12-Jan-17
CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016 Summary Draft
Chiquita Boyd
The CDC conducted a study to test the effects of longterm opioid use in adult patients dealing with chronic pain. It is estimated that 11.2% of adult patients suffer with some form of chronic pain lasting 3 months or more. The study utilized two styles of methodologies to assess and reach their findings, Meta-analysis and GRADE, Grading of Recommendations Assessment, Development and Evaluation. Drawing information from patients being treated on a continues bases; palliative (hospice/nursing homes) and end of life care excluding those with an active cancer treatment. The study is meant to be an aid for clinicians as a guide that
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The last time the CDC looked at this issue was 2014 using the same methodologies drawing from cases from 1999 – 2014, at that time it was noted that no studies had been conducted greater than 1 year but did include a systematic review on effectiveness/risks and supplemental reviews on benefits, harms, values, preferences and costs; also including data from observational studies and randomized clinical trails which also posed a problem since none of the studies went passed 12 weeks thus creating limitations. During that study the CDC characterized the GRADE and Meta-analysis was of low quality. They also found that the 2014 study showed 3-4% of patients out of the 11.2% were being prescribed opioids for long term use, that 165,000 people died from opioid related overdoses and that in 2013 an estimated 1.9 million people abused or overdosed on medically prescribed opioids. From the study studies conducted in 2014 and 2016 the CDC came up with helpful guidelines/recommendations for clinicians to assist in making decisions as it relates to patient care, such things as if at all possible and first recommendation use other forms of non opioid treatments, doctors
The CDC website provides ample educational information regarding tuberculosis. It gives a detail description of what Tuberculosis is, the testing used and how it works. The website also addresses the risk factors of tuberculosis and warns that traveling to countries such as Africa, Asia and Central America puts them in a higher risk of contracting TB. In addition, it provides people with preventive measures to avoid being infected. They advise against close proximity with infected, and to be cautious around people working in health care facilities, prisons, shelter or an over populate area and advise to refrain from consuming unpasteurized milk products. In addition, the Website provides Data and Statistics, which can help support previous
Mike Alstott knows first-hand how opioids, when used correctly, can play an important role in managing pain and helping people to function, but he is also keenly aware of the growing crisis of opioid misuse and overdose. More American adults are dying from misusing prescription narcotics than ever before. An estimated 35 people die every day in the U.S. from accidental prescription painkiller overdoses resulting from things like not taking a medication as directed or not understanding how multiple
Opioid addiction is a condition that is preventable as well as one which individuals display several noticeable risk factors before the actual addiction prognosis to the point of causing death. There is a strong correlation between the early misuse of prescription opioids, which are prescribed for non-cancer pain management, and the development of a dependence on such opioids. Early detection of risk factors such as the misuse of opioids that are prescribed will help indicate that a patient is developing an addiction.1 Physicians, nurses, pharmacists, and other healthcare providers must closely monitor patients and the rate at which opioids are consumed as well as refilled.
As better and more comprehensive education is provided both to the general public and practicing clinicians the hope is to reduce the negativity surrounding the users of opioids, and to eliminate demeaning language coupled to them as well. This could improve patient morale and help the needless continuation of physical suffering within patients, as they would be more comfortable approaching and using opioids for therapeutic purposes1. That being said there are those within our communities who do abuse these substances and pharmacists must recognize the signs of abusers, it is important for them to reach out, without comment, to help those suffering from opioid abuse once they have been
Opioid-induced adverse effects are a very interesting topic and does play a big part in patient safety. It’s estimated that more than half of older adults who reside in a healcre related community have a chronic pain disorder, with the long-term care setting rate of prevalence substantially increased (up to almost 90%). Physicians across all care settings are tasked with the daunting challenge of providing pain relief while, at the same time, minimizing opioid-induced side effects. Some of the common opioid-induced side effects are Constipation, Nausea, Vomiting, Pruritus, Sweating, Sedation, Fatigue, Headache, Delirium, Confusion, Clouded vision, Dizziness, Xerostomia, Postural Hypotension, Bladder Dysfunction such as Urinary Retention,
Considerable cautions have been obtained throughout the United States to decrease the misuse of prescription opioids and helps to minimize opioid overdoses and related complications. Even though the pain medications have a significant part in the treatment of acute and chronic pain situations, it sometimes happen that the high dose prescription or the prescribed medications, without having enough monitoring, can create bad outcomes. It is always a dilemma for the providers to find who is really in need of pain medications and to identify those who are questionably misusing opioids.
The use of opioid-based prescription medications to treat non-terminal chronic pain can cause side effects from short term use, and is overly common and ineffective. Firstly, opioid usage can induce negative short-term effects. According to William A. Darity, Jr., short-term opioid usage causes negative effects such as “euphoria, drowsiness, and impaired motor and cognitive functioning” (“Drugs”). The short term effects of the opioids may cause the patient to isolate him or herself socially due to being self-conscious about his or her friends and peers seeing the individual in their current condition. Due to his or her fragile emotional state, however, if the patient isolates him or herself during a time in which he or she should have increased
In recent years, more people in the United States have been using opioids for non-medical purposes. In fact, the National
According to NIH, millions of people suffer from opioid use disorder throughout the United States. This epidemic has continued to spread and the numbers of people who are becoming addicted is on the rise so much that the total burden of cost is at 78.5 billion dollars per year for prescription opioid misuse, this includes the cost of addiction treatment, criminal justice services, and health care (NIH, 2017. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis) Unfortunately there does not seem to be an end to this epidemic anytime soon. The numbers are unremarkable; natural and semi-synthetic opioids peeked at 14,427, heroin at 15,446 and synthetic opioids other than methadone at 20,145. That is a total of 50,018 deaths for some type
There is no question that the alarming rate of deaths related to opioid overdose needs to be addressed in this county, but the way to solve the problem seems to remain a trial and error approach at this point. A patient is injured, undergoes surgery, experiences normal wear and tear on a hip, knee or back and has to live with that pain for the rest of their life or take a narcotic pain medication in order to improve their quality of life and at least be able to move. The above patients are what narcotic pain medications were created for, a population of people that use narcotic pain medications for fun is what is creating a problem. Narcotics are addictive to both populations, however taking the narcotic for euphoric reasons is not the intention of the prescription that the physician is writing. The healthcare system needs to find a way to continue to provide patients that experience chronic pain with the narcotics that work for them while attempting to ensure the Drug Enforcement Agency (DEA) doesn’t have to worry about a flood of pain pills hitting the streets by granting access to the population with a substance abuse problem.
Opioid use in the US has increased over the years, and this has led to an increase in substance abuse. Substance abuse is not only associated with use of illicit drugs but also prescription drugs. In 2015, of the 20.5 million reported cases of substance abuse, 2 million had an abuse disorder related to prescription pain relievers and 591,000 associated with heroin.1 The increase in substance abuse disorder has led to an increase in opioid related death. In 2015 drug overdose was the leading cause of accidental death in the US with 52, 404 lethal drug overdoses.2
The use of opioids and other drugs continues to gradually increase in the United State. According to Centers for Disease Control and Prevention (CDC), the number of overdose deaths involving opioids has quadrupled since 1999” (CDC website). Individuals are abusing prescription opioids such as oxycodone, hydrocodone, and methadone. Prescriptions opioids that are supposed to be used as pain relievers, cough suppressants and for withdrawal symptoms are being use by individuals in order to feel relaxed or for the overwhelming effect of euphoria. These types of drugs are to be taken orally, but people are snorting, smoking, and injecting them in order to get a better high. I have personal encounters with opioid drugs and opioid abuser on a regular
The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.
Article 11: Chronic pain is associated with impairment in sleep. The relationship between using prescribed opioids and sleep is unclear. The focus of the study was to examine differences in self-reported sleep quality between groups of patients who were different by chronic pain and prescribed opioid status. The use of opioids with chronic non-cancer pain continues to increase. Common adverse effects associated with the initiation of opioids including constipation, nausea, somnolence, and vomiting. Up to 50% of patients stop taking opioid therapy because of intolerance or insufficient pain relief. Research shows that pain often results in disruptions to sleep and impaired sleep itself a risk factor for pain. In a comprehensive review
Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865).