Hydrocodone: A Case Study

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

While our major access to these drugs is doctors, we cannot simply lay blame on them, as there is not enough knowledge about these treatments to correctly appropriate drugs, and therefore extra is given (Hemphill 373). Alexander of the Department of Epidemiology of the Journal of the American Medical Association, states that “There are serious gaps in the knowledge base regarding opioid use for other chronic nonmalignant pain” (Alexander 1865-1866), which leads to the unfortunately large number of leftover drugs. In fact, the main place that people get their drugs are from leftover prescriptions (Hemphill 373).

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.

In fact, there was thought to be more of a need for them. Before the last two decades, opioids were used for cancer related or acute pain. However, in the 1990s chronic non cancer patients got attention because people nationally felt there was a shortage in patients receiving opioids, thus making them deprived of adequate pain management. Because of this, clinicians were encouraged to treat chronic non-cancer pain and patients in hospice care more often than they were used to. It was also encouraged to use high doses of opioids for long periods of time (Cheatle). The idea that providers seemed overly cautious about these medications caused a large increase in opioid prescriptions from health care providers. Threat of tort and litigation for some doctors that were deemed for not prescribing enough to alleviate pain of patients was also a concern for doctors This quickly turned a shortage of prescription opioids into a national prescription opioid abuse epidemic in under twenty years. From 1999 to 2010, the amount of prescription opioids sold to hospitals, pharmacies, and doctors offices quadrupled, and three times the number of people overdosed on painkillers in this time (Garcia). While some patients have benefitted from the increased sales and loose guidelines of prescription opioid analgesics, the increasing in opioid misuse, abuse, and overdose is truly daunting. As a nation, we need to back track, and

Doctors and clinical prescribers have discovered their role in curtailing the increased opioid prescriptions in America. It is without a doubt that they play a role in facilitating the opioid misuse endemic in the past by being enablers of the situations. When patients ask for pain medications, they do not take time to analyze the pain complaints or suggest alternative medications other than opioids. Even in instances when one doctor declines to offer a patient an opioid prescription for their pain needs, the patient is likely to find another who will give the prescription. However, there has been wide recognition of the opioid misuse endemic such that clinical prescribers are practicing more vigilant prescribing and are advocating opioid-free

Despite common knowledge that with extended use, opioids result in tolerance and addiction; the healthcare community quickly adopted the practice. At the same time, patient advocacy and pain management groups lobbied to loosen opioid prescribing restrictions (Manchikanti et al.). Concurrently, an initiative to identify pain as “the 5th vital sign” immerged to stronger prioritize pain management (Alexander, Kruszewski, & Webster, 2012). Spurred initially by an American pain organization, later found to be funded by the pharmaceutical manufacturer of OxyContin, this initiative was also quickly adopted by the medical community, and other medical and government organizations. Medical practitioners became the target for big pharma’s marketing strategies to further their profits, and they fell prey. Opioid medications are now commonplace in medicine cabinets across the U.S., benefiting the pharmaceutical companies to the tune of 10 billion dollars

In 2012, enough opioid prescriptions were written to cover every adult in America at least once , but that trend has already begun to be reversed. Last year, 17 million fewer opioid pain relievers were prescribed than in the year before. The concern is that the new guidelines and policies are blunt instruments that are denying patients who appropriately use their prescription opioids access to medications, rather then blocking access for the recreational, illicit user of opioids. There are reports of physicians who are wary about writing prescriptions for opioid pain relievers, those who blindly follow guidelines without considering the nuances of an individuals’ needs, and those who have

Although addiction and overdose of opioids was not declared an epidemic by the Center for Disease Control and Prevention (CDC) until 2011, the beginning of the epidemic can be traced back as early as the 1980’s when attention in medical care began to turn toward pain management. By the early 2000’s the Joint Commission on Accreditation of Healthcare Organizations named pain “the fifth vital sign,” implying that pain is as important clinically as pulse rate, temperature, respiration rate, and blood pressure (Wilson, 2016). At the same time, there has been an emphasis change from patient wellness to patient satisfaction metrics. Non-steroidal anti-inflammatory drugs such as Advil, Aleve, or aspirin have raised safety their own safety concerns, contributing to increased use of opioids. The lack of patient access to and insurance coverage for chronic pain management specialists or alternative healing therapies also contributes to the opioid epidemic (Hawk,

In the United States, opioids have become a major component in healthcare because they are an exceptional method of relieving pain. For those who are recovering from a recent inpatient surgery or those with cancer who are in a great deal of pain, it is a necessity. A known problem with opioids is that they are addictive, which leads to overuse of the medication by the patient. Opioids are also highly sought after as a street drug, this leads to patients exaggerating their pain level in order to receive more pills and selling their excess medication to others. Doctors will often prescribe opioids to patients who do not need such an aggressive form of pain relief, for example, people with arthritis or who have gone through a minor outpatient surgery. This can lead to a long-term use of these pain relieving drugs and possible addiction, which goes against the original purpose of opioids. In order to solve America’s dependence on opioids, medical professionals must go back to the original method of prescribing them, that is, only short-term use for people recovering from surgeries or in pain due to cancer, instead of a long-term solution for acute pain.

The issue of pain management has been an ongoing crisis for ages. The need for solutions and methods of avoiding pain is natural, however, as time has passed, misuse of these solutions has gotten out of hand. The abuse of prescription opioids, in particular, must be acknowledged. By prescribing opioids to patients, doctors are inadvertently creating drug addicts and fueling the heroin epidemic. As patients grow tolerant to opioids, they are forced to search for stronger drugs, commit crimes, and ultimately die. Alternate solutions for pain management and regulation of opiates must be implemented in order to prevent the meaningless loss of lives.

Opiates have been commonly used in the United States for several decades. During the late 19th century opium and morphine became regular ingredients in a lot of widespread patent medicines (Spohn & Belenko, 2015, p. 25). Since then, the use and abuse of opiates has been a serious epidemic that has been growing at a fast pace in the United States for many years now. Every day roughly forty-one people die from overdoses which are related to prescription painkilling drugs in the United States (Clark, 2014, p. 1).

There are many various kinds of prescription of pain relievers, which include: opioids, corticosteroids, antidepressants and anticonvulsants (anti-seizure medications). Among them I would like to focus on opioid medications and its side effects. Opioid medications are narcotic pain medications that contain natural poppy plant, synthetic opiates such as; methadone, fentanyl, tapentadol and tramadol, as well as the semi- synthetic opioids such as; oxycodone, hydrocodone, oxymorphone, hydromorphone and heroin. Opioid prescriptions are morphine (C17H19NO3), heroin (C21H23NO5), codeine (C18H21NO3) and thebaine (C19H21NO3). They are highly addictive substances are called opiates. Opioid medications have been used for hundreds and thousands of years to treat both pain and mental health problems. It is also use in a short-term pain after surgery. According to the survey in the past two decades, the prescription of opioid in the United States has been increased to the higher levels that is more than 600% (Paulozzi & Baldwin, 2012). However, that opioid medications are very dangerous to the patients’ respiratory system, other parts of the internal body and even can cause death. It should be only being use after wise discernment and with a great care.

Doctors prescribe opioid as a painkiller to patients, but they should switch to an alternative to using opioids for that reason. In an Opioid Abuse article, it is stated that “opioid analgesic are now the most commonly used prescribes class of medications in the United States (Volkow)”. This right here should be making it clear that opioid is usually the first choice of a pain killer medication to be given out to patients. The rate of patients being addicted to this medication has been going up. In 2014, it has been said that the rate of opioid addiction affecting the U.S adults was 2.5 million. There are other alternatives that our medical field could be distributing as

Doctors and other medical professional specialize in providing quality medical care for their patients, are now fighting to control pain without the risk of misuse and abuse of prescribed medications by their patients. One disadvantage of quality care is providing opioid medications to help control extreme pain for some patients. Many patients have become dependent on opioid—highly addicted painkillers such as fentanyl, hydrocodone, morphine, oxycodone, propoxyphene, and methadone. According to 21 Health Organizations and the Drug Enforcement Agency (DEA) cited by ACPM, “effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively” (the American College of Preventive Medicine, 2011). Aggressively fighting patients’ pain with opioid medications have led to an increase rate of addictions to the level in which it is known as uncontrollable epidemic in today’s society.

Chronic pain is an important public health problem that negatively impacts the quality of life of affected individuals and exacts a tremendous cost in both healthcare costs and lost productivity. The Institute of Medicine (IOM) in its landmark report on relieving pain in American estimated that 100 million individuals suffer from chronic pain at a socio-economic cost of between $560 and $635 billion annually [IOM, 2011]. Opioids have been increasingly prescribed for the management of chronic pain, and along with this increase in use has come an increase in opioid misuse and abuse. Of the opioids that are abused, 60% are obtained directly or indirectly through a physician’s prescription.