Opioid Prescribing Practices

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

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.

In the last two decades, opioid addiction started affecting more and more Americans. But who is at fault for this epidemic? The pharmaceutical companies. They make and distribute their drugs to doctors and pharmacies and are making billions off the American worker’s dollar. All while, lying to doctors about these miracle drugs effectiveness and advocating against protective measures for the drugs.

Opioids are taking over the United States with its addictive composition, once patients are take opioids there is no escaping. The drug directed from opium which is obtained from a plant (Katz). Opioids are most commonly found in prescription pill from making underground sales more common. Since opioids are derived from a plant this makes the reality of home grown drugs more of an issue. American citizens overdosing on opioids is what is sparking the crisis because opioid “overdoses killed more people last year than guns or car accidents” (Katz). Opioids are extremely addictive and that is why so many citizens overdose on these types of drugs. After patients become hooked on opioids their body constantly is needing more and more opium to escape they pain they think they are enduring. The overdosing of Americans is not a small percentage of the population either, it is estimated that “over two million people in America have problem with opioids” proving this growing issue is an ongoing crisis (Katz). The United States government needs to take action immediately to the opioid crisis because doctors are overprescribing patients because they seemingly overreact to pain, and opioids are one of the most addictive drug types in the world.

Last year there were over 64,000 reported opioid-related deaths in the United States – making it the leading cause of accidental death in people under the age of 50 in this country (Katz). Opioids, also referred to as painkillers, have become a growing problem over the past two decades particularly in rural communities all across the country where the death rates are higher per capita compared to the death rate in cities (“America’s Opioid Epidemic is Worsening”). These narcotics, such as codeine, fentanyl, hydrocodone, morphine and oxycodone are extremely addictive and, as a result, this silent killer has quadrupled the overdose death toll since 1999

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).

The United States of America has had a war against drugs since the 37th president, Richard Nixon, declared more crimination on drug abuse in June 1971. From mid-1990s to today, a crisis challenges the health department and government on opioid regulation, as millions of Americans die due overdoses of painkillers. Opioids are substances used as painkillers, and they range from prescription medications to the illegal drug, heroin. Abusing these substances can cause a dependency or addiction, which can lead to overdoses, physical damages, emotional trauma, and death. To ease the crisis, physicians are asked to depend on alternatives to pain management. Law enforcement cracks down on profiting drug-dealers and heroin abusers. People are warned against misusing opioids. The controversy begins for those who suffer from chronic pain, because they depend on opioids. There’s so a correlation to the 1980s cocaine epidemic, and people are upset over racial discrimination. Nonetheless, the best way to avoid this crisis is to recover the people at risk, reduce inappropriate opioid description, and have a proper response.

The rate of death due to prescription drug abuse in the U.S. has escalated 313 percent over the past decade. According to the Congressional Quarterly Transcription’s article "Rep. Joe Pitt Holds a Hearing on Prescription Drug Abuse," opioid prescription drugs were involved in 16,650 overdose-caused deaths in 2010, accounting for more deaths than from overdoses of heroin and cocaine. Prescribed drugs or painkillers sometimes "condemn a patient to lifelong addiction," according to Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. This problem not only affects the lives of those who overdose but it affects the communities as well due to the convenience of being able to find these items in drug stores and such.

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.

Here in America, there is an ongoing tragedy ceaselessly unfolding right before our eyes. Beyond the calamities of gun violence, the loss of innocent lives through ruthless crimes and deadly motor vehicle accidents, there is a crisis occurring in the very homes of many Americans. There is a proceeding addiction to the pill bottles hidden behind bathroom mirrors, needles poking through the surface of fragile skin to get a “fix”, and prescriptions being written left and right with the intention to help but the potential to kill. Here in America, over 115 people die every single day from overdosing on opioids and this is a reality that has been nothing short of deadly since as early as 1990.

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

The drug epidemic in America is a growing problem and continuing to take hundreds of lives everyday, particularly opioids. These highly addictive drugs are taking the world by storm and claiming thousands of life with no remorse. The pharmaceutical industry is making millions off the addiction and pain of the American people causing a widespread of drug overdoses and deaths all across the United States. According to The New York Times, “Public Health officials have called the current opioid epidemic the worst drug crisis in American history, killing more than 33,00 people in 2015.” (Scott Morgan) Addiction, money, and the vulnerability all play a part in the opioid widespread epidemic.

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

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,

A relatively new form of contract that has received increasing attention, particularly in the pain medicine community, is known as an “opioid contract.”With the increased emphasis upon the importance of effective assessment and management of pain to quality patient care, and the growing acceptance of the need that some patients with moderate to severe chronic pain (of both malignant and nonmalignant origins) have for opioid analgesics, the opioid contract has been touted as a means of carefully circumscribing the parameters Within which opioid therapy will be provided.7 such contracts have not meet with universal acceptance (Lipkin 2012).. Some physicians argue that such contracts place an adversarial, or at least accusatory, cast upon the physician–patient relationship, while others maintain that to single out opioid analagesia for such contracts inappropriately places the Physician in the role of drug law enforcer (Lipkin 2012).