Howard Dedes, M.D. on the Opioid Epidemic


On average, 130 Americans die every day from an opioid overdose. From 1999 to 2017, more than 700,000 people have died from a drug overdose. The opioid epidemic has been an ongoing struggle since the 1990s and although agencies are working hard to prevent these issues, we have yet to figure out how to greatly reduce these staggering statistics. At Physician Partners of America (PPOA), we do what we can to provide our patients with opioid alternatives so they can live their best and healthiest lives.

Howard Dedes, M.D., of PPOA’s Fullerton, CA clinic, is an advocate for his patients’ well-being. PPOA’s physicians have great knowledge on the subject of opioids and hope to be a part of combating the opioid epidemic. Below are opioid facts from Dr. Dedes.



What are opioids?

Opioids are very strong pain medications that, when properly managed, work well for certain types of pain and short-term use. Treatment for broken bones, burns, severe injuries and cancer are examples of pain that respond well. In recent years, there has been a great increase in the use of prescription opioids for the treatment of conditions like chronic, non-cancer pain such as back pain or osteoarthritis.


Opioid effectiveness

Although opioids might mask the pain for a bit, serious risks are involved and there is lack of evidence about their long-term effectiveness. The problem is that if you use them for a while, it is difficult to get the same effect as you did when you first started the medication. There have been long term studies following patients with chronic back pain who have been given increasing amounts of opiates, and others who were not on long-term opiate courses. The researchers found no long-term benefit to the extended use of opiates.

“That’s not to say that people with chronic pain may not have the need for pain medicine if their pain flares up,” says Dr. Dedes. “It’s just that the high doses of opioids that were once expected are becoming rarer.”


The opioid epidemic

In the late 1990s, pharmaceutical companies began encouraging opioids at greater rates due to reassurance from the medical community that patients would not become addicted to opioid pain relievers. This led to the extensive misuse of these medications before it became clear that they could, in fact, be highly addictive.

“I believe the opioid crisis is real, and it’s a difficult topic when dealing with patients who have been given increasing amounts of opiates for several years,” says Dr. Dedes

Medication increased at a high level can have the opposite effect. It’s called OIH (opiate induced hyperalgesia), which makes the pain actually worsen despite increasing the opiate strength or frequency. This leads to the body becoming physically dependent to the opiate medication. If this occurs, as the body feels the amount of medication lowering in its system, there is an increased craving for the medication and a feeling of pain.

Then there are patients who try and stop immediately after hearing about the opioid crisis. Unfortunately, this is not beneficial, as they can feel sick and then restart the medicine and after that are afraid to reduce the amount of opiates for fear of getting sick again, from the opiate withdrawals.


Risks and reducing opioids

In order to reduce their use of opiate medications, patients must be committed to their health. This includes wanting to get better without being dependent on a medication – specifically a medicine that at high doses has been linked to dependence, addiction, mood changes, low testosterone, respiratory depression, or even death.

“If they are committed,” says Dr. Dedes, “I will work just as hard to help them lower their daily opiate amount, while still allowing them to be functional.”

Although pain control is good, quality of life can suffer when someone constantly feels “foggy” and tired from the pain medication. Dr. Dedes makes it a point to focus on a patient’s function and ability to do the things he or she want to do – garden, golf, sit through a movie with grandkids, for example – and then focus on controlling the pain to achieve this.

To help manage a patient’s pain opioid-free, Dr. Dedes will usually start by suggesting daily exercise to help improve flexibility or strength, and in turn, combat the source of pain. Exercises can range from mild to intensive, initially with a therapist and then on their own. It is important for patients to start at a level they are comfortable with and increase intensity from there.

When a more aggressive approach is needed, Dr. Dedes specializes in the ability to perform minimally invasive procedures that target the patient’s specific pain. He tailors treatment plans to each individual because he understands all pain is different.

“The truth is that the intervention has to be specific to the individual,” says Dr. Dedes. “Pain varies between individuals even if they have similar looking MRI reports.”

There are many new procedures and conservative treatments that can be done to reduce the need for opioids. It is Physician Partners of America’s goal to battle opioid addiction by offering interventional solutions to chronic pain. If you would like to learn more about how we can help, please visit us at


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