Research Paper on Opioid Prescriptions: Effectiveness and Increasing Reliance

Introduction

Opioid prescriptions have increased remarked over the years in the United States and beyond due to its anesthetic value. According to Younger et al. (2011), the opioid analgesic is the second most dispensed drug class in the US, while lipid regulators hold the first spot. The effectiveness of opioid treatments in subduing pain is well-documented in numerous studies (Rosenblum, Marsch, Joseph, & Portenoy, 2008; Younger et al., 2011; Ballantyne, 2017). However, according to the latest evidence, the overreliance of opioid analgesics has impacted all manners of pain management, leading to an endemic of prescription opioid abuse. It is critical to explore how the current trend in opioid treatments is impacting the society, as overprescribing of outpatients has allowed vulnerable individuals to access the seemingly addictive drug outside the hospice setting where healthcare experts have no control. This paper explores the use of opioid anesthesia in the management of post-surgical pain and its impact on society.

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Background

Oxycodone and hydrocodone are powerful and effective opioids used in the management of moderate and severe pain. In 2015, the US consumed 40% of thebaine, which is the main ingredient used in oxycodone and hydrocodone. In 2008, hydrocodone was dispensed over 128 million times in the US alone (Younger et al., 2011). The trend in opioid oversubscription and overdosing has reached an alarming level. Undesirable side effects such as misuse and opioid use disorder have been reported raising the question of whether the drug should be discontinued (Younger et al., 2011; Koepke et al., 2018). According to Koepke et al. (2018), opioid overdose has surpassed motor accidents as one of the leading causes of unintended deaths in the US. This trend forced the US Center for Disease Control and Prevention to make an official declaration that opioid has reached endemic levels (Ballantyne, 2017). This background offers an excellent platform for understanding the role and appropriateness of opioid anesthesia after a surgical encounter considering the many cases where a patient may require multiple surgeries; therefore, ends up using opioids for an extended period.

Surgical Anesthesia

Patients required anesthesia for pain management during and after a surgical operation. For adult patients who need multiple surgeries, the use anesthesia, especially after operations, is significantly high as they undergo through a long, painful journey of recovery. According to Carroll, Angst, and Clark (2004), 20%-30% of patients continue to experience severe or moderate pain after surgery. A more recent study by Koepke et al. (2018) revealed that 75% of adult patients considered post-surgical pain as either moderate or extreme. Further, the study revealed that 99% of all adult surgery patients in the US receive opioids perioperatively at some point during their care and recovery. This is a significant figure considering that 51 million Americans undergo inpatient surgery every year (Hah, Bateman, Ratliff, Curtin, & Sun, 2017). According to Koepke et al. (2018), the use of opioid anesthesia is far much higher than necessary since hospitals consider pain management as a crucial measure of care quality. In other words, managing post-surgical pain is becoming more important than the possible side effects that such opioids may bring due to oversubscribing.

Impact of Opioid Anesthesia on the Society

Opioids Abuse

Opioid abuse is one of the challenges associated with the use of opioid anesthesia in the management of post-surgery pain. According to Rosenblum et al. (2008), the number of opioid abuse cases increased from 628,000 in 1990 to over 2.4 million in 2004 while the treatment admission increased by 186% in 5 years (1997-2002). As Figure 1 demonstrates, this trend has continued since the beginning of the 21st century making the US the leading consumer of prescribed opioids.

Figure 1: Opioid-related overdose deaths, pain relief admissions, and quantities of opioid painkillers sold in the US between 1999 and 2010 (Koepke et al., 2018).

According to Koepke et al. (2018), Americans consumed opioid drugs more than any other country in the world. Consequently, the CDC declared the opioid epidemic a public health emergency in 2017 as a result of the ever-increasing opioid-related deaths. The evidence above shows a society that is gradually drifting to opioids dependence. The evidence on opioid-related deaths and pain relief treatment admissions are enough proof that that the opioid anesthesia leads to a more serious problem than the solution it is meant to provide in pain management. In a society where drug abuse is a major social issue, opioid treatment is worsening the already bad situation. For example, the overprescribing is making a legal drug a worse problem than illegalized drugs. This trend means that members of the society will continue abusing a drug that is meant to manage pain by consuming it even when they do not need it. This trend is supported by the evidence that patients keep opioids even when they finish their dose instead of disposing of them and use them later without doctors' prescription (Hah et al., 2017). In other cases, patients take opioid overdose in an attempt to achieve better results as far as pain management (Hah et al., 2017). Therefore, the problem of drug abuse is a major concern when it comes to opioid treatments. Importantly, the fight against drug abuse is bound to fail since Americans are now abusing legal drugs that anti-narcotic agencies are not fighting.

Quality of Life

The use of opioids in pain management is associated with various psychological problems such as depression and anxiety, which affects the quality of life of surgery patients and their relatives. According to Hah et al. (2017), opioid treatments are linked to immunosuppression, as well as opioid-induced endocrinopathy, which leads to depression, decreased energy and sexual dysfunction. Mood disorders and anxiety are common side effects of using opioid anesthesia for an extended period among surgery patients (Hah et al., 2017). Also, opioid-related adverse events (AEs) such as nausea, respiratory depression, pruritis, bowel dysfunction, and vomiting affect the quality of life considering that surgery patients continue taking opioid treatments months after an operation (Gan, 2017). Since over 50 million patients undergo inpatient surgery every year in the US alone (Hah et al., 2017), the use of opioid anesthesia leads to a massive psychological impact on society. For example, Hah et al. (2017) noted how 77% of chronic opioid users before surgery usually continue using the drugs after the procedure. Consequently, millions of people end up suffering depression, anxiety, mood disorders, and other psychological problems.

Socioeconomic Status

The use of opioid treatments after surgery affects society by influencing the socioeconomic status of millions of people. According to Hah et al. (2017), the use of opioid treatment contributes to a lower socioeconomic status. At this point, it is not just the social and economic status of the surgery patient but also his or her family members. According to Gan (2017), the use of opioid treatment in the management of pain for months after surgery usually takes a toll on households' finances. The findings further revealed that opioid-related AEs such as bowel dysfunction and respiratory depression lead to a significant economic impact due to increased hospital costs. The increased length of stay of surgery patients due to opioid-related AEs does not only adversely impact their social lives but also lead to an increase in financial burden. The medical condition of a family member affects the entire household as time and resources are directed towards treatment.

Morbidity and Mortality

At the society level, opioid has a negative impact on the social structure and society in general. As aforementioned, opioid treatments are associated with high morbidity and mortality rates in societies where losing productive and dependable members is a major concerned. As noted by Koepke et al. (2018), opioid overdose has surpassed motor accidents to become a leading cause of unintended deaths in the US. The high mortality rates caused by the oversubscription of opioid treatments will continue to affect households in many ways. For example, losing productive adult members of households is a major concern since the lives of dependent members are at stake. The lives of dependent members of families are at stake when the society loses many productive members. At the national level, the economic burden is even larger as a significant amount of funds is deviated to the treatment of opioid-related AEs instead of focusing on other public services.

Conclusion

In summary, there is adequate empirical evidence to show the extent to which opioid anesthesia is used for extended periods after impatient surgery procedures. As millions of Americans undergo surgery every year, the threat of opioid oversubscription and abuse continues to increase. The trend in which opioids are the main anesthesia for managing moderate and severe pain after surgery is worrying considering the opioid-related adverse effects. Opioid addiction, poor quality of life, low socioeconomic status, and high morbidity and mortality rates are some of the main adverse effects of opioid anesthesia. Therefore, alternative pain management therapy is needed to assist surgery patient cope throughout their painful recovery period. Doing so will significantly reduce the impact of opioid anesthesia on a patient in particular and the society in general.

First, it is critical to address opioid drug abuse to protect surgery patients from becoming drug addicts. Second, it is possible to improve the quality of life of surgery patients by ensuring that pain management therapy does not lead to opioid-related adverse effects. Thirdly, an alternative pain management therapy can assist in reducing the negative socioeconomic effects associated with extended use of opioid drugs. Lastly, reducing the abuse of opioid drugs will reduce the high morbidity and mortality rates allowing dependable members of the society to support their families. Therefore, in a society where 99% of surgery patients use opioid anesthesia, it is necessary to rethink about the trend. In particular, considering possible alternatives is critical as a way of protecting the lives of patients who have to undergo multiple surgeries.

References

Ballantyne, J. C. (2017). Opioids for the treatment of chronic pain: mistakes made, lessons learned, and future directions. Anesthesia & Analgesia, 125(5), 1769-1778.

Carroll, I. R., Angst, M. S., & Clark, D. J. (2004). Management of perioperative pain in patients chronically consuming opioids. Regional Anesthesia and Pain Medicine, 29 (6), 576 -591

Gan, T. J. (2017). Poorly controlled postoperative pain: prevalence, consequences, and prevention. Journal of pain research, 10, 2287.

Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E. (2017). Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesthesia and analgesia, 125(5), 1733-1740.

Koepke, E. J., Manning, E. L., Miller, T. E., Ganesh, A., Williams, D. G., & Manning, M. W. (2018). The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioperative Medicine, 7(1), 16.

Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and clinical psychopharmacology, 16(5), 405.

Younger, J. W., Chu, L. F., D'Arcy, N. T., Trott, K. E., Jastrzab, L. E., & Mackey, S. C. (2011). Prescription opioi...