in Iowa on Jan. 6.
The perplexing revival of one of Trump’s most politically damaging crusades comes at a time when the Obama-era health law is even more popular and widely used than it was in 2017, when Trump and congressional Republicans proved unable to pass their own plan to replace it. That failed effort was a big part of why Republicans lost control of the House of Representatives in the 2018 midterms.
Despite repeated promises, Trump never presented his own Obamacare replacement. And much of what Trump’s administration actually accomplished in health care has been reversed by the Biden administration.
Still, Trump secured some significant policy changes that remain in place today, including efforts to bring more transparency to prices charged by hospitals and paid by health insurers.
Trying to predict Trump’s priorities in a second term is even more difficult given that he frequently changes his positions on issues, sometimes multiple times.
The Trump campaign did not respond to a request for comment.
Perhaps Trump’s biggest achievement is something he rarely talks about on the campaign trail. His administration’s “Operation Warp Speed” managed to create, test, and bring to market a covid-19 vaccine in less than a year, far faster than even the most optimistic predictions.
Many of Trump’s supporters, though, don’t support — and some even vehemently oppose — covid vaccines.
Here is a recap of Trump’s health care record:
Public Health
Trump’s pandemic response dominates his overall record on health care.
More than 400,000 Americans died from covid over Trump’s last year in office. His travel bans and other efforts to prevent the global spread of the virus were ineffective, his administration was slower than other countries’ governments to develop a diagnostic test, and he publicly clashed with his own government’s health officials over the response.
Ahead of the 2020 election, Trump resumed large rallies and other public campaign events that many public health experts regarded as reckless in the face of a highly contagious, deadly virus. He personally flouted public health guidance after contracting covid himself and ending up hospitalized.
At the same time, despite what many saw as a politicization of public health by the White House, Trump signed a massive covid relief bill (after first threatening to veto it). He also presided over some of the largest boosts for the National Institutes of Health’s budget since the turn of the century. And the mRNA-based vaccines Operation Warp Speed helped develop were an astounding scientific breakthrough credited with helping save millions of lives while laying the groundwork for future shots to fight other diseases including cancer.
Abortion
Trump’s biggest contribution to abortion policy was indirect: He appointed three Supreme Court justices, who were instrumental in overturning the constitutional right to an abortion.
During his 2024 campaign, Trump has been all over the place on the red-hot issue. Since the Supreme Court overturned Roe v. Wade in 2022, Trump has bemoaned the issue as politically bad for Republicans; criticized one of his rivals, Florida Gov. Ron DeSantis, for signing a six-week abortion ban; and vowed to broker a compromise with “both sides” on abortion, promising that “for the first time in 52 years, you’ll have an issue that we can put behind us.”
He has so far avoided spelling out how he’d do that, or whether he’d support a national abortion ban after any number of weeks.
More recently, however, Trump appears to have mended fences over his criticism of Florida’s six-week ban and more with key abortion opponents, whose support helped him get elected in 2016 — and whom he repaid with a long list of policy changes during his presidency.
Among the anti-abortion actions taken by the Trump administration were a reinstatement of the “Mexico City Policy” that bars giving federal funds to international organizations that support abortion rights; a regulation to bar Planned Parenthood and other organizations that provide abortions from the federal family planning program, Title X; regulatory changes designed to make it easier for health care providers and employers to decline to participate in activities that violate their religious and moral beliefs; and other changes that made it harder for NIH scientists to conduct research using fetal tissue from elective abortions.
All of those policies have since been overturned by the Biden administration.
Health Insurance
Unlike Trump’s policies on reproductive health, many of his administration’s moves related to health insurance still stand.
For example, in 2020, Trump signed into law the No Surprises Act, a bipartisan measure aimed at protecting patients from unexpected medical bills stemming from payment disputes between health care providers and insurers. The bill was included in the $900 billion covid relief package he opposed before signing, though Trump had expressed support for ending surprise medical bills.
His administration also pushed — over the vehement objections of health industry officials — price transparency regulations that require hospitals to post prices and insurers to provide estimated costs for procedures. Those requirements also remain in place, although hospitals in particular have been slow to comply.
Medicaid
While first-time candidate Trump vowed not to cut popular entitlement programs like Medicare, Medicaid, and Social Security, his administration did not stick to that promise. The Affordable Care Act repeal legislation Trump supported in 2017 would have imposed major cuts to Medicaid, and his Department of Health and Human Services later encouraged states to require Medicaid recipients to prove they work in order to receive health insurance.
Drug Prices
One of the issues the Trump administration was most active on was reducing the price of prescription drugs for consumers — a top priority for both Democratic and Republican voters. But many of those proposals were blocked by the courts.
One Trump-era plan that never took effect would have pegged the price of some expensive drugs covered by Medicare to prices in other countries. Another would have required drug companies to include prices in their television advertisements.
A regulation allowing states to import cheaper drugs from Canada did take effect, in November 2020. However, it took until January 2024 for the FDA, under Trump’s successor, to approve the first importation plan, from Florida. Canada has said it won’t allow exports that risk causing drug shortages in that country, leaving unclear whether the policy is workable.
Trump also signed into law measures allowing pharmacists to disclose to patients when the cash price of a drug is lower than the cost using their insurance. Previously pharmacists could be barred from doing so under their contracts with insurers and pharmacy benefit managers.
Veterans’ Health
Trump is credited by some advocates for overhauling Department of Veterans Affairs health care. However, while he did sign a major bill allowing veterans to obtain care outside VA facilities, White House officials also tried to scuttle passage of the spending needed to pay for the initiative.
Medical Freedom
Trump scored a big win for the libertarian wing of the Republican Party when he signed into law the “Right to Try Act,” intended to make it easier for patients with terminal diseases to access drugs or treatments not yet approved by the FDA.
But it is not clear how many patients have managed to obtain treatment using the law because it is aimed at the FDA, which has traditionally granted requests for “compassionate use” of not-yet-approved drugs anyway. The stumbling block, which the law does not address, is getting drug companies to release doses of medicines that are still being tested and may be in short supply.
Trump said in a Jan. 10 Fox News town hall that the law had “saved thousands and thousands” of lives. There’s no evidence for the claim.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Change Your Brain, Change Your Life – by Dr. Daniel G. Amen
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To what extent can we change our brains, and to what extent are we stuck with what we have?
Dr. Amen tells us that being mindful of both ends of this is critical:
- Neuroplasticity means we can, indeed, change our brains
- We do, however, have fundamental “brain types” based on our neurochemistry and physical brain structure
He argues for the use of brain imaging technology to learn more about the latter… In order to better go about doing what we can with the former.
The book looks at how these different brain types can lead to situations where what works as a treatment for one person can often not work for another. It’s also prescriptive, about what sorts of treatments (and lifestyle adjustments) are more likely to do better for each.
Where the book excels is in giving ideas and pointers for exploration… Things to take to one’s doctor, and—for example—request certain tests, and then what to do with those.
Where the book is a little light is on including hard science in the explanations. The hard science is referred to, but is considered beyond the scope of the book, or perhaps beyond the interest of the reader. That’s unfortunate, as we’d have liked to have seen more of it, rather than taking claims at face value without evidence.
Bottom line: this is distinctly “pop science” in presentation, but can give a lot of great ideas for learning more about our own brains and brain health… And then optimizing such.
Click here to check out “Change Your Brain; Change Your Life” on Amazon today!
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Good to Go – by Christie Aschwanden
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Many of us may more often need to recover from a day of moving furniture than running a marathon, but the science of recovery can still teach us a lot. The author, herself an endurance athlete and much-decorated science journalist, sets out to do just that.
She explores a lot of recovery methods, and examines whether the science actually backs them up, and if so, to what degree. She also, in true science journalism style, talks to a lot of professionals ranging from fellow athletes to fellow scientists, to get their input too—she is nothing if not thorough, and this is certainly not a book of one person’s opinion with something to sell.
Indeed, on the contrary, her findings show that some of the best recovery methods are the cheapest, or even free. She also looks at the psychological aspect though, and why many people are likely to continue with things that objectively do not work better than placebo.
The style is very easy-reading jargon-free pop-science, while nevertheless being backed up with hundreds of studies cited in the bibliography—a perfect balance of readability and reliability.
Bottom line: for those who wish to be better informed about how to recover quickly and easily, this book is a treasure trove of information well-presented.
Click here to check out Good To Go, and always be good to go!
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