Opiates are the most potent analgesic agents, therefore, they’re used commonly for the treatment of acute severe pain following trauma, extensive burns or surgery. They are often used for patients with painful terminal diseases like cancer in order to help alleviate the pain that comes with their disease and treatments. In the past years, their use has grown being that providing adequate pain relief is now considered an important standard of care and is even required by law in some states. Opiates are also known for being able to reduce anxiety and produce mild sedation. Their use is very controversial when chronic non-malignant pain is discussed. The most powerful opiate analgesics are also the most likely to cause abuse and addiction, and are therefore accountable for several deaths related to drug misuse. This has caused a reluctance among some physicians to prescribe them.
There have been many people who up to this moment have seen the problem first-hand and have asked others to help change it. One of them is Vivek H. Murthy, M.D., M.B.A., who on August 24, 2016, mailed a letter and pocket card to 2.3 million doctors, nurses, dentists, and other clinicians asking them to help address America’s escalating opioid epidemic.
Murphy states that the annual number of overdose deaths involving prescription and illicit opioids has nearly quadrupled since 2000. There’s a parallel between these deaths by overdose and the increasing growth in the amount of opioid pain relievers being prescribed, and there are more than 2 million people in the United States addicted to prescription opioids, with more than 12 million having misused these medications in 2015. Aside from this, there’s also an existing comeback in heroin use and the spread of HIV and hepatitis C that’s said to be one of the many by-products brought on by this opioid epidemic. With limited access to adequate treatment, many find themselves in a horrible situation. Murphy states that the police officers he met in Seattle, that began carrying naloxone in the spring of 2016, had saved 10 lives within a few months. Murphy presses that those in health professions need to use their position as leaders in society to help change how the country sees addiction He, along with the authors of this blog, want to change the ways people see addiction, from a personal failing to a chronic disease of the brain that needs help and understanding in order to get better.
In the US, the prevalence of opioid dependence in patients receiving prescription opioids is as high as 26%. In primary care, it’s seen that the estimated rate of opioid misuse is 21–29%.
The rate of addiction is 8–12%, while the estimated rates of substance use disorder in patients with chronic pain seen in pain clinics are as high as 45%. One current case in which opioids are continuing to be prescribed, where their use is more detrimental than beneficial to the patient's health, is in the management of abdominal pain and gastrointestinal diseases and conditions. It’s known that chronic opioid use can be detrimental to the gastrointestinal tract and central nervous system, and what’s worse the evidence for the efficacy of opioids for gastrointestinal pain is lacking. That being stated, there are still opioid prescriptions being made for people with these conditions. The truth is, there is evidence that supports opioid use for chronic noncancer pain; however, the evidence supporting the effectiveness of opioids is for short-term use (<3 months) and is largely focused on musculoskeletal pain.
Opioid-induced bowel dysfunction (OIBD) is a collection of gastrointestinal motility disorders induced by opioids. Some of the most common effects are constipation, nausea, abdominal pain or discomfort, gas, ileus, gall bladder contraction and gastro-oesophageal reflux. In a study, among 489 patients with chronic noncancer pain, opioid-induced constipation (OIC), one of the most common disorder in OIBD, had a negative effect on quality of life, particularly on work performance and productivity (38%), performing activities of daily living (49%), social interactions (45%), sex lives (45%) and the ability to leave the house (43%). If it’s still too hard to believe that opioid prescriptions are being given without good enough reasons, one study in 2016 revealed that emergency room physicians perceived pressure to prescribe opioids to avoid administrative criticism and poor patient satisfaction.
Medical use and nonmedical use of prescription opioids is often seen in studies about adults, but in the following graphs national trends in the medical and nonmedical use of prescription opioids among high school seniors between 1976 and 2015 were examined.
FIGURE 1
In Figure 1, we see the trends of medical and nonmedical use of prescription opioids among high school seniors from 1976 to 2015. (The dotted line reflects the update in the list of examples of prescription opioids in 2002). Here we see how lifetime medical use of prescription opioids among high school seniors was more likely and prevalent than nonmedical use of prescription opioids (NUPO) over this time period.
FIGURE 2
In Figure 2, the prevalence of NUPO differed less by sex even though the lifetime medical use of prescription opioids tended to be more prevalent among female adolescents relative to male adolescents.
FIGURE 3
In Figure 3, the trends are divided by race between the years 1983 and 2015. The timeline here changed mainly because there were changes in the response options to the race question, therefore, race trends were examined starting in 1983 to have consistent race categories over time. Here we see that the prevalence of medical use of prescription opioids and NUPO was higher among white adolescents relative to black adolescents. This could be because of the availability of these drugs to white adolescents, since in Figure 3 it’s shown how white adolescents already have a higher medical use for prescription opioids. This ready availability can lead to dependence in teens, and that dependence of opioid use could eventually lead to their nonmedical use.
FIGURE 4
In Figure 4, the trends in patterns of lifetime use history for prescription opioids among US high school seniors show that the most prevalent pattern of exposure to prescription opioids was medical use only (without a history of NUPO) over the course of the study period. These patterns ranged from a low of 8.5% (SE = 0.9) in 2000 to a high of 14.4% (SE = 0.8) in 1989.
It’s shown in Figure 4 how there is a prevalent pattern that those who misuse prescription opioids for nonmedical purposes had initiated medical use previously and then began NUPO.
This pattern ranges from a low of 2.6% (SE = 0.2) in 1979 to a high of 5.4% (SE = 0.6) in 1990. Among all these patterns the least prevalent one tended to be NUPO before initiating medical use of prescription opioids. This data helps put into perspective the important role that those in medical professions play in a person’s NUPO, since it’s their part in over prescribing powerful opioids that has helped lead the opioid epidemic.
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