Problem Statement/Introduction:
Prescription pain medication abuse has become an epidemic. The statistics on this form of abuse are increasing and are fatal. Prescription opioid pain medicine are being abused and are leading to more deaths than all other street illicit drugs including cocaine and heroin. Over 86% of OxyContin abusers report that they had not been prescribed the drug for medical purposes. Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American to have a bottle of pills. In 2012, of the 41,502 drug overdose deaths in the USA, 22,114 (53%) were related to pharmaceuticals. Of the 22,114 deaths relating to pharmaceutical overdoes in 2012, 16,007 (72%) involved prescription pain medications. At least 78% of all OxyContin addicts report that they had previously received treatment for their disorder. This is an astonishingly high rate of relapse, attributed to the fact that it is easily purchased, and there are minimal legal sanctions in place for addicts caught abusing the drug. People who are at risk of abusing the drug include males, parents who are abusing the prescription pain medications, and other persons with existing psychiatric problems.
Objective:
The major aim of this paper is to educate the public on how prescription pain medication can be addictive and also recommend proper ways of avoiding the abuse of such drugs. However, the paper will be solely based on the abuse of opium. This will include the definition of opium, its therapeutic effects, working mechanism, methods of abuse, distribution mechanisms, societal implications and the effects on the abuser. A discussion, summary, and a conclusion will also be included in the paper to provide a wider perspective into the topic of discussion.
Literature Review:
What is Opium? Opium is the dried milky juice that contains natural pain relieving substances extracted from the unripe seedpod of the opium poppy. It is also a CNS Depressant. Opium is the key source for many narcotic drugs and is classified as a schedule II drug. Natural and synthetic opiates are collectively known as opioids; some generic & branded names of these drugs are Methadone, Morphine, Codeine, Fentanyl, Vicodin, Percocet and OxyContin among others (Davis, 2014). These prescription drugs are prescribe only as needed, used to treat moderate to severe pain for example severe burns, cancer, surgery, bone pain and not something minor such as a headache (Drug-Free.org, 2014). According to the National Institute on Drug Abuse (2014), abuse can be classified in many ways including taking medication that has been prescribed for somebody else, taking a prescribed drug in a higher quantity or in another manner than prescribed, or taking a drug for another purpose than prescribed. Some abusers remove sustained release coat to get rapid release causing similar rush of euphoria to heroin (ISATE, 2013).
Going cold turkey from these prescription pain medications can result in serious medical complications. Opioids attach to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract (Pain EDU, 2007). The drug attaches to certain opioid receptors, and then blocks transmission of pain messages to the brain. Abusing this drug has its consequences just as any other drug. Physical and psychological dependence tolerance may result in needing a higher amount to relieve pain or control the desire to get same initial high. The side effects include constipation, nausea, vomiting, dizziness, and loss of appetite, confusion, addiction, irritability, socially withdrawn, anxiety, paranoia, coma, severe respiratory depression, and death (Pain EDU, 2007). Opium has a teratogenic effect on the cardiovascular system. Prescription drug abusers may feel it is safe to use opiates because they are used in medicine and may not think it is addictive like an illicit drug (ISATE, 2013).
Doctors and even pharmacists are being held responsible for the distribution of these prescription opiates (CDC, 2014). Jayawant & Balkrishnan (2005) state that “over 86% of OxyContin abusers report that they had not been prescribed the drug for medical purposes indicates the control over the distribution of prescription pain medicine is NOT as stringent as it needs to be.” A doctor in a Brooklyn based office was arrested at home for selling oxycodone prescriptions. According to the Department of Homeland Security (2014), the arrest is the result of a 2 year investigation conducted by special agents from US Immigration & Customs Enforcement and Drug Enforcement Act. Undercover DEA posed as a patient for a duration of 4 years, requesting prescriptions in multiple names and as requested the doctor did in exchange for $200 a prescription. 227 prescriptions yielded nearly 41,000 pills worth $700,000 on the Black market (DHS, 2014). In Nov 2012, another physician was arrested for selling prescription narcotics in exchange for $250 or more a prescription. Though being a pain management specialist, the doctor failed to conduct physical examinations or question the need for the medication (Attorney General of NY, 2013).
Medicaid patients questioned why they were being charged when their insurance paid in full for the office visit & prescription (Jayawant & Balkrishnan, 2005). He was caught and arrested for illegally distributing narcotic pills when it wasn’t deemed medically necessary (Attorney General of NY, 2013). These cases exemplify just how one corrupt medical practice can flood the black market with thousands of highly addictive prescription pain medication.
Currently, we have ISTOP; June 2012 NYS legislature unanimously passed Attorney General Schneidermans internet system tracking over-prescribing act, which will require doctors to consult real time database of their patients drug history before prescribing controlled substances (Attorney General of NY, 2013). Nearly half (24) states are participating in Medicaid expansion, which helps expand coverage of substance abuse services and treatment. Nearly all (49) states have a prescription drug-monitoring program PDMP Rx drug monitor program to help identify “doctor shoppers”. 32 states have law requiring/permitting pharmacist to require ID prior to dispensing controlled substances (Attorney General of NY, 2013). People who abuse prescription pain medications face the same consequences as illicit drugs. The abuser starts to neglect responsibilities, miss school/work, loss of family/friends, marital problems often ending in divorce, and legal issues (Davis, 2014). They may also become depressed without the drug. If they started taking the pills for emotional problems without the supervision of a medical professional, the drug may mask or numb upset feelings.
Discussion:
Abusing these drugs have devastating effects similar to illicit drugs such as heroin (ISATE, 2013). Relapse is very common so intervention will be difficult. It is not as hard as it seems to receive or purchase them (NIDA, 2014). Although it is prescribed for pain, tolerance is easily built, ultimately resulting in addiction. The most common long-term effect of abusing prescription pain medicines such as opioids is the addiction itself. Some begin their abuse with a prescription written for them either for real or faked pain, sooner or later doctors determine that there is a abuse going on and won’t prescribe them anymore. This is when the addict will either doctor shop or buy on the streets resulting in the current epidemic in the abuse of opium.
As a control measure, we should only allow hospitals to dispense these pain medicines. Expand access and availability of effective treatment such as introducing more natural at home remedies or refer to physical therapy, chiropractor, and/or acupuncture could also reduce such abuse (Healthy-Americans.org, 2013). There should also be improved prescription drug monitoring program incorporated into the electronic health record system for better efficiency. Lastly, education to the masses regarding the adverse effects of such abuse should also be conducted (Healthy-Americans.org, 2013).
Conclusion:
There are more deaths caused by abusing prescription drugs as compared to using street illicit drugs. Severe psychological complications can arise. Doctors need to be stricter in prescribing these controlled substances however; it is hard when you are putting your life on the line with health professionals who really pose as “drug dealers”. I conclude that if these prescription medications are prescribed and taken only as directed we can try to decrease the level of addiction. This can only be achieved through joint efforts by both the medical practitioners and the public towards reducing abuse of prescription medication.
References
Attorney General of NY (2013). Long Island Doctor Arrested For Selling Prescriptions For Narcotic Drugs. Retrieved on December 5, 2014 from http://www.ag.ny.gov/press-release/long-island-doctor-arrested-selling-prescriptions-narcotic-drugs
Center for Disease Control and Protection (2014). Prescription Drug Overdose in the United States: Fact Sheet. Retrieved on December 5, 2014, from http://www.cdc.gov/homeandrecreationalsafety/overdose/facts.html
Davis, C.P (2014). OxyContin Side Effects Center. Retrieved on December 5, 2014, from http://www.rxlist.com/oxycontin-side-effects-drug-center.htm
Drug-Free.org (2014). OxyContin. Retrieved on December 5, 2014, from http://www.drugfree.org/drug-guide/oxycontin/
Healthy-Americans.org (2013). Prescription Drug Abuse: Strategies to Stop the Epidemic. Retrieved on December 5, 2014 from http://healthyamericans.org/reports/drugabuse2013/
Jayawant, S. S., & Balkrishnan, R. (2005). The controversy surrounding OxyContin abuse: issues and solutions. Therapeutics and clinical risk management, 1(2), 77.
National Institute on Drug Abuse (2014). Prescription and Over-the-Counter Medications. Retrieved on December 5, 2014, from http://www.drugabuse.gov/publications/drugfacts/prescription-over-counter-medications
Pain EDU (2007). Pain Medications: How Long is Too Long? Retrieved on December 5, 2014, from https://www.painedu.org/articles_timely.asp?ArticleNumber=10
