overdose

Overprescription of Opioids Epidemic

opioidsStarting at the turn of the century, an increased amount of data has shown, over an array of studies, that deaths by caused by drug overdose have increased for the fourteenth consecutive year, mostly due to opioid analgesics, which are “derived from the poppy and used for pain relief,” and include Hydrocodone, Morphine, and Oxycodone. Opioids are more readily being prescribed in the past decade than ever previously before by doctors to patients, often without consideration of the severity of their condition, their state of mental health, and alternative medications and options.Though providing therapeutic pain relief to millions of Americans, this staggering number of drug overdoses is now higher than the number of deaths from motor vehicle accidents.

Additionally, a logical presumption would be that the rise in opioid prescriptions would correlate with a decline in chronic pain and even illnesses; however, this is not the case. The Center for Disease Control went on to state that there are noticeably “clear correlations between national trends for prescription opioid sales, admissions for substance abuse treatment, and deaths.”   According to a 2012 JAMA article, the specific amount of overdose deaths attributable to prescription opioids exceeds those attributable to cocaine and heroin combined. This rapidly-emerging and pervasive epidemic is gaining visibility, yet despite this increased awareness of the problem there is not much action being done towards beginning to solve it.

The lack of change and continual abuse of prescription opioids, is largely due to a higher demand from patients, particularly those with mental disorders and a history of substance abuse, to treat chronic pain that has fostered a powerful industry that grosses in billions of dollars each year. The increase in opioid overdoses correlates with the increase in opioid prescriptions, highlighting the leniency on the care provider level with prescribing opioid analgesics, a lack of regulation of patients prescribed to opioids, as well as proper education and warning being provided to these specific patients. Cross-prescribing and pill mills also play a vital role in the easy access to opioids and the increase in abuse. The number of overdoses due to opioids is especially high among individuals with mental diseases and those with a history of substance abuse, meaning that increased precautions must be taken when prescribing these individuals to opioids.

As stated by JAMA’s 2012 article, “Patients with mental health or substance use disorders are at increased risk for nonmedical use and overdose from prescription painkillers as well as being prescribed high doses of these drugs.” One of the primary causes of the heightened susceptibility is that the process is cyclical: chronic pain can cause depression, as well as a multitude of other mental health disorders, and depression and other mental health disorders can cause pain. This community is also exposed to a high vulnerability due to a lack of specialized regulation—which includes intricately keeping track of the medical and behavioral backgrounds of each patient and using that information when determining the dosage, level of precautionary information, and amount of follow-up visits—in the amount and level of opioids they are prescribed, frequent hospital visits with multiple doctors, multiple prescriptions, and a higher accessibility to prescriptions as a remedy for their disorders including depression, anxiety, and posttraumatic stress disorder. Also, because opioids suppress pain and can create a euphoric relaxed sensation, they can provide a release from stress which is particularly higher in individuals with mental health disorders or a history in substance abuse.

Action against this epidemic could include an increase in repercussions for mal-practicing physicians, the implementation of mandatory online databases across the nation to regulate what doctors are prescribing opioids to which patients, and an option for alternative pain treatments. With these implementations there will be less of an incentive to inappropriately prescribe opioids and, consequently, a decreased amount of unqualified patients who have access to prescription opioids. Social determinants are impactful, particularly for the population I described including the genetics they were born with, the families in which they were born into, as well as their conditions in which they live. However, even if they are unable to modify their situation, the regulation of patients on a care provider level can aid in decreasing opioid abuse and, in turn, the health of patients in spite of these outside influences.

Sources:

http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

httpp://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/oxycontin/Pages/opioids_dyk.aspx

http://www.ncbi.nlm.nih.gov/pubmed/24211157

http://www.ncbi.nlm.nih.gov/pubmed/21668754