Chronic Pain and Drug Abuse

Opioids are the most common medications prescribed for chronic pain in the United States; in 2014, there were 245 million opioid prescriptions given for relieving pain in the United States.6 Whether it be a minor surgery or an ache, many people rely on opioids to get rid of their pain. Some uses aside for pain are anesthetics, cough suppression, diarrhea suppression, and lastly for addiction itself (surprising!).4 I will discuss some factors as to how and/or why abuse of pain medications exists, which include: being prescribed by physicians, co-occurring disorders, genetic, biological, environmental, or psychological.5 Also, I will discuss the mechanism of action as well as some preventative methods to prevent one from getting addicted.

We need to understand how opiates work as far as its effects on the brain. They bind to the mu-opioid receptors, which are in the brain to work on easing the pain.6 Specifically, the areas are the pain perception such as the periaqueductal gray, thalamus, cingulate and insula.6 The emotional area is the amygdala and the brain reward area is the ventral tegmental and nucleus accumbens (these are responsible for pleasure and well-being).6 Therefore, the potential of developing a dependence on opiates is higher.

First reason opiate abuse has been occurring is because doctors have been over prescribing opiates to patients according to the standards of the Centers of Disease Control.3 Why we may ask? According to a survey done by the National Safety Council, many doctors mentioned they prescribe pain medications for reasons other than just pain as the benefits outweigh the risks.4 Next, many insurances do not cover “non-pharmaceutical interventions” such as physical therapy or massage therapy, hence why opiates tend to be prescribed.3 Lastly, physicians tend to inappropriately screen patients before prescribing opiates.3 This means they do not consider the addicting behavior that these patients possess before prescribing opiates.     

There are side effects that come with opiate abuse as with any addiction. Here are some major side effects: nausea, vomiting, sedation, skin changes, miosis, constipation, respiratory depression, heart rate changes, dependence and lastly spasms.1 However, some of the side effects can be beneficial as mentioned above. For example, certain opioids, such as codeine, can be used as a cough suppressant. Furthermore, other opioids, like methadone and buprenorphine, “are used to help wean patients off some of the more potent opioids such as heroin.”4

There needs to be preventative methods in place for those who get addicted. One way is to refer or recommend patients to drug treatment programs3 as soon as they are prescribed the medications. Along with that, the patients need to be properly educated on how to take them and the risk of abusing them.2 According to Chicago Tribune, 38% of physicians refer patients and 10% discontinue caring for their patients.3 Another way is to appropriately train doctors to treat addictions3 as they are the one to prescribe the opiates. These methods not only decrease abuse of opiates but also decrease health care costs.1 According to Dr. Hahn, presenting photo identification upon picking up a prescription will decrease abuse.2 An abundance of the abuse is due to identity theft, hence this suggestion might help with that.2 

Opioid abuse is almost like a learned behavior. It can be best explained using Pavlov’s experiment and how one is conditioned to a stimulus. The pain is the stimulus while taking the opiate is the behavior, which makes any minor pain a conditioned stimulus.2 With the help of physicians and how they can monitor patients via screening and prescribing, we can potentially reduce those who have a tendency to abuse opiates. 

References:

1. Benyamin, R., Trescot, A. M., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., . . . Vallejo, R. (2008, March). Opioid complications and side effects. Retrieved January 01, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18443635

2. Hahn, K. L. (2011). Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs. American Health & Drug Benefits, 4(2), 107–114.

3. Keilman, J. (2016, March 26). Almost all doctors routinely overprescribe pain pills: survey. Retrieved December 31, 2017, from http://www.chicagotribune.com/news/local/breaking/ct-prescription-painkiller-overuse-met-20160324-story.html

4. Mandal, M. D. (2013, October 13). Opioid Uses. Retrieved December 31, 2017, from https://www.news-medical.net/health/Opioid-Uses.aspx

5. Opiate Abuse & Addiction Effects, Signs & Symptoms. (n.d.). Retrieved December 31, 2017, from http://www.mtregis.com/opiates/effects-signs-symptoms

6. Volkow, N. D., M.D., & McLellan, T. A., Ph.D. (2016, March 31). Opioid Abuse in Chronic Pain - Misconceptions and Mitigation Strategies — NEJM (D. L. Longo M.D., Ed.). Retrieved December 31, 2017, from http://www.nejm.org/doi/full/10.1056/NEJMra1507771#t=article