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Scientific and Mathematical Perspectives of Inquiry Paper
Overprescription of Opioids Related to the Increase of Opioid Addiction as a Public Health Issue
Would Approaching the Overprescription of Opioids as a Public Health Issue Decrease Rates of Opioid Addictions for Low-Income Americans?
A Future Nurses Perspective
West Coast University
Evidence of the connection: Overprescription of opioids and opioid addiction
The opioid epidemic has been a widespread public health issue in the U.S. for a long time. According to the statistics powered by the Central of Disease Control (CDC) (2019), 760K people died since 1999 as a result of a drug overdose, where two out of three deaths in 2018 were connected to opioids. Overdose on opioids rose by 30% from 2016 to 2017 (CDC, 2019). The opioid crisis in the community is evident with this type of drug being overprescribed and misused leading to the development of addiction and overdose. According to the study conducted by Meisenberg et al. (2018), overprescribing of opioids to patients with chronic and non-chronic pain could be reduced by using methods available to most health systems (e.g., non-addictive pain medications), yet, many health care facilities continue to overprescribe these substances due to the care cost associated with this practice. One of the main issues in this problem is the prescription of highly addictive opioid medications to patients who do not require such strong painkillers, which leads to overprescribing.
According to CDC (2020), the opioid epidemic had three waves in the U.S., such as the increase of opioid prescription in the 1990s, increased use of heroin among the population, and overprescription of synthetic opioids. One earlier research connected the frequency of prescription of opioids to the number of reimbursement physicians received for this practice (Van Zee, 2009). According to Van Zee (2009), marketing of OxyContin as a panacea for all types of pain without a warning that it might lead to addiction and overdose became a public tragedy for the U.S. citizens. Lack of education concerning the outcomes of the use of opioids on a regular basis led to the long-term addiction and overdoses that included the lethal cases.
Medication Condition One: Opioid Use Disorder
When patients develop a persistent desire to use prescribed opioids, they are no longer in control of their opioid use. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Opioid Use Disorder (OUD) could be defined as a state when the patients experience unsuccessful efforts to control opioid use with a time spent searching for the opioids, their use, and recover from their effect (APA, 2015). Patients with OUD experience strong cravings or urges to obtain and use opioids (APA, 2015). According to Neuman et al. (2019), inappropriate opioid prescription in patients who have just experienced surgery was associated with the high prevalence of OUD in such patients and misuse of opioids. According to this study, physicians have a tendency to prescribe opioids to patients after surgery assuming they experience acute pain that could not be managed by non-addictive medications without consulting their patients first (Neuman et al., 2019). As a result, many patients are not in control over their health and recovery as well as they cannot choose whether to consume addictive medications or not.
Medication Condition Two: Opioid Overdose
As it was noticed earlier, opioid overdose is a dire problem in the U.S., which is mostly stimulated by the increased prescription of synthetic opioids. According to the study conducted by Stopka et al. (2019) that involved more than three million adult participants, 50% of the adult population was prescribed opioid pain medications that increased the frequency of overdoses due to opioids among the sample. The increase of overdose frequency among patients with prescribed opioids was connected to addictive properties of these substances, overprescription, and opioid misuse as a result (Stopka et al., 2019). A study conducted among military veterans concerning opioid overdose showed that the aspects of psychological, physiological, and social adjustment pain and distress have to be considered when prescribing opioids, which lead to a high prevalence of overdoses in this population group (Bennett et al., 2017). This finding implies that a tendency to overdose due to prescription opioids is connected to the psychological state of the patients that physicians often ignore when prescribing pain medications.
Medication Condition Three: Short-Term Symptoms of Opioid Misuse
Misuse of opioids that includes the use of prescribed opioid medications frequently or an increased dose of these drugs could lead to a number of short-term symptoms that do not usually require additional treatment. Yet, opioid misuse requires urgent prevention. Overall, when patients increase the dose of prescribed opioids or use them more frequently than it was prescribed, they could develop nausea, vomiting, slow breathing rate, weakened immune system, hallucinations, risk of choking, clogged blood vessels, increased risk of developing infection diseases, and even coma (Cochran et al., 2017). The symptoms depend on the type of drug used, the mode of use (IV, orally), and the dose. Patients could develop the symptoms of misuse without contacting the physician, which often leads to overdose.
Economic Burden: Financial and Healthcare
Patients with developed OUD or experience of opioid misuse tend to spend their finances on buying opioids, seeking the consultation of physicians who can prescribe them, or even looking for these substances illegally. According to the analysis of this topic, elderly patients are especially vulnerable to financial losses due to opioid use and misuse, as this is one of the most vulnerable population groups that has limited financial resources (Oh et al., 2019). Low-income citizens are also vulnerable to financial losses due to the development of long-term OUD and misuse of opioids, which includes access to health care, purchasing opioid drugs, and managing the outcomes.
The healthcare system experiences financial losses due to the opioid epidemic, increased levels of overdose, and long-term addiction. According to the estimations, the total economic burden of the opioid epidemic is $78.5 billion (Florence et al., 2016). The main part of this sum is money spent on the treatment of patients with AUD and overdoses. Nearly one-quarter of the cost stems from the public sector in health care, AUD treatment, and costs connected to criminal justice (Florence et al., 2016). The health care system loses money when it comes to the opioid misuse of OUD, especially when it comes to the treatment of low-income or vulnerable population groups, as the majority of them access the treatment through Medicare and Medicaid programs.
APA. (2015). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). New School Library.
Bennett, A. S., Golub, A., & Elliott, L. (2017). A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City. PloS One, 12(6), e0179054. https://doi.org/10.1371/journal.pone.0179054
CDC. (2019). Opioid crisis statistics. U.S. Department of Health and Human Services. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html
CDC. (2020). Opioid data analysis and resources. https://www.cdc.gov/drugoverdose/data/analysis.html
Cochran, G., Rosen, D., McCarthy, R. M., & Engel, R. J. (2017). Risk Factors for Symptoms of Prescription Opioid Misuse: Do Older Adults Differ from Younger Adult Patients?. Journal of Gerontological Social Work, 60(6-7), 443457. https://doi.org/10.1080/01634372.2017.1327469
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), 901906. https://doi.org/10.1097/MLR.0000000000000625
Meisenberg, B. R., Grover, J., Campbell, C., & Korpon, D. (2018). Assessment of Opioid Prescribing Practices Before and After Implementation of a Health System Intervention to Reduce Opioid Overprescribing. JAMA Network Open, 1(5), e182908. https://doi.org/10.1001/jamanetworkopen.2018.2908
Neuman, M. D., Bateman, B. T., & Wunsch, H. (2019). Inappropriate opioid prescription after surgery. Lancet, 393(10180), 15471557. https://doi.org/10.1016/S0140-6736(19)30428-3
Oh, G., Abner, E. L., Fardo, D. W., Freeman, P. R., & Moga, D. C. (2019). Patterns and predictors of chronic opioid use in older adults: A retrospective cohort study. PloS One, 14(1), e0210341. https://doi.org/10.1371/journal.pone.021034
Stopka, T. J., Amaravadi, H., Kaplan, A. R., Hoh, R., Bernson, D., Chui, K., Land, T., Walley, A. Y., LaRochelle, M. R., & Rose, A. J. (2019). Opioid overdose deaths and potentially inappropriate opioid prescribing practices (PIP): A spatial epidemiological study. The International Journal on Drug Policy, 68, 3745. https://doi.org/10.1016/j.drugpo.2019.03.02
Van Zee A. (2009). The promotion and marketing of OxyContin: commercial triumph, public health tragedy. American Journal of Public Health, 99(2), 221227. https://doi.org/10.2105/AJPH.2007.131714
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