Opiate addiction: addressing the epidemic

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Over the last six years much has been done to identify, understand, educate and treat the epidemic of opiate addiction. Initial statistics were startling. In 2012, 282 million opioid prescriptions were dispensed to Americans. From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999 (CDC.gov). Millions of Americans are prescribed opioids to treat their pain. As a result, prescription misuse, opioid-use disorder, and overdoses have become a growing problem in the United States.

You have surgery and after the procedure is completed, you experience pain. Medications are prescribed for pain management for a limited time after the procedure—until the pain ceases. This is often not the case. Prescribed dosages are often stronger than needed, the prescribed number of pills far exceeds what is needed and usage continues far beyond when pain management is needed, developing into an addiction. 

When opiate prescriptions cannot be refilled, people move to heroin and street-produced fentanyl as substitutes. The problems multiply and despite all the interventions and preventive measures that have been taken, deaths from inadvertent overdoses continue to rise.

Opioid overdose deaths soared from 21,000 in 2010 to nearly 50,000 in 2017 and it is estimated that another 510,000 American lives will be lost in the next decade (NIH, 2017). One of the most alarming realities is that these addictions still stem from initial, medically appropriate, prescribed medications.

Regulatory oversight and processes have been implemented on state and federal levels. Prescribers are acutely aware that prescribing practices are watched carefully in an attempt to prevent over-prescribing. Hospital protocols limit the number of pills, dosages, and a set number of refills allowed for take-home medications. Grant monies have funded the development of statewide task force groups. The Connecticut Department of Mental Health and Addiction Services partnered with community providers to offer mass educational seminars to the public (Change the Script Project). People identified as patients suffering from opiate addiction are given take-home Narcan to help prevent overdosing if use continues. Despite the implementation of these control steps, they are not producing the positive improvements necessary.

What will it take to impact society’s willingness to address the problem to prevent more deaths over the next decade? 

If a large part of the problem is a medical prescription, that is where even further changes are needed for significant impact.

It is not a simple fix to limit the number of pills per prescription, if in doing so a more potent opiate is prescribed. Over-prescribing continues as some surgeons, worried about patient satisfaction, might be giving more potent drugs to compensate for giving fewer pills. It is not just young people who are affected: 4,234 (24.9 percent) of all opioid overdose deaths involve prescribed opioids for individuals aged 45 to 54 (2018 Choices Matter Survey).

Managing pain after surgery must become a multifaceted approach. Many over-the-counter non-steroidal anti-inflammatory medications such as Advil/Motrin can be effective if taken at proper intervals after surgery. Longer-acting anesthesia can carry a patient further after a procedure, negating the need for opiate medications altogether. Patients can be taught relaxation techniques as a distraction, or to relieve anxiety, which leads to a reduced perception of pain. Conversations between physicians and patients must take a more in-depth look at the overall mental health of the patient before surgery to identify strengths and potential risks and to individualize the preventive plan of care.

Multiple levels must be addressed to impact this crisis and the start must be to limit the primary source of addiction. To the degree that these problems begin with risky exposure to prescribed potent medications, the medical world must continue to address how they practice. Each of us must take responsibility for our health and that of our children. Educate yourself, ask the right questions, do not be afraid of pain or the need for treatment. You deserve to be pain-free, but how you achieve that may not be as simple as taking prescription pain medications. The risk is real, and the responsibility to seek the best course of action is up to the patient. Ask why your doctor has chosen a medication, how long you should need it, and what else can you do to help prevent the avoidable but possible dependency that can occur. Ask for alternatives to opioids. Would an over-the-counter pain medication be sufficient? Addiction is a sneaky foe that does not discriminate by age, status, or personal resolve. Know the information, ask for alternatives, and do everything possible to prevent this from being you.

Research: National Center for Health Statistics, Health, United States, 2010; National Institute of Health:  nihcm.org/categories/sources-and-burden-of-opioid-deaths;  www.cdc.gov/drugoverdose/data/statedeaths.html; Choices Matter Survey nihcm.org/categories/sources-and-burden-of-opioid-deaths; Change the Script Project www.ctclearinghouse.org/topics/change-the-script/; www.cdc.gov/drugoverdose/data/prescribing.html

By Nancy A. Scheetz, APRN, B.C, 

Executive Director of Farmington
Valley Visiting Nurse Association