My mom disregarded the addictive power of opioid painkillers until she became the pharmacy technician who dispenses the pills. On a daily basis, she sees the same customers asking about their tightly controlled substances. The customers’ stories usually fall along these lines: they received workplace trauma and were prescribed a strong opioid painkiller. They became addicted to opioids and once their prescriptions ran out, they transitioned to cheaper and dangerous versions of opioids. In an attempt to recover, the customer tried the opiate replacement therapy methadone. According to the seasoned pharmacist, the unfortunate ending is that these customers receive another workplace trauma and go back to using opioids.
In the last decade, America’s population has consumed 80% of the world’s opioid supply [5]. The culture of overprescribing opioids has been changing, but the COVID-19 pandemic accelerated the percentage of opioid overdoses by almost 40% [2]. Opioid misuse destroys communities to the point where the opioid epidemic has been declared a public health emergency.
The opioid epidemic is a grueling battle that comes from a place of providing comfort for the patient. There are beneficent reasons in prescribing strong painkillers for patients because a life in excruciating pain is miserable. When a provider runs out of treatment options and the patient is left with the symptom of pain, providers want to relieve their patient’s pain. And from a patient’s perspective, it’s important for today’s workers to be able to return to normal life as soon as possible. From an administrative perspective, opioid prescriptions are also accompanied with higher ratings of satisfaction of care in hospitals [1]. Patients want their pain to be managed in the short term, not to earn an expensive addiction.
It’s important to differentiate severe, post-operative pain from chronic pain problems. Post-operative pain is a short term problem and is a sign of the body recovering through the release of cytokines. On the other hand, chronic pain is a long term issue that can become a risk factor for reliance on prescribed opioids [6]. It may be ethical to explore less addictive forms of painkillers, such as medical marijuana. Medical marijuana has been found to be effective for chronic pain case studies (for example spinal cord injuries), but still needs more research into long term effects [3].
If pain management creates a long term problem of addiction, then the solution with opioids should only be used in controlled long term issues. While opiate pain management can be dangerous, individual factors like age should play a role in giving leniency towards opiate management. The bioethical principle of beneficence calls to provide comfort care for our elderly; reducing the pain of nursing home patients at the end of their lives is just and controls for abuse. There’s inherently more morality in taking an aggressive approach to opiate pain management with a 70-year-old under the care of a nursing home and not a young 30-year-old. As a society, we tend to look at 30-year-olds as the future and the increased risk of addiction so early is a shame. Besides, a nursing home should be able to provide the comfort care a 70-year-old needs while also controlling against possible abuse of the drug.
There’s no one-size-fits-all approach for opioid prescriptions. It’s counteractive to entirely ban opioids because it’s not a simple “mind over matter” solution. Able bodied leaders who wouldn’t understand chronic pain are taking away patient’s autonomy to choose whether to taper off their pain with opioids or not. And from a practitioner’s perspective, doctors may become less inclined to listen to their patient’s needs if they interpret the behavior to be “drug seeking” when a patient genuinely is in need of higher pain management. This can cause mistrust and frustration between practitioners and their patients [5].
How can practitioners better bridge this gap surrounding the patient’s mysterious chronic pain? How can different scheduling of opioid prescriptions (as needed versus scheduled) mitigate risk factors for opioid prescription? How does opiate treatment affect different roots of chronic pain and can opiate treatment be replaced with other types of drugs including benzodiazepines and THC? How can practitioners better balance a patient’s quality of life and risk of overdose? These are not easy questions to answer, but the facts remain the same: the opioid epidemic should ultimately be solved by a patient's rationale and a practitioner’s dutiful listening.
The writer of this article highly recommends readers to go to their local pharmacy and ask for over the counter Naloxone. Call 911 should you suspect a possible overdose.
Sources
1 Brian Sites, “Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions,” PubMed, January 16, 2018 https://pubmed.ncbi.nlm.nih.gov/29311169/.
2 “Overdose Deaths Accelerating during COVID-19,” CDC, December 13, 2017, https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html.
3 Kevin Hill, “Chronic Pain and Other Medical and Psychiatric Problems,” JAMA, June 2015, https://jamanetwork.com/journals/jama/article-abstract/2338266?casa_token=grbHcs6sxsoAAAAA:XHUd8N9TpujIox7io1GanRdEJ7FBeRQGCqIxb7sTawvxfS9ey99JfcHuO9F7AZqEKgWSoV9GMA.
4 Roger Chou, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain,” September 2014, https://www.ncbi.nlm.nih.gov/books/NBK258809/?report=printable.
5 Marion Greene, “Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature,” October 2015, https://link.springer.com/article/10.1007/s40429-015-0074-7.
6 Mark Edlund, “The Role Opioid Prescription in Incident Opioid Abuse,” July 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032801/.
7 Erik Maclaren, “Oxycodone History Statistics,” December 2018, https://drugabuse.com/opioids/oxycodone/history-statistics/