Doctors Must Better Know Patients Before Prescribing Opioids

Prescription opioids are medications typically used to help people with moderate or severe pain. Unfortunately, significant numbers of people become addicted to these medications and/or experience non-fatal or fatal episodes of opioid overdose. In a report published in 2014 in the American Journal of Public Health, a team of researchers from the University of Cincinnati explored the role that doctors play in inadvertently boosting the risks for opioid addiction and the odds that any given opioid abuser will experience an overdose event.

Prescription Opioid Addiction

All opioid substances, including illicit/illegal drugs and legitimate medications, are capable of triggering opioid addiction. This fact holds true because all opioids can create lasting changes in brain chemistry that set the required terms for physical drug dependence. In turn, dependent opioid users have an inherent risk for developing the highly dysfunctional symptoms of full-blown addiction. As a rule, most prescription opioid users who follow their doctors’ instructions don’t have particularly high odds for developing an addiction, even when long-term use of a medication leads to the onset of physical dependence. However, two groups of individuals — people who abuse their opioid prescriptions and people who take opioid medications without a prescription — have clearly elevated opioid addiction risks. According to figures compiled through an annual federal research project called the National Survey on Drug Use and Health, nearly 2 million Americans are addicted to prescription opioids or have diagnosable symptoms of non-addicted prescription opioid abuse.

Prescription Opioid Overdose

Opioid substances trigger overdoses by drastically slowing down the rate of electrochemical activity in the central nervous system (brain and spinal cord). Some people survive these overdose events; however, others die, especially when they don’t receive prompt medical care. A federal agency called the Substance Abuse and Mental Health Services Administration uses a program called the Drug Abuse Warning Network (DAWN) to track the number of people across the U.S. who require emergency room treatment for prescription opioid consumption. In 2011, the last year with fully available figures from DAWN, 488,004 Americans sought emergency treatment related to prescription opioid use/misuse. The majority of these individuals took an opioid medication designed to relieve pain. The most commonly involved medications were products containing the opioid oxycodone (e.g., OxyContin and Percocet), a combination of two or more types of opioids, products containing the opioid hydrocodone (e.g., Vicodin and Lortab) and products containing the opioid methadone.

What Role Do Doctors Play

Whenever a doctor prescribes an opioid medication to a patient, he or she must balance the needs of pain management against the very real risks for abuse, addiction and overdose. Generally speaking, doctors tend to worry about pain management first and rely on proper dosing guidelines to reduce the chances that any serious problems will arise. In part, this approach has been supported by the wide availability of a range of opioid medications intended for use in fairly narrowly defined situations.

In the report published in the American Journal of Public Health, the University of Cincinnati researchers question the role that doctors following established dosing guidelines may unintentionally play in providing an avenue for opioid medication misuse, and thereby providing an avenue for cases of addiction and overdose. Critical to this questioning is an improved understanding of the circumstances in which misuse of prescribed opioids tends to occur. Currently, the research community doesn’t know why some consumers of these medications eventually go on to use them improperly, even when they initially closely follow their doctors’ dosing instructions.

The researchers believe that, for at least some individuals, the medically justifiable consumption of opioids is the main vector for opioid addiction. For this reason, they believe that doctors who prescribe opioid medications must do more to increase their patients’ awareness about the risks of addiction. In addition, the researchers believe that doctors who prescribe these medications must examine the potential for addiction more closely, even when giving their patients amounts of prescription opioids that fall within established guidelines for effective pain management. This means that doctors must weigh the pros and cons and pain management and abuse/addiction/overdose on essentially a case-by-case basis. The report’s authors note that number of Americans dying from prescription opioid overdose has roughly kept pace with the increasing use of these medications in pain management.

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