Basically, too much of opioid use is harmful. Unfortunately, opioid abuse has affected the healthcare system. Over the years, the healthcare sector has conducted multiple studies to develop new and better treatment methods and drugs for various health problems. These surveys have yielded positive results including the identification of medications that have addressed serious health problems. For instance, the discovery of opioids was a breakthrough in pain management (Lutz & Kieffer, 2013). However, some people realized these drugs could serve other purposes other than medical reasons, thus leading to their abuse. Even though opioids are essential in pain management, they are among the drugs abused widely. The challenge has created a healthcare ethical dilemma regarding whether caregivers should continue prescribing opioids and expose patients to the risk of abuse or discontinue their use by patients. Therefore, it is important to analyze the issue by focusing on its pros and cons in order to establish the possible impacts and resolutions.
Opioids and their Use in Disease Treatment and Management
Opioids are a class of drugs that include heroin, fentanyl, morphine, codeine, hydrocodone, and oxycodone (Centers for Disease Control and Prevention [CDC], 2017, par. 1). The drugs are derived naturally from the opium poppy plant, though; some opioids like fentanyl are synthetic, since they are manufactured in the laboratory and have the same chemical structure as naturally occurring ones. Some opioids, like heroin are illegal in several countries. However, others like morphine, fentanyl, codeine, hydrocodone, and oxycodone serve medical purposes especially for treating severe pain (Government of Canada, 2018, p. 1).
Pros and Cons of Opioids Use
The primary advantage of opioid use is its medicinal value. Prescription opioids are used for medical purposes especially, in the management of pain. They provide strong analgesia for moderate-to-severe pain during and after surgical operation. The opioids that are used often in pain controlling include oxymophone, hydrocodone, oxycodone, codeine, morphine, and fentanyl (CDC, 2017, par. 1; Government of Canada, 2018, par. 1). These drugs work by triggering the brain to release endorphins, which interact with pain receptors to reduce one’s perception of pain. Therefore, opioids block pain receptors, which prevent the brain from perceiving pain sensations.
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The opioids receptors are distributed in the brain, spinal cord, and various peripheral nociceptors. The three receptors include the mu, kappa, and delta. The mu modulates mechanical, chemical, and thermal nociception at a supraspinal level. The kappa modifies spinally mediated thermal nociception and chemical visceral pain. The delta receptors are responsible for modulating mechanical nociception and inflammatory pain opioid agonists, which include morphine, meperidine, fentanyl, sufentanil, alfentanil, remifentanil, hydromorphone, codeine, oxycodone, oxymorphone, methadone, and propoxyphene. The drugs bind predominantly to the mu receptor to activate analgesia (Lutz & Kieffer, 2013, p. 196). This working principle makes opioids highly preferred medications for pain management. To achieve optimal results, the drugs are commonly administered intravenously. However, other common administration routes include subcutaneous, intramuscular, epidural, transmucosal, intrathecal, and transdermal. Owing to their role in pain management, opioids, which are narcotics, are often used by patients who have advanced cancer.
The release of endorphins by the brain relates to some pleasurable feelings. Since opioids stimulate the brain to release endorphins, they have the advantage of relaxing people through a powerful sensation of well-being. Naturally, physical activities and orgasm trigger the release of beta-endorphin, which binds to the mu-opioid receptors to promote positive feeling. Notably, the natural beta-endorphin binds to the same receptors where pain medicines or opioids such as morphine fix. Therefore, taking opioids help in improving the mood to overcome sadness or lowliness feelings owing to the released beta-endorphin. Importantly, the natural beta-endorphin does not cause addiction or dependence, which makes it different from other forms.
However,, the use of opioids has various disadvantages. For instance, prescription opioids have numerous side effects including drowsiness, constipation, sedation, nausea, vomiting, respiratory problems, and urinary retention (Government of Canada, 2018, par. 3). Notably, these side effects are likely to have adverse effects on the patient’s outcomes and satisfaction.
The abuse of opioids is among the significant disadvantages of this drug. As discussed earlier, opioids have a relaxing effect through mood elevation. This aspect encourages people to use these drugs for non-medicinal purposes. Consequently, the prescription and administration of opioids increase the risk of abuse when the patients experience the relaxing effect. The prolonged use creates addiction, dependency, and the risk of overdose, which could be fatal in the long-term (National Institute on Drug Abuse [NIDA], 2018a). The persistent use of the drug for over one year increases the risks by five percent (National Institute of Health [NIH], 2018). Therefore, the statistic implies that about five percent of people who use opioids for medical purposes are at risk of overdose, dependence, and abuse. Fortunately, treating this addiction can be through prescribers monitoring patients and subjecting them to regular screening especially, if the victim has used the drug for over one year (NIH, 2018). These steps are essential to prevent the undesired effects of abuse and overdose.
The misuse and abuse of prescription opioids occur in three forms. First, a patient may take medicine in a different way from how the doctor prescribed (NIDA, 2018a). The type of abuse could happen once the patient experiences the pleasurable feelings associated with the regular use of the drug. Second, the abuse of the prescription occurs when someone takes the medicine that belongs to another patient (NIDA, 2018a). Primarily, it involves stealing or borrowing prescription medicine from another person in order to experience the relaxing feeling. Eventually, the person abusing the drugs prevents the patient from completing the prescribed dose, which deters the medicine from working suitably and achieving their intended results. Third, abuse of opioids can also occur through purchasing and taking the drugs without a prescription to experience the relieving feeling. This form of drug abuse is the most common in society, since people buy these drugs from pharmacies especially, in countries where the sale of opioids is not highly regulated (NIDA, 2018a).
The addicts take opioids in different forms and administration routes. For instance, some swallow the drug in the normal form while others inject the liquid into their blood vessels. The latter usually crush the pills and mix the content with water, and after dissolving, they inject the mixture into a vein for the drug to enter directly into the bloodstream. Some people snort the powder (NIDA, 2018a). Regardless of the administration route, taking opioids without a doctor’s prescription is dangerous and predisposes a person to irreparable harm including death.
In the United States, approximately 115 people die daily due to opioid overdose (NIDA, 2018b). The history shows the severity of the health problem associated with opioids. In the late 1990s, pharmaceuticals increased the prescription of opioids pain relievers with the assurance that addiction was not a health challenge. Consequently, the action had an adverse impact on society, since there was widespread use and misuse before the government and other health-related agencies realized opioids were highly addictive and prone to abuse. The overdose rates were excessively high. For instance, in 2015, about 33,000 Americans succumbed to overdose of opioid like powerful fentanyl that is an artificial opioid (NIDA, 2018b). Furthermore, about two million people suffered from health problems associated with the misuse of opioids. An additional half a million people had disorders related to the abuse of heroin (NIDA, 2018b). Notably, these statistics reveal the intensity of the disadvantages associated with using opioids for medical purposes especially, relieving pain. Unfortunately, the justified use increases the risks of dependence, addiction, overdose, and health consequences. An overdose happens when one takes the drugs in excess, which slows down or stops breathing, thus leading to unconsciousness or death in case the affected person does not seek medication immediately.
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The statistics also show the intensity of the problem in society. Estimations indicate that between 21% and 29% of patients who take opioids for the management of chronic pain misuse the drugs. Notably, 8% to 12% of these patients suffer from disorders associated with opioids use while about 4% to 6% eventually transition to heroin, which is more dangerous (NIDA, 2018b). There is a strong relationship between heroin use and abuse of opioids, since eight in every ten heroin users had a history of misused opioids (NIDA, 2018b). The overdose and abuse of opioids are on the rise globally with the United States experiencing 30% to 54% between 2016 and 2017 depending on the city and state (NIDA, 2018b). Therefore, there is a dire need to address this health challenge and prevent it from harming more people in the society.
The abuse of opioids has serious health complications. For instance, it is linked with neonatal abstinence syndrome (NAS), which occurs when pregnant women misuse opioids during pregnancy. NAS is a health condition whereby the newborn withdraws from the drugs that they were exposed to when in the womb (Government of Canada, 2018). Addictive drugs usually cause this problem. Studies conducted in the United States discovered that children born with NAS increased by five times between 2000 and 2012 and the figures were in line with the dramatic surge in the maternal abuse of opioids (NIDA, 2015). The rise in the incidence contributes to the government’s spending of about $1.5 billion to treat NAS (NIDA, 2015). Therefore, the misuse of opioids misuse has severe health and cost implications.
The health issues associated with abuse of opioids like overdose, dependence, and death, requires a collaborative effort from different stakeholders. Various agencies and healthcare organizations have presented solutions to this issue. For instance, the American Academy of Family Physicians (AAFP) recommends continuing education among the primary caregivers on the safe use of opioids, since they balance between the management of chronic pain and the risks of misusing the drugs (AAFP, 2018). Notably, opioids are essential in pain management thus, it is impossible to discontinue their use without inventing a better pain management system. Therefore, the family physicians and other primary caregivers must assess a patient’s risk of drug abuse before prescribing opioids. In case patients need the drugs, health care professionals must provide education regarding the health consequences of abusing opioids, subject the patients to regular screening, and treat when signs of dependence emerge.
The prevention against the misuse of opioids mainly focuses on five areas. First, the increased access to treatment for drug overdose and dependency alongside recovery services for patients (NIDA, 2018b). The priority concentrates on people who suffer from opioid abuse and dependence. Second, emphasis should promote drugs meant to reverse opioid abuse, misuse, and addiction (NIDA, 2018b). These drugs reverse the adverse effects thus, supporting the patients to overcome the problem. The first two approaches fall under reactive measures category, since the action is taken after the problem occurs. However, proactive and predictive measures would yield better results by preventing the occurrence of opioid abuse, misuse, and dependency.
Health care professionals prevent the occurrence of the problem through improved public health surveillance. The strategy involves continuous monitoring of the risks associated with opioid abuse and implementing appropriate preventive measures such as providing public health and education (NIDA, 2018b). The approach intends to create public awareness regarding the consequences of abusing opioids, as well as the available help in society for people at risk. Consequently, it becomes possible to influence healthy lifestyle whereby people start using opioids according to the physician’s prescription and avoid illegal use.
The persistence of the problem is largely based on the realization that the drugs form the primary management method for chronic pain. Therefore, efforts to addressing the abuse of opioids require the formulation of alternative and highly effective pain management systems. The United States Department of Health and Human Services is already collaborating with research institutions and healthcare professionals to establish improved and safe pain management practices with the aim of lowering the use of opioids (NIDA, 2018b).
Importantly, there are evidence-based non-pharmacological techniques for managing chronic pain. However, the complementary therapies for pain management require skills among caregivers, patients, and family members. Therefore, there is a dire need to promote these non-pharmacological techniques through education and training in the effort to reduce opioid prescription. The approach should focus on available non-pharmacological methods, their effectiveness, applications, and benefits. Knowledge acquired through training and education of the primary caregivers will empower them to offer non-pharmacological pain management techniques to replace opioids especially, when they realize the increase in the risks of addiction.
Opioids are commonly used for pain management. However, their prolonged use increases the risk of abuse, since they stimulate the brain to produce beta-endorphins that create a pleasurable and relaxing feeling. Indeed, the misuse and addiction of opioids are serious and growing health challenges with severe implications including death from overdose. Therefore, combating this problem requires a collaborative and multidimensional approach that focuses on preventing and curing. Importantly, research is underway to develop better and more effective pain management systems in the effort to replace or lower opioid prescriptions. Furthermore, researchers have established better and improved treatment options for people suffering from opiate abuse and addiction. Moreover, efforts are also required through other methods, especially education. The addiction prevention strategy should concentrate on educating caregivers and patients about the alternative and non-pharmacological approaches for managing chronic pain in an attempt to reduce opioid prescription.
- American Academy of Family Physicians. (2018). Pain management and opioid misuse. Retrieved on November. 4, 2018 from https://www.aafp.org/patient-care/public-health/pain-opioids.html
- Centers for Disease Control and Prevention. (2017, Aug. 24). Opioid basics. Retrieved on November.4, 2018 from https://www.cdc.gov/drugoverdose/opioids/index.html
- Government of Canada. (2018, Aug. 23). About Opioids. Retrieved on November. 4, 2018 from https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/about.html
- Lutz, P., & Kieffer, B. L. (2013). Opioid receptors: Distinct roles in mood disorders. Trends in Neurosciences, 36(3), 195-206. doi: 10.1016/j.tins.2012.11.002
- National Institute of Health. (2018a). Opioid addiction. Retrieved on November. 4, 2018 from https://ghr.nlm.nih.gov/condition/opioid-addiction#genes
- National Institute on Drug Abuse. (2018a). Prescription opioids. Retrieved on November. 4, 2018 from https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
- National Institute on Drug Abuse. (2018b). Opioid overdose crisis. Retrieved on November. 4, 2018 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
- Schirmer, A. (2015). Emotion. Thousand Oaks, CA:SAGE Publications, Inc.
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