Opioids Literature Review
Over the last two decades, the misuse of prescription drugs has grown significantly in the United States, particularly amongyouths aged between 18 to 25 years (Schrager, Kecojevic, Silva, Bloom, Iverson, & Lankenau, 2014). The prescription of opioids like hydrocodone and oxycodone are some of the most regularly abused forms of medication among the young adults. Notably, opioids are considered the most critical issue in public health since its abuse is linked to an array of negative health problems. The adverse outcomes associated with opium misappropriation include drug dependency, lethal overdose, and drug injection. Consequently, opioid trajectory among the adolescent starts with the inception of the drug which entails numerous forms of abuse over a given period (McHugh, Nielsen, & Weiss, 2015). Individuals that develop opioid misuse earlier in their lives or have mishandled the medication for many years have a possibility of being diagnosed with substance abuse disorder. Moreover, an overdose of opioids for a given number of years has been linked to transitioning to other drugs such as heroin among the users. Additionally, a prolonged period of overdose has similarly been related to the possibility of being involved in alternative methods of administering the prescription, like snorting (Compton & Volkow, 2006). This paper provides an exploration of the use of opioids and its management interventions.
History of Opioid Use in America
America’s first prevalence of opioid dependence transpired in the second phase of the nineteenth century. Notably, in the 1840s, the projected domestic supply of opium and morphine could have assisted approximately over 0.72 of the addicted opioid populace per a thousand persons. Over the next five decades, the use of the drug among the citizens reached 538% (Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, & Alexander, 2015). However, the consumption attained its peak in the mid-1890s when the need for the prescription could have helped more than 4.59 injectors. Considerably, the increasing level of the addiction started to reduce and by the end of 1920, the population hooked by opioid had reached 1.97 per 1,000 people in the U.S.
Importantly, the occurrence had different origins such as mothers incorporated the drugs during pregnancy to relieve pain and used opium tinctures and patent medications on their kids (Kolodny, 2015). Consequently, soldiers applied opium and morphine as a form of treating diarrhea and painful wounds while on the battlefields. Similarly, the Chinese migrants smoked the drug, a behavior that extended to the White populace. However, the basis of the prevalence occurred during the period of 1870-1895 when the iatrogenic morphine dependency overlapped with the spread of hypodermic prescription. Considerably, the consumption of morphine helped to diminish symptoms associated with opium overdose, thereby making its acquisition escalate leading to poor control of its supply. As such, opioid addiction incidences led to a transient growth in the rate of nonmedical heroin use in the urban regions during the twentieth century (Kolodny, 2015). Moreover, after the Second World War, the epidemic significantly impacted the minority populace, especiallyin the ghettos.
Prevalence of Opioid in America
The epidemic of opiate medication misuse has increased significantly in the U.S. since the late 1990s to the mid-2000s. The level of the abuse rose from 2.3 million to 2.8 million addicted users during the same period annually (Dart, Surratt, Cicero, Parrino, Severtson, Bucher-Bartelson, & Green, 2015). For instance, in 2012, opiate was second to cannabis in the prevalence both in illegal consumption and drug integration disorders. As such, opioids are the most frequently abused form of prescribed medicine and are the greatest contributor to addiction. Nevertheless, the population of adults abusing the drug escalated from 4.9 million in the year 1992 to 12.5 million in the year 2012 (McHugh, Nielsen, & Weiss, 2015).
Notably, the United State is the leading state with the highest number of opioid abusers followed by Canada, New Zealand, and India. For example, a population-based investigation revealed that 5% of the Canadian citizens misused opioids in 2014. Consequently, in America, the growing level of opioid abuse is parallel to the rise of the prescribed drugs (McHugh, Nielsen, & Weiss, 2015). In essence, during the year 2012, there was numerous supply of opioid prescription as there was an increase in the number of adult users. Similarly, the rate of opioid prescriptions proliferated in older individuals, the pediatric emergency, and in an ambulatory context.
Numerous investigations extrapolate that the Native Americans and Caucasians have the greatest prevalence of opioid abuse and other prescription medications. In essence, people that misuse the medicine are youths that are less likely to have a family (Ostling, Davidson, Anyama, Helander, Wyche, & Kaye, 2018). Considerably, various examinations portray that men have the highest consumption of opium overdose as compared to women. However, other studies suggest an equal level of epidemiology in both men and women. Notably, women are more likely to mishandle the prescribed drug through a process that is consistent with their intended use. For example, women can integrate the medicine through a legitimate trajectory form of administration such as oral or sublingual.
Physiology and Pharmacology of Opioid
Opioids decrease the degree of pain symptoms and are frequently recommended for the management of pain-related illness whereas cough and diarrhea are other signs of their consumption. Opium has a significant impact on enhancing euphoria which can significantly influence their abuse (American College of Obstetricians and Gynecologists, 2017). Importantly, opioid dependency can be established based on a continuous integration of different opioids, especially on people with causal genetic susceptibility. However, heroin is currently used as a substitute for opioid and can be injected, inhaled, or smoked by the users. Nevertheless, other prescribed medicinal opioids like codeine, fentanyl, morphine, oxycodone, and hydromorphone can easily be abused. The drugs can be administered through various techniques such as swallowing, injection, smoked, chewed, or incorporated as suppositories. Notably, all the products have the capability to stimulate respiratory depression, overuse, and death (Marshall et al., 2017). Additionally, an overdose of opioids influences the threat of cellulitis and creation of abscess at the injection area. Moreover, the common use of snorting equipment also transmits the risk of contracting hepatitis C and viruses like HIV.
Continuous consumption of opioid causes an anticipated psychological addiction that leads to symptoms of withdrawal upon termination of its use. Notably, signs of withdrawal entail comprehensive discomfort, vomiting, diarrhea, sweating, and widened pupils. For the short performing opioids like heroin, their withdrawal indicators begin from four to six hours after its inception and gradually decrease within the duration of five to seven days (American College of Obstetricians and Gynecologists, 2017). However, long-acting opium withdrawal indicators are exhibited between 24-36 hours of its administration and may go for several days.
Mortality Rate Resulting from Opioid Overdose
Since 2000, the level of deaths in America related to drug overdose has significantly increased with the rate of mortality resulting from opioids being 200%. In 2014, the number of people that died from opium misuse totaled 47, 055, an increase of 6.5% from the previous year. Similarly, the rate of deaths in both sexes escalated substantially for individuals between 25-44 years of age (Rudd, Aleshire, Zibbell & Matthew, 2016). Additionally, the rise was witnessed among the non-Hispanic whites and blacks living in the Northeastern and Southern areas of the State.
Considerably, in 2013 and 2014, the degree of demises involving methadone abuse remained constant whereas those that incorporated natural and semisynthetic opioid increased. Notably, in 2014, five states had the greatest prevalence of opioid abuse deaths and they include West Virginia, New Mexico, New Hampshire, Kentucky, and Ohio (Rudd, Aleshire, Zibbell, & Matthew, 2016). States with a higher statistical growth in the occurrence of opium overuse mortality as from 2013 to 2014 encompass Alabama, Illinois, Maryland, Michigan, and New Mexico.
Graph 1: Drug prevalence
Source: (Rudd, Aleshire, Zibbell & Matthew, 2016)
Economic Impact of Opioid Addiction
The escalating level of individuals addicted to the use of opioid medication has a significant impact on the economy. According to Florence et al. (2016), the expenses incurred in the provision of intervention techniques for addicts totaled $78.5 billion of the national budget in the year 2013. The investigation revealed that 73% of the cost is aligned with nonfatal costs such as healthcare expenditure, criminal justice expenses, and diminished performance because of incarceration. Therefore, the amount spent by the national and county governments to help curb the menace has been rising since more people are engaged in the vice.
The possibility and intensity of the risks associated with opioid abuse are substantially independent and are controlled by numerous aspects. As such, no single alteration in the prescription character can be projected to mitigate the uncertainties while effectively managing the pain (Volkow & McLellan, 2016). For instance, the dangers cannot be prevented by alleviating prescription to a different type of patient. However, various techniques can be integrated to mitigate the threats and confine the prescribed medications to a minimum effective dose within a short period.
Limiting Drug Diversion
The common type of diversion of drugs is the provision of opioid analgesics by the affected to family members that attempt to self-diagnose a generic pain. Notably, the behavior occurs on prescription offered mainly for the management of chronic and acute pains among the patients (Hawk, Vaca, & D’Onofrio, 2015). As such, to curb the menace, it is essential to enlighten the patients on the risks associated with sharing medicine and the benefits of safe storage and dumping of the drugs after use.
Minimizing Risk of Overuse
The influencing features linked to overdose can be alienated into those that are connected to opioid itself and ones that are related to the perilous conditions of the affected. Notably, research indicates that high prescriptions of all opioids enhance the chances of an overdose (White, 2015). Consequently, the endorsed mitigation techniques encompass an overdose risk evaluation and urine drug screening prior to prescription of the medicines.
Reducing the Chances of Addiction
Healthcare efforts to alleviate the occurrence of dependency can be integrated into the primary care context in which there is an evaluation of the risks before prescription of opiates (Rudd, Aleshire, Zibbell, & Matthew, 2016). As such, emerging indicators of addiction can be recognized and managed by constant monitoring such as urine testing to determine the availability of various opioids or drug misuse. Additionally, incorporation of medical-assisted treatment in the management of addiction has proved to produce a positive outcome.
Prescription opioids like hydrocodone and oxycodone are some of the most regularly abused forms of prescribed medicines among the youths. Individuals that develop opioid abuse earlier in their lives have a significant possibility of being diagnosed with substance abuse disorder. The adverse outcomes associated with opium misappropriation include drug dependency, lethal overdose, and drug injection. However, numerous investigations extrapolate that the Native Americans and Caucasians have the greatest prevalence of opioid misuse and other prescription medications. The level of the drug abuse increased from 2.3 million to 2.8 million addicted users during the period of 1990-2000. As such, prescription opioid abusers use a substantial amount of healthcare materials than the non-dependence persons. The drugs can be administered through various techniques such as swallowing, injection, smoking,, chewing, or incorporated as suppositories. Notably, the overdose administration of opioids stimulates the risk of cellulitis illness and creation of abscess at the injection area. Nevertheless, some of the techniques that can be used to minimize the prevalence of the condition include limiting drug diversion, minimizing the risk of overuse, and reducing the chances of addiction.
American College of Obstetricians and Gynecologists. (2017). Opioid use and opioid use disorder in pregnancy. Committee opinion No. 711. Obstetrics & Gynecology, 130(2), e81-e94. Retrieved from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy
Compton, W. M., & Volkow, N. D. (2006). Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug & Alcohol Dependence, 81(2), 103-107. Retrieved from: https://www.drugandalcoholdependence.com/article/S0376-8716(05)00182-1/fulltext
Dart, R. C., Surratt, H. L., Cicero, T. J., Parrino, M. W., Severtson, S. G., Bucher-Bartelson, B., & Green, J. L. (2015). Trends in opioid analgesic abuse and mortality in the United States. New England Journal of Medicine, 372(3), 241-248. Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMsa1406143
Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016). The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Medical care, 54(10), 901-906. Retrieved from: https://journals.lww.com/lww-medicalcare/Abstract/2016/10000/The_Economic_Burden_of_Prescription_Opioid.2.aspx
Hawk, K. F., Vaca, F. E., & D’Onofrio, G. (2015). Focus: Addiction: Reducing fatal opioid overdose: Prevention, treatment and harm reduction strategies. The Yale journal of biology and medicine, 88(3), 235. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553643/
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annual review of public health, 36, 559-574. Retrieved from: www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031914-122957
Marshall, B. D., Krieger, M. S., Yedinak, J. L., Ogera, P., Banerjee, P., Alexander-Scott, N. E., … & Green, T. C. (2017). Epidemiology of fentanyl-involved drug overdose deaths: A geospatial retrospective study in Rhode Island, USA. International Journal of Drug Policy, 46, 130-135. Retrieved from: https://www.ijdp.org/article/S0955-3959(17)30133-0/fulltext
McHugh, R. K., Nielsen, S., & Weiss, R. D. (2015). Prescription drug abuse: from epidemiology to public policy. Journal of substance abuse treatment, 48(1), 1-7. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250400/
Ostling, P. S., Davidson, K. S., Anyama, B. O., Helander, E. M., Wyche, M. Q., & Kaye, A. D. (2018). America’s Opioid Epidemic: a Comprehensive Review and Look into the Rising Crisis. Current pain and headache reports, 22(5), 32. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/29619569
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Matthew Gladden, R. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. American Journal of Transplantation, 16(4), 1323-1327. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.13776
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Matthew Gladden, R. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. American Journal of Transplantation, 16(4), 1323-1327. Retrieved from: https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm
Schrager, S. M., Kecojevic, A., Silva, K., Jackson Bloom, J., Iverson, E., & Lankenau, S. E. (2014). Correlates and consequences of opioid misuse among high-risk young adults. Journal of addiction, 2014. Retrieved from: https://www.hindawi.com/journals/jad/2014/156954/
Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263. Retrieved from: https://www.nejm.org/doi/full/10.1056/nejmra1507771
White, N. D. (2015). Opioid abuse and overdose: prevention strategies. American Journal of Lifestyle Medicine, 9(6), 412-415. Retrieved from: http://journals.sagepub.com/doi/abs/10.1177/1559827615598527