Opioids: A Qualitative Study

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.

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.

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

Painkillers are prescribed so fluently within doctors offices, hospitals, and other similar facilities. Part of the issue comes from our physicians and those patients who complain about their “pain.” Rarely do physicians say no to a begging patients, but also they rarely take the time to run the necessary test to find the root of the problem. As a beginning solution, educational classes on dealing with and treating chronic pain and how to properly dispose of unused pharmaceuticals like opioids are gaining popularity(Meldrum). With the proper knowledge, people can begin to understand how opioids become so addicting. Along with knowledge about the epidemic comes help for those affected. Treatment centers for those who need it should be implemented at a proper cost and with availability for everyone. Through the Affordable Care Act, treatment coverage has been broadened. This contributes to actual care for addicts rather than punitive measures. Along with treatment options, emotional support to an addict goes a long way. Addicts can return to a life full of bad choices when they feel as if no one cares to see them get better(Newcomer). With proper treatment and precautions, the epidemic can be solved.

As we see the further progression of the opioid epidemic within the United States, pharmacists become the frontlines to recognizing and providing care for these patients. It is however difficult to provide care for a patient when even the professionals within the medical community have an associated stigma attached to the use of these drugs. Patients who have a need for these painkillers recognize this stigma, and by doing so decide to avoid consulting their doctors and do not seek the care which they need. They do this to avoid the discriminatory treatment they receive both within and on the outside of the healthcare system, and to avoid the legal repercussions associated with the misuse and abuse of these products1. It is therefore the pharmacists' job to avoid the stigmatization of these people and respect those who use these treatments for legitimate medical purposes.

I come from a small community in the mountains that once was a beautiful place to live. Methaphetimes and opioid addiction have taken over the town. Now my hometown that was full of fascinating Appalachian history is now known as a drug town. In the 1990's the use of opioids increased significantly across the nation and then by 2010 the use of heroin went up in its place (Davies & Talbots, 2017). I feel that a lot of people started taking pain medication innocently, but now it has turned into a horrible epidemic. I think that to get the opioid crisis under control, prescriptions for pain medications should be carefully monitored. I know there are many pain management clinics in my area. I feel that the majority of these places are pill mills for addicts and they need to be closed for good. I realize that this does not solve the issues of heroin abuse, but at least it

First, for providers to use opioids as the first option in prescribing pain killers needs to be addressed. Knowing that opioids are very addictive should sway providers to look for other options for their patients before looking towards opioid type drugs. Second, once a patient is prescribed opioids for pain management, there needs to be limitations placed on how many pills the patient can have at one time. There also needs to be a limitation placed on the amount of time a patient can use any form of opioids. Third, once a patient’s prescription runs out, they often times start looking to find that same high by buying these drugs illegally off the streets. Therefore, after a patient stops using an opioid medication, they need to have some type of specialty care available to them (mandatory if used for a prolonged period of time) to address any potential withdrawal symptoms; care that can provide counseling and or medications that enable the patient to be weaned off of the drug. Fourth, the need to identify why patients are not seeking recovery is crucial. Not many opioid addicts seek treatment; the first step in recovery is to seek help. Fifth, determining how to get opioid addicts into a recovery program will help exponentially to get people away from opioid use and on the road to recovery. Sixth, opioid addicts do not have high success rates for continued recovery after leaving a treatment program. Identifying the needs of the addicts after treatment is one of the most important elements to staying clean and

Traditionally, doctors prescribed opioid treatments for pain-related medical conditions. Chronic pain in particular is difficult to treat. While the search for a cure is underway, the best most patients can hope for is effective management of their condition.

A segment published by Postmedia News deliberates the good, the bad, and the ugly of opioid pain medication. The author of this article, Sharon Kirksey captures the personal and medical interpretation on this increasing problem. Prolonged use of these medications not only cause physical damage to internal organs, they also have a high risk for addiction. Sharon Kirkey wonderfully illustrates statistics in the form of monetary value, time, and human life. Although these facts and stories come from Canada, this topic is a huge problem in the United States as well.in

For my research, I would like to make an impact on the number of opioids prescribed at in the Emergency Department at Houston Medical Center. The United States has an opioid crisis and uses more opioids than all other countries in the world combined (Cassidy, Dasmahapatra, Black, Wieman, & Butler, 2014) . This usage of opioids leads to abuse, dependence and hyperanalgesia. The over prescribing of opioids became dramatically increased following pharmaceutical companies downplaying side effects related to their medications. With the addition of pain as a 5th vital signs and pain becoming a question on the HCAHPS, there has been a rapidly progressing sector of narcotic prescriptions.

To help combat the opioid crisis, there are some existing policies that have been set in place by the government and various agencies. For instance, the U.S. Centers for Disease Control and Prevention (CDC) have implemented the use of Prescription Drug Monitoring Programs (PDMPs). These state-run programs are electronic databases that track down the prescriptions of controlled substances, including opioids. Physicians and other medical personnel can utilize this database to look at specific information such as the type of drug prescribed, the quantity, and so on. In addition, they can look at a patient’s history with controlled substances, which in turn helps them to avoid the prescription of controlled substances to a person with possible

Another component of the pain management model is the implementation of the Emergency Department Information Exchange (EDIE) program which is a networked service providing accessibility to patient data of previous visits to the Emergency Department and prescription obtained in other EDIE facilities (Cahana, Dansie, Theodore, Wilson, & Turk, 2013). For patients denied of prescription, an EDIE issues a message to the patient’s PCP, if the patient has already received one. Prescription drug monitoring programs such as the one used by UWDPM is one of the systems of checks devised to help curtail the increasing number of opioids

The Emergency Department (ED) see approximately 2000 patients each week, the patient volume increasing between the months of October thru March. Of these patients that are seen, approximately 27% have a known history of chronic pain with repeated visits to the hospital ED to be treated with and receive a prescription for opioid narcotics. Review of a narcotic database identifies that many of these patients have received multiple prescriptions for opioid narcotics from other facilities and other providers in recent weeks. Other hospitals in the city have created a chronic pain treatment protocol for such identified patients in order to decrease the number of prescribed narcotics issued in the ED and to decrease patient ED visits by encouraging chronic pain patients to return or become established with a pain management specialist.