The Population Of Interest, Patients With Chronic Back Pain

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.

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 populations of interest are the staff nurses who work on the Addiction Medicine adult inpatient unit treating patients with drug and alcohol misuse disorders and the adult patients on this unit undergoing treatment for drug and alcohol misuse disorders.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5, opioid use disorder (OUD) is characterized by patterns of opioid use that are problematic and persist for at least one year (American Psychiatric Association, 2013). Evidence of problematic use of opioid is demonstrated through the presence of at least 2 symptoms which include withdrawal, craving, and continued use of opioids despite the disruptions it causes in personal and professional life. The substances used by persons with OUD are heroin and nonmedical pain relievers ([NMPR]; i.e. nonmedical use of opioid pain relievers), and estimates for DSM-5-defined OUD tend to combine the prevalence of use for each of these substances to determine overall

First of all the author provides a well know resource The World Health Organization. This Organization is a specialized agency of the United Nations who has been around for many years. It’s a well reliable facility which provides estimates of patients who obtain pain medication for chronic pain. The author also states that the drug is a stimulant that relieves severe pain and produces a highly addictive powerful feeling of well – being. (Berrettini, 2016)

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.

Substance abuse disorders have been considered a major epidemic by public health authorities during this century. Most recently, those who use, and abuse opioids have been in the spotlight. The growing number of overdoses, deaths, and individuals who are identified as opioid abusers has, of late, been the subject of media attention. Now coined “The Opioid

According to the guidelines, there are three important principles to follow for the improvement of patient safety and care. Non-Opioid therapy is suggested if patients are non cancer chronic pain patients or in hospice care. Additionally, if opioids are needed, the lowest dose possible for the shortest amount of time is recommended to reduce risk of opioid overdose. Lastly, clinicians must monitor all patients carefully when they prescribe them opioid analgesics. Prescription opioid use is not solely the responsibility of the health care providers. There are a few guidelines patients should follow regarding chronic pain to ensure their safety. Patients should become informed about prescription opioids and learn the risk factors involved. Before going to the doctor about pain, they should consider physical activity, non opioid medications, or cognitive behavioral therapy before automatically thinking they are in need of painkillers (CDC Guideline for Prescribing Opioids). Continuing education (CE) is another regulation. While Continued Medical Education (CME) is required in most states in the U.S. for physicians every ten years, there should be a continuing pain medicine education requirement for all physicians due to the heavy increase in prescription

The opioid crisis has been gradually increasing since the discovery of opioids as pain management medication by pain specialists in the 1980s. If the crisis is not mitigated, more people are likely to suffer the consequence of the effects of addiction and overdosage, given the highly addictive nature of opioids. Mitigating the crisis requires collaborative efforts, particularly from clinical prescribers and drug manufacturers who need to recognize that these drugs are potentially harmful when used repeatedly and misused. Physical therapy is an alternative mitigation measure in handling chronic pain. Evidence shows significant success rates among patients who have chosen the physical therapy route as opposed to the opioid

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 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.

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,

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

Jamison RN, Serraillier J, Michna E. Assessment and treatment of abuse risk in Opioid prescribing for chronic pain. Pain Res Cl. 2011;2011:1-12. doi:10.1155/2011/941808.