Opioid Prescriptions: 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.

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

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

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).

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.

Almost one hundred years ago, prescription drugs like morphine were available at almost any general store. Women carried bottles of very addictive potent opiate based pain killers in their purse. Many individuals like Edgar Allen Poe died from such addictions. Since that time through various federal, state and local laws, drugs like morphine are now prescription drugs; however, this has not stopped the addiction to opiate based pain killers. Today’s society combats an ever increasing number of very deadly addictive drugs from designer drugs to narcotics to the less potent but equally destructive alcohol and marijuana. With all of these new and old drugs going in and out of vogue with addicts, it appears that the increase of misuse and

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 over use of opioid has been one of the major public health problem in the United States (Substance Abuse and Mental Health Services Administration, 2018). Opioids include prescription medications that are used to treat pain symptoms which includes codeine, morphine, methadone, hydrocodone, and etc., as well as illegal drugs such as heroin and illicit potent on opioids such as fentanyl analogs (Substance Abuse and Mental Health Services Administration, 2018). The opioid overdose could happen due to many factors such as when a patient deliberately misuses a prescription, or misuse heroin (Substance Abuse and Mental Health Services Administration, 2018). Opioid overdose could happen due to the prescriber miscalculated the opioid dose or when

There are three predominate forms of Medication Assisted Treatment (MAT) that have proven effective in combating opioid use disorder. Methadone, buprenorphine, and naltrexone have all shown to be effective in the treatment of substance use. When prescribed and monitored properly, MAT has been shown to reduce illicit drug use and reduce the rate of accidental overdose. However, while as many as 2.5 million people are suffering from substance use disorder, less than 40% have access to MAT

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

This lack of independence could further cause the patient to feel hopeless in their own recovery, which would lead to a lack of effort in getting better, causing a strain on the family members who are doing everything they can to improve the patient’s condition. Secondly, in spite of the short term effects, doctors do not practice appropriate care when prescribing opioid-based medications. According to Anna Lembke, in recent years American doctors have been “prescribing opioids with abandon for chronic, non-terminal pain” (“problem”), leading to an “epidemic of opioid painkiller overprescribing” (“Drug”, 57). If the patient feels like the doctor is giving him an opioid medication because it is the easiest course of action to deal with the pain, the patient may not fully trust his or her doctor to have the patient’s best interests at heart. The family of the patient may have the same mistrust for the doctor. Further than mistrust, it is possible that the patient and those caring for him or her may question the doctor’s knowledge and credentials. This mistrust could lead to the patient and the family (specifically the caregiver) neglecting to follow the doctor’s specific instructions as to usage of the medication, which could cause the pain relief to be less effective than is necessary, or could cause the patient to be in

In the United States, there has been upward swing of opioid abuse over the past decade. Overdose deaths involving opioids – both prescription pain relievers and heroin – almost quadrupled between 1999 and 2014. Well-intentioned efforts to curb prescription opioid abuse have yielded new policies with unfortunate, unforeseen consequences for the 15% of the US population that suffer from chronic pain – nearly 45 million people.

The National Center on Addiction and Substance Abuse provides guidelines and recommendations to healthcare providers in terms of how to screen for an addiction. Opioid addiction is screened primarily through patient interviews involving both specific and open ended questions about their lifestyle, mood, and drug use. A psychiatric exam may also be administered to look for psychological factors indicating an addiction such as depression, anxiety, and other psychological symptoms related to addiction and withdrawal. Withdrawal is evaluated by gradually taking a patient off opioids and if symptoms of withdrawal are found the severity of the withdrawal itself is then evaluated.2 If a patient is diagnosed with an addiction to opioids then the transition to tertiary prevention, or treatment will occur. However, treatment will only occur if early detection and screening techniques are utilized fully by healthcare provider otherwise it is likely an overdose will kill the opioid

The opioid epidemic is considered a “great mistakes of modern medicine.” I feel that with the availability of counteractive drugs such a naloxone; the opioid abuse rate will increase. Knowing that there is a counteractive drug in the market, patients will fear less of opioid overdose and will promote opioid usage. Naloxone as a harm reduction approach to opioid use is an excellent choice for patients but comes with consequences.

Unbeknownst to the everyday individual, there is a raging issue going on within our nation that involves the rising surge of narcotic misuse and overdose. According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2014, more than 165,000 people have died in the United States from overdoses related to prescription opioids. In 2014, almost 2 billion people either abused or overdosed on prescription opioids, and of which 14,000 were fatal. Today, the heartbreaking statistics indicate to us that at least half of all overdose deaths involve a prescription opioid. (CDC, 2016) Thus, this information leads us all to wonder where these addictions are sparked and where the prescriptions are being administered. One extremely popular route, involves our Emergency Departments (ED) all across the nation. For the remainder of this paper, we will discuss the clinical portion of this issue, and the interventions that all medical professionals can put into place to help lower the numbers of these statistics.