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Articles Closely Examine the Issue of Prescription Opioid Abuse
A series of articles in the July 2009 issue of Mayo Clinic Proceedings closely examines prescription opioid abuse among patients and physicians. Steven Passik, PhD., of the Department of Psychiatry and Behavioral Sciences Center at Memorial Sloan-Kettering Cancer Center in New York, says that addiction to and abuse of prescription drugs are prevalent and that they exact an immense toll on patients, physicians, and society.
Opioid drugs have been used by people for thousands of years and are the longest continuously used class of medications, according to William Lanier, MD, editor-in-chief of Mayo Clinic Proceedings. Opioids are chemicals that work by binding to specific receptors to decrease pain and increase pain tolerance. Side effects of opioids include sedation, respiratory depression, and constipation.
Physical dependence on opioids can and will develop, which can lead to severe withdrawal symptoms upon abrupt discontinuation of use. Dependence and the feeling of euphoria these drugs can produce often lead to abuse and overdose.
Dr. Lanier says that the recent growing increase in opioids stems from five sources: advances in the design of the drugs; expansion and innovation in methods of drug delivery; increased public awareness of pain management options and aggressively treating pain as the “fifth vital sign”; growing recognition of the serious consequences of opioid misuse and addiction; and legal consequences of physicians under- or over-prescribing.
Aside from people suffering from chronic pain, anesthesiologists have the greatest risk of opioid abuse and dependence among health care providers because of the highly addictive medications they administer to patients daily. Sedation nurses and nurse anesthetists also are at a high risk for opioid abuse.
Dr. Howard Smith, MD, Department of Anesthesiology, Albany Medical College, New York, said that approximately 10 to 20 percent of physicians will develop a substance abuse problem in during their career—a rate similar to or exceeding the general population. He also noted that opioids are a cornerstone of pain management for people experiencing chronic pain from cancer of back injury and surgery.
Dr. Passik says that health care professionals treating patients with chronic pain must balance aggressive treatment with the need to minimize the risk of misuse and abuse. Doctors Charles Argoff and Daniel Silvershein, both from the Department of Neurology, Albany Medical College, New York, write that those managing chronic non-cancer pain need to give each patient a comprehensive assessment, a structured regimen or program, ongoing reassessment of the pain condition and response to therapy, and a continual appraisal of the patient’s adherence to treatment. Their colleague, Dr. Howard Smith, stresses the importance of understanding the metabolism of opioids in different patients.
It is crucial for patients, physicians, and family and friends to have a keen awareness of the potential for addiction. Keith Berge, MD, Department of Anesthesiology, Mayo Clinic; Marvin Seppala, MD, Hazelden Foundation, Center City, Minn.; and Agnes Schipper, JD, Mayo Clinic Legal Department point out that family, friends, and co-workers of health care providers need to confront any suspected addiction and abuse. In addition, health care facilities should have written policies and procedures to assist with instances of abuse.
Dr. Passik says that new opioid formulas designed to minimize abuse could help with the problem. The drugs being developed are chemically designed to diminish euphoric effects and possibly reduce problematic use. Until the drugs are proven effective, responsibility coupled with expertise, insight, diligence, and compassion can help meet the challenges of opioid use in pain management.
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