What does the public need to realize about opioids and their use in the treatment of chronic pain?
First of all, people must realize that humans belong to an increasingly medicated society—all the way down to its youngest members. Take the case of OxyContin. Some doctors have become comfortable with using OxyContin as an effective medication for severe acute postoperative pain and for severe pain associated with terminal illnesses. Yet, others have also used it to treat pain of other causes, like acute back pain, fibromyalgia, and acute injuries.. Some patients quickly became addicted to this medication. (Edward Pullen M.D., "Oxycontin Should Be Prescribed Less Often By Doctors,"Drugs and Pharma, www.kevinmd.com)
Since medical schools and residency programs have strongly encouraged physicians to treat pain more aggressively, opioids such as OxyContin have become popular medications as well as popular drugs of abuse. Physicians face the dilemma of trying to treat pain adequately without becoming a supplier of opioids for diversion and overt abuse by patients or family members.
Now, most people tend to associate prescription drugs as "safe products" endorsed by both manufacturers and physicians. The widespread marketing of Rx drugs has helped create immense consumer demand and has thus stimulated growing drug dependency. Sadly, many Americans, often the very young, die from drug overdose as evidenced in approximately 20,000 confirmed cases per year. Imagine the numbers if all drug-related deaths were accurately reported.
More Drugs In the 'Hippie Years'?
In fact, new research suggests that more and more people are dying from abusing or misusing drugs, including both prescription and illegal drugs. One such study found that deaths from "accidental poisonings" across all age groups are more than ten times higher than they were in the late 1960s, especially among white Americans.
"I went in expecting to see a blip (in increased accidental poisonings) with the baby boomer(s)," Dr. Richard Miech, the study's lead author and head of Health and Behavioral Sciences at the University of Colorado Denver, told Reuters Health. After all, he said, "you've seen pictures of Woodstock."
Miech said he was surprised the boomer generation's impact on the death rates was overshadowed by a "huge increase" in accidental poisoning deaths overall. He attributes this increase to the growing number of prescription drugs being taken in the U.S. by all age groups.("More People Dying From Drug Abuse," www.redorbit.com, December 25 2010)
According to the U.S. Drug Enforcement Administration, nearly 7 million Americans are abusing prescription drugs — more than the number abusing cocaine, heroin, hallucinogens, Ecstasy, and inhalants combined. Additionally, 25% of drug-related emergency room visits are now associated with abuse of prescription drugs.
In its annual survey of teen drug use in 2005, the National Institute on Drug Abuse reported that OxyContin use by 12th graders was up 40 percent nationwide in just three years. Five times as many 12th graders reported using OxyContin than reported using methamphetamine. (Chris Arnold, "Teen Abuse of Painkiller OxyContin on the Rise," National Public Radio, December 19 2005)
A new, more urgent message needs to be trumpeted: all drugs—prescription or street—can be dangerous and should be used with caution and restraint, if at all.
The Problem With Opioids
Taken appropriately, opioids such as OxyContin can relieve pain. Depressants like Xanax can help with anxiety or sleep disorders, and stimulants like Ritalin can help those who suffer from attention-deficit hyperactivity disorder (ADHD) or narcolepsy. The problem lies in the phrase "taken properly." Many of the opioids are improperly distributed to those who cannot judge either the safe dosage or the effects of toxic usage. Often, "use" becomes "abuse" which, in turn, becomes "death."
For example, though marketed as a sustained release medication, as much as 30% of OxyContin is absorbed immediately and the rest is absorbed more slowly from the intestinal tract. This fairly large immediate release portion gives a prominent euphoric response, the desired response to opioids by abusers. People high on drugs will continually make costly, even deadly decisions as they obtain means to a fix. Crushing the capsules, which releases everything simultaneously, is like playing Russian roulette and risking life and limb.
Of course, taking these potent drugs without a doctor's close supervision or mixing them with alcohol or other drugs can be more lethal, as evidenced by the national increase in visits to hospital emergency departments for patients who overdosed on prescription drugs. When abused, the powerful chemicals contained in these drugs adversely affect the brain, heart, or respiratory system, and repeated use usually leads to horrible addiction.
Recent Findings With Implications
The National Survey on Drug Use and Health is conducted annually among individuals 12 and older by the federal Substance Use and Mental Health Services Administration. Jennifer Havens, PhD, MPH, of the University of Kentucky in Lexington, Kentucky., and her colleagues analyzed responses from 17,842 participants 12 to 17 years old in the 2008 survey. (J. Havens et al, "Nonmedical Prescription Drug Use In a Nationally Representative Sample of Adolescents," Archives of Pediatrics and Adolescent Medicine , 2010)
The research found that teens living in rural areas were more likely than their urban peers to abuse prescription drugs.13.0% of rural teens reported nonmedical use of prescription drugs at some point in their lives, compared with 11.5% of respondents living in suburban or small metropolitan-area counties and 10.3% of those in urban areas (P=0.02).
Havens also reported that relative to urban youths, teens from rural areas were especially more likely to report nonmedical use of tranquilizers such as diazepam and opioid painkillers.
"While we were able to identify potential targets for intervention such as increased access to health, mental health, and substance abuse treatment, this may be difficult for rural areas where such resources are in short supply or nonexistent," Havens and her colleagues observed. (The number of deadly drug overdoses in New York City fell to its lowest point in a decade in 2008, when 666 people died, a new Health Department report says.)
Another study (Journal of Pain, April 2010) showed that men and women had similar frequencies of aberrant drug behavior but different risk factors for abuse of opioids.
"Since little has been published about gender differences and misuse of prescription pain medication, it is valuable to document whether risk factors for abuse are gender specific to some degree," said study researcher Robert N. Jamison, PhD, a clinical psychologist at Harvard's Brigham and Women's Hospital. (reported by Bill Hendrick, "Study Shows Men and Women Have Different Risk Factors for Abuse of Prescription Painkillers," WebMD Health News, April 29 2010)
Women who misuse pain drugs are more likely "to admit to being sexually or physically abused or have a history of psychiatric or psychological problems," Jamison reported.
Women who are being treated for pain not caused by cancer and who exhibit signs of significant stress should be treated for mood disorders and counseled on dangers of relying on pain pills to help them sleep or reduce stress, the researchers said.
"Men taking pain pills should be closely monitored for suspected behavioral problems," Jamison found. In addition, their pills should be counted to check adherence, and frequent urine screens also should be done.
Understanding the Problem and Saving Lives
Only through the re-education of the masses can society begin to eliminate the tragic costs of drug abuse. The real impact of proper education depends upon significant changes in policies and measures used to slay the dragon of dependence. Prevention, regulation, and treatment -- all are imperative needs that require new thinking. No simple pill will cure this problem..
1. A much broader interpretation of abuse must be recognized as prescription drugs and opioids become increasingly popular.
2. Safe Interventional Pain Management (IPM) techniques must be employed by physicians.
3. Poor clinician training must be improved.
4. A significantly greater appreciation of all risks with medications must be instilled in the minds of medical workers and patients.
5. Much more adequate and coordinated prescription monitoring programs must be established and enforced.
6. Prevention, intervention, rehabilitation, and relapse prevention must be funded as top priorities.