Due to the continued mishandling of opioids, the accessibility of the drug is becoming more and more regulated. As a society, we must cope with this epidemic without sacrificing the very people who need this drug to endure horrible, physical pain.
Overview of Opioids
Opioids are a broad class of drugs that include both legal and illicit substances. Examples of opioids include prescribed painkillers (such as morphine, methadone, and hydrocodone) and heroin. Common brand names that fall under this category are OxyContin, Percocet, Vicodin, and Demerol.
Opioids chemically react with opioid receptors, which are located in the nervous system as well as the brain, and release endorphins. These neurotransmitters contribute to a patient’s feelings of euphoria as well as pain relief, which often leads to its misuse. Over time, the body acclimates to the opioids and slows the release of endorphins, which leads some to increase their dosages to maintain pain relief and an altered brain state. Regular use of this drug, unfortunately, does lead to dependence—which is evident in America’s growing opioid epidemic.
America’s Opioid Epidemic
Tracing the current crisis back to one source is impossible, but there are vital pieces throughout history that we can link to this evolving puzzle. In the 1980s, the accessibility of opioids changed drastically. A drug that once was only prescribed for patients with a terminal illness, was later extended to include chronic pain sufferers. This led to a steady expansion of opioid use, propelled by an insistence that opioids were a legitimate mechanism for pain control. Researchers on the drug had also severely underestimated its addictive potential. Prescribing practices slowly began to shift as physicians issued prescriptions for larger doses in an attempt to limit refill requests and help patients better manage pain. This increased the risk of dependence for opioid users—as much as 80% of opioid abusers had a prescription for the drugs before the start of their addiction.
However, efforts to reduce opioid dependence have proved valuable. In 2006, healthcare providers wrote an average of 72.4 opioid prescriptions per 100 persons, which decreased to 58.5 prescriptions per 100 persons in 2017. This represents a reduction of over 19%, and the figures for high dosage prescriptions are similar—decreasing from 11.5 prescriptions to 5.0 prescriptions per 100 people in that same time period. The CDC Drug overdose report has concluded that opioid prescribing practices have continued to improve in recent years; yet, levels of opioid abuse and overdose continue to steadily rise.
In 2016, there was a rapid increase in opioid-related overdoses, ending in 63,632 deaths for the year. Of these, prescription opioids were responsible for 17,087 deaths. As doctors begin to restrict the access of opioids, those who start their addiction using prescription drugs turn to illegal means in order to maintain their addiction. Some patients .even transition to more potent illegal substances, like heroin.
Limits on Opioid Prescriptions
Today, doctors better understand the addictive quality of opioids and are often reluctant to increase dosages at the risk of a patient’s long-term health. At local, state, and federal levels, officials are taking measures to mitigate the overuse of opioids. There’s been an increase in the collection of public health data regarding opioid use, improved access to treatment and recovery services, as well as inventive and non-addictive methods to manage chronic pain. However, in addition to these dynamic and necessary solutions, more and more states are implementing severe controls over opioids to subdue the seemingly endless tide of overdoses and abuse.
In addressing the threat of opioids, these initiatives unfairly restrict access to pain medication by patients who demonstrate an exigent need for them, such as cancer patients and the terminally ill. In 2016, the CDC issued guidelines that opioids for treating acute pain should be issued for periods from 3-7 days. Though merely guidelines, many states adopted these standards as legal injunctions, limiting prescriptions to supplies only lasting 7 days. These limits adversely and unnecessarily constrain pain management and create further barriers for patients seeking legitimate means to address their physical suffering. Prescription-limit laws rarely exempt cancer survivors from these constraints. In fact, from 2016-2018, their usage of opioids dropped from 24% to 10%, even though many cancer survivors endure severe, lifelong pain.
Dr. Julian Grove is a pain doctor in Arizona who has worked with the state to alter prescription regulations. According to him, the effect of these laws on doctors is that "a lot of practitioners are reducing opioid medications, not from a clinical perspective, but more from a legal and regulatory perspective for fear of investigation.” Doctors are facing extreme pressures to curtail opioid prescriptions, and this hypervigilance, unfortunately, hampers the quality of life and standard of care for many patients.
More research suggests that these laws may actually be having the opposite rather than the intended effect. To cope with the possibility of patients running out of pain medication after surgery, doctors are prescribing more medicine up-front. A study performed by Dr. Jennifer Waljee reported there was an average of a 7-tablet-per-patient rise in hydrocodone prescriptions after the regulation change.
The Future of Opioid Access
Surely, the goals of pain management should be mediated with the sobering realities of opioid exploitation. One of the ways the medical community is approaching a resolution is with a $40.4 million research program to develop a more rigorous understanding behind the causes of chronic pain, susceptibility, and new avenues for treatment. In addition to further research, doctors are looking to nonopioid medication to treat post-operative pain including acetaminophen, ketorolac, and ketamine.
Ensuring sufferers have access to modern medical advancements is of the utmost importance. Pain assessment software such as JTECH’s pain management Testing Systems allow medical practitioners to properly assess a patient’s pain levels and compile data reports of the results. This technology could be instrumental in the future of opioid access and treatment of pain. The pressure algometer measures the pressure pain threshold of specific muscle locations, providing doctors with objective data to better be able to treat chronic pain. These tools also function as monitoring systems to track a patient’s progress and determine if physical therapy is a viable treatment. This technology eliminates subjectivity in diagnoses by equipping doctors with unbiased data in order to demonstrate a patient’s need for pain medication.
There are no simple solutions to a problem as complex as America’s opioid epidemic. But, with our expanding knowledge about addiction and pain, we continue to strive for superior remedies that address the needs of all Americans.
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