Opioids In The ICU: A Case Study

Opioid addiction is so prevalent in the healthcare system because of the countless number of hospital patients being treated for chronic pain. While opioid analgesics have beneficial painkilling properties, they also yield detrimental dependence and addiction. There is a legitimate need for the health care system to provide powerful medications because prolonged pain limits activities of daily living, work productivity, quality of life, etc. (Taylor, 2015). Patients need to receive appropriate pain treatment, however, opioids need to be prescribed after careful consideration of the benefits and risks.

Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865).

Narcotic analgesics, especially morphine are underused for pain control with in the medical field. This underuse is because medical professionals, including doctors, fear patient addiction, side effects and possible lose of their licenses. These fears deny adequate healing and a better quality of life to those who would benefit from a more effective use of these drugs, as done in hospice care.

Mike Alstott knows first-hand how opioids, when used correctly, can play an important role in managing pain and helping people to function, but he is also keenly aware of the growing crisis of opioid misuse and overdose. More American adults are dying from misusing prescription narcotics than ever before. An estimated 35 people die every day in the U.S. from accidental prescription painkiller overdoses resulting from things like not taking a medication as directed or not understanding how multiple

Considerable cautions have been obtained throughout the United States to decrease the misuse of prescription opioids and helps to minimize opioid overdoses and related complications. Even though the pain medications have a significant part in the treatment of acute and chronic pain situations, it sometimes happen that the high dose prescription or the prescribed medications, without having enough monitoring, can create bad outcomes. It is always a dilemma for the providers to find who is really in need of pain medications and to identify those who are questionably misusing opioids.

As the number of opioid related deaths rises, so does the cost it takes to treat and prevent drug overdoses in multiple counties across the nation. Naloxone is the drug that first responders use to reverse the progress of an overdose and return breathing to a patient. According to an NPR article about the cost for a fire department in Washington, D.C., “The city paid about $6 for a prefilled syringe of naloxone in 2010, says spokesman Vito Maggiolo. This year, that same syringe runs about $30. Maggiolo says the fire department spent about $170,000 on naloxone in the last 10 months.” Not all brands are rising as drastically at the same rate, but the cost associated with acquiring these drugs raises concerns for many state senators. States only authorize a certain percentage of funds to be used for first responder equipment, and constant rise for the price of naloxone would mean counties receive less of the drug to administer victims. Depending

Opioids are being over prescribed in the United States resulting in increased deaths by drug overdose. Pain medication strategies are being looked into as substitutes for pain management. Over decades, the amount of medicine being prescribed has more than tripled. State policies regarding the medication were implemented and who'd a small decrease in the likelihood of opioid prescriptions. Nationally, death rates are on the rise. Studies monitoring prescription drugs do not account for illegal opioids and manufactured fentanyl. While not mentioned in this article, there is a possible correlation between young people prescribed opioids and illegal drug use seeing that overdoses are common in patients already abusing their prescription medication, yet overdose death being most common after

In fact, there was thought to be more of a need for them. Before the last two decades, opioids were used for cancer related or acute pain. However, in the 1990s chronic non cancer patients got attention because people nationally felt there was a shortage in patients receiving opioids, thus making them deprived of adequate pain management. Because of this, clinicians were encouraged to treat chronic non-cancer pain and patients in hospice care more often than they were used to. It was also encouraged to use high doses of opioids for long periods of time (Cheatle). The idea that providers seemed overly cautious about these medications caused a large increase in opioid prescriptions from health care providers. Threat of tort and litigation for some doctors that were deemed for not prescribing enough to alleviate pain of patients was also a concern for doctors This quickly turned a shortage of prescription opioids into a national prescription opioid abuse epidemic in under twenty years. From 1999 to 2010, the amount of prescription opioids sold to hospitals, pharmacies, and doctors offices quadrupled, and three times the number of people overdosed on painkillers in this time (Garcia). While some patients have benefitted from the increased sales and loose guidelines of prescription opioid analgesics, the increasing in opioid misuse, abuse, and overdose is truly daunting. As a nation, we need to back track, and

The over use of opioid has been one of the major public health problem in the United States (Substance Abuse and Mental Health Services Administration, 2018). Opioids include prescription medications that are used to treat pain symptoms which includes codeine, morphine, methadone, hydrocodone, and etc., as well as illegal drugs such as heroin and illicit potent on opioids such as fentanyl analogs (Substance Abuse and Mental Health Services Administration, 2018). The opioid overdose could happen due to many factors such as when a patient deliberately misuses a prescription, or misuse heroin (Substance Abuse and Mental Health Services Administration, 2018). Opioid overdose could happen due to the prescriber miscalculated the opioid dose or when

The use of opioid-based prescription medications to treat non-terminal chronic pain can cause side effects from short term use, and is overly common and ineffective. Firstly, opioid usage can induce negative short-term effects. According to William A. Darity, Jr., short-term opioid usage causes negative effects such as “euphoria, drowsiness, and impaired motor and cognitive functioning” (“Drugs”). The short term effects of the opioids may cause the patient to isolate him or herself socially due to being self-conscious about his or her friends and peers seeing the individual in their current condition. Due to his or her fragile emotional state, however, if the patient isolates him or herself during a time in which he or she should have increased

Opioid addiction is a condition that is preventable as well as one which individuals display several noticeable risk factors before the actual addiction prognosis to the point of causing death. There is a strong correlation between the early misuse of prescription opioids, which are prescribed for non-cancer pain management, and the development of a dependence on such opioids. Early detection of risk factors such as the misuse of opioids that are prescribed will help indicate that a patient is developing an addiction.1 Physicians, nurses, pharmacists, and other healthcare providers must closely monitor patients and the rate at which opioids are consumed as well as refilled.

Rates of opioid-related overdose have been rapidly increasing in the United States. From 2010-2015, overdose deaths attributed to the use of illicit opioids has increased by over 200% (1). In 2016, the number of opioid-related deaths reached 64,070, the highest number ever recorded in the nation’s history and anticipated to increase (2). While opioid-related overdose had been largely caused by prescription opioid misuse, the problem is increasingly due to heroin and other illicit opioid use (3, 4). Increasingly, illicitly-manufactured fentanyl (IMF), an opioid much stronger than heroin, has become an increasingly common additive pervasive in the supply in the United States and has contributed to the steep rise in opioid-related overdose (5-8).

While, CURES helps to identify red flags, there are no guidelines for pharmacists to ultimately make the final decision to fill an opioid prescription or not. CVS though, is making substantial changes to its pharmacy program. If a patient has a prescription for several weeks’ worth of an opioid and wants to fill that prescription for more than seven days, pre-authorization will be required and the drugs will have to be paid for out of pocket. CVS pharmacists will begin providing patients with thorough explanations as to why some of their opioid prescriptions won’t be filled. They will also be sure to counsel patients on the dangers of opioid dependence and addiction. As mentioned in Time, Dr. Steve Stanos, president of The American Academy

“Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers” by Katie Thomas & Charles Ornstein

1Fentanyl is a powerful synthetic opiate analgesic, which has a primary function in managing malignant and non-malignant contractible pain, similar to morphine however it is more potent. This is because fentanyl has an octanol-water partition of 9550 compared to morphine, which has 6. This effectively demonstrates that fentanyl is highly lipid soluble, crossing the blood brain barrier more rapidly. Hence it has a quicker reaction time but at a shorter duration compared to morphine. It is commonly used to treat patients with severe pain or patients experiencing pain after a surgery. Fentanyl can also be used to treat patients with chronic pain that are physically tolerant to opiates. Patients who are not physically tolerant to opiates