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  • Vidyasagar Vangala

The Opioid Epidemic

Historically, opioids have been prescribed for peri operative care, acute trauma, and life-altering diseases, whereas in most recent years, there has been a shift towards using opioids to treat chronic pain. Opioids are a class of drug that contain the illegal drug heroin and legal prescription pain-relieving drugs, such as hydrocodone, Oxycodone, codeine, and morphine. In the United States, chronic pain prevalence has increased exponentially, and over the past 20 years, opioid prescribing laws for non-cancer chronic pain have been liberalized and have allowed for a dramatic increase in opioid use and abuse. Opioids have also gained popularity because they are very effective at controlling pain and are relatively cheap. Although the rise of legally prescribed opioid use has benefited those suffering with acute and chronic pain, as a result, an opioid epidemic has ensued with many adverse consequences. Opioids are now among the most abused drug in the United States.

The opioid use has evolved to the present epidemic state due to increased awareness of the access of pain relief medications, intense marketing by pharmaceutical companies, and new laws of the Joint Commission of the Accreditation of Healthcare Organizations (JCAHO) in 2000. These positions lack the belief that there are dangerous adverse events that accompany opioid use and follow the assumption that they are highly effective and safe. Short-term use of opioids can cause euphoria, pain relief, sedation, and drowsiness. Long-term use of opioids can cause harmful side effects that vary in severity ranging from nausea and constipation to overdose and death. It is important to evaluate patients that have been prescribed opioids for potential harm. Patients are at an increased risk of harm if the patient is 65 years and older, pregnant, has anxiety or depression, has COPD, has hepatic or renal disease, or has a personal or family history of substance abuse. Opioids produce euphoria in addition to pain relief, which can cause them to be misused by either taking them in higher quantities than prescribed or using them without a prescription. Regular use of opioid pain relievers, even when taken as directed, can lead to dependence and, when misused, can lead to overdoses and deaths. Prescription opioid overdose deaths have skyrocketed and in 2014 alone there were more than 14,000 deaths from opioid use. The rise of opioid use is a raging issue in the United States that, if left uncontrolled, will continue to take lives, either by death or addiction. Opioids can be beneficial to essential pain relief when used correctly. It is important to limit the amount of unnecessary opioid prescriptions for chronic pain conditions and monitor patients closely for harm or misuse. Patients should know their options when it comes to opioid misuse and addiction. Methadone clinics are treatment centers for people who are addicted to opioids. Patients there will receive methadone treatment, an opioid analgesic, which is referred to as replacement therapy. This is not a cure for addiction however, but is effective during the treatment and rehabilitation process for comprehensive treatment. For further treatment options and methadone clinic locations, visit https://www.cdc.gov/rxawareness/treatment/index.html. Newer medications, in addition to methadone, are on the horizon for opioid addiction treatment. The FDA has approved the first time-release implant for Buprenorphine, an opioid analgesic, which could last up to six months. This new technique has a long-lasting advantage over daily oral doses, such as the way methadone is taken, in which it prevents patients from being able to deviate from treatment. However, the Buprenorphine implant is only for constant low-dose maintenance therapy and is not to be used as initial therapy. This method of administration also has its advantages over another drug Suboxone, or Buprenorphine/naloxone, which is to be taken daily. Each drug and method of administration has its advantages and disadvantages. Certain mediation treatments are suited for different patients and choosing the correct one is essential to the effectiveness of the treatment. By Christina Woolford (edited by Dr. Vangala)

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