Essay Example on Opioid Epidemic: A Story of 3 Waves

Introduction

The opioid epidemic can be summarized in three waves. The first wave started in 1991 when mortality rates involving opioids began to rise exponentially in the prescription of opioid, and opioid-combination medication for the treatment of pain. The upsurge in opioid prescriptions was impacted by guarantees given to prescribers by pharmaceutical firms, and medical amenities claiming that the risk of addiction to prescription opioids was utterly low. Sadly, by 2000, 87 percent of patients using opioids were using them for non-cancer pain. The second trend of the opioid epidemic began around 2010 with a rapid upsurge in deaths emanating from heroin abuse (Lindsy et al., n.d). The deaths due to heroin-associated overdose augmented by 285 percent from 2002 to 2013, and about 80 percent of heroin users indicated they had misused prescription opioids prior turning to heroin (Lindsy et al., n.d). The third wave of the epidemic started in 2013 as an upsurge in deaths connected to synthetic opioids, such as Fentanyl. The greatest increase in drug-related deaths happened in 2016 with over 20,000 death being reported from Fentanyl and related drugs (Lindsy et al., n.d). This sharpest upsurge in Fentanyl mortality rates has been associated with the illegal manufacture of Fentanyl in the United States.

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Jones et al., (2018) study noted that the mean consumption of opiates per patient in the postanesthesia care unit (PACU) augmented fro 40.4 mg of morphine equivalent to 46.3mg from 2000 to 2002 with no linked upsurge in the length of stay, naloxone use, and vomiting. Another study found that the high frequency of opioid overdose doubled from 11.0 to 24.6 per 100,000 inpatient hospital days with the execution of a new standardized numerical pain treatment procedure (Jones et al., 2018).

Bell et al., (2009) conducted a study that examined the prevalence, frequency, severity, and effect of opioid-induced bowel dysfunction (OBD) in patients getting opioid medication for chronic pain, and taking purgatives. A total of 322 patients consuming daily oral opioids and laxatives completed the 45-item questionnaire. During the survey, 45 percent of patients reported <3 bowel movements per week (Bell et al., 2009). The most widespread opioid-induced side effects included constipation (80 percent) and straining to pass a bowel movement (56 percent). The side effects that adversely impacted the chronic pain patients included insomnia, constipation, fatigue, and hard bowel movements (Bell et al., 2009). The chronic pain patients had at least a mildly negative effect on their entire quality of life and activities of daily living.

Past Efforts to Combat Opioid Abuse and their Effectiveness

Califf et al., (2016) argued that the FDA has strongly backed the growth and evaluation of abuse-deterrent developments of opioids, and the agency has approved five policy response to reducing harm from opioid abuse. The presence of abuse-deterrent formulations elicits questions, such as how to stimulate their use in place of products without abuse-deterrent products and the need to alter criteria for the review and approval of oral opioid formulations that do not have abuse-inducing features (Califf et al., 2016). The rapid advancements in the formulation, and dispensing of injectable and intranasal naloxone provide a good example of reducing addiction to opioid drugs. Another policy response that was identified relevant to this case, is prioritizing of Non-opioid alternatives for pain relief, such as Non-pharmacologic techniques to pain management (Califf et al., 2016). The FDA has approved the use of nonopioid medications for the treatment of chronic pain disorders, these drugs include milnacipran, duloxetine, and pregabalin. These drugs do not have an increased risk of addiction and do not also increase risks of myocardial infarction, stroke, or severe gastrointestinal bleeding (Califf et al., 2016).

Dineen (2016) indicated that progress in plummeting barriers to suitable treatment is adversely impacting at the state level in response to opioid-related morbidity and death rate. It has been noted that several state legislatures are responding in incoherent ways to the alleged threat of abuse of prescription medications by attacking opioids solely and by incentivizing doctors to avoid opioid use and patients suffering from chronic pain and related syndromes. However, the intractable pain management acts implemented by the FDA were seen as primary policy measures and have succeeded in the last twenty years aimed at reducing opioid addiction (Dineen, 2016).

Current Policy Actions being Discussed to Combat Opioid Abuse

Alalade et al., (2020) Buprenorphine-naloxone is been shown in clinical practice to be a highly effective police response in reducing the side effects arising from opioid addiction. Traditional opioids were established to lack some efficiency when added on top of Buprenorphine-naloxone secondary to the antagonism at the opioid receptors. Currently, there are three pragmatic alternatives for perioperative buprenorphine management to increase its efficacy on opioid users (Alalade et al., 2020). The first and second practical approaches insist that physicians should focus on perioperative buprenorphine as opposed to convectional opioids which are not effective in pain management and addiction mitigation. Finally, a highly thoracic epidural analgesia (HTEA) provides a clear chance to permit for intraoperative and postoperative analgesia after sternotomy (Alalade et al., 2020). The reason is that there is a less potential risk of epidural hematoma with anticoagulation that may be necessitated by inappropriate opioid prescriptions.

Ethical Ramifications Regarding Abuse of Opioid

Carter & Hall (2008) has assessed whether opioid-addicted individuals can provide free, and informed consent to use opioid in chronic pain management. Opponents indicate that when opioid-dependent users seek treatment, they are normally in desperate social, fiscal, and health circumstances. These individuals may be neurocognitively affected and seeking consent from them to use opioid drugs to treat chronic management. However, proponents state that the best way is to result in non-opioid drugs and also seek consent from chronic pain patients before prescribing a dose to them (Carter & Hall, 2008). Therefore, this study establishes that informed consent is a critical element in medical ethics and should be obtained in ways that increase the freedom and decision-making capacities in opioid addicts, such as recommending the use of non-opioid drugs, or drugs to reduce the addiction (Carter & Hall, 2008).

The growing spread of women with opioid addiction in pregnancy prompts the need to understand medical, ethical, and legal considerations by Obstetricians. Other than succinctly assessing the medical care of opioid abuse in pregnancy, Kremer & Arora (2015) advocated for the need of enhanced access to opioid maintenance therapy, and social amenities as a way of improvin healthy pregnancy outcomes.

References

Alalade, E., Bilinovic, J., Walch, A. G., Burrier, C., Mckee, C., & Tobias, J. (2020). Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse. Journal of Pain Research, 13, 295. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008173/

Bell, T. J., Panchal, S. J., Miaskowski, C., Bolge, S. C., Milanova, T., & Williamson, R. (2009). The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain medicine, 10(1), 35-42.

Califf, R. M., Woodcock, J., & Ostroff, S. (2016). A proactive response to prescription opioid abuse. New England Journal of Medicine, 374(15), 1480-1485. https://www.nejm.org/doi/full/10.1056/NEJMsr1601307

Carter, A., & Hall, W. (2008). Informed consent to opioid agonist maintenance treatment: Recommended ethical guidelines. International Journal of Drug Policy, 19(1), 79-89. https://www.researchgate.net/profile/Adrian_Carter/publication/5771726_Informed_consent_to_opioid_agonist_maintenance_treatment_Recommended_ethical_guidelines/links/5b32ea430f7e9b0df5ccc3ec/Informed-consent-to-opioid-agonist-maintenance-treatment-Recommended-ethical-guidelines.pdf

Dineen, K. K. (2016). Addressing prescription opioid abuse concerns in context: synchronizing policy solutions to multiple complex public health problems. Law & Psychol. Rev., 40, 1. http://dspace.creighton.edu:8080/xmlui/bitstream/handle/10504/113520/Dineen_40LawPsycholRev1.pdf?sequence=1&isAllowed=y

Kremer, M. E., & Arora, K. S. (2015). Clinical, ethical, and legal considerations in pregnant women with opioid abuse. Obstetrics & Gynecology, 126(3), 474-478. https://cdn.journals.lww.com/greenjournal/Abstract/2015/09000/Clinical,_Ethical,_and_Legal_Considerations_in.4.aspx

Lindsy, L., Diana, N. P., & Pela, S. The history of the opioid epidemic. https://www.poison.org/articles/opioid-epidemic-history-and-prescribing-patterns-182