Principles of Ethics 445N

Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION

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Week 3 Assignment: Course Project Milestone - Opioid Epidemic

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Week 3 Assignment: Course Project Milestone - Opioid Epidemic

The opioid epidemic is a major issue affecting American society. Opioid abuse is one of the most common public health issues affecting the country. The epidemic has resulted in over 500,000 deaths, and the number is still rising. The opioid epidemic was reported as a public health issue by the U.S. government in 2017 (Hah et al. 2017). The medical community, especially pain medicine professionals, are fully aware of the issue while participating actively in the current developments. The opioid epidemic has to be handled swiftly to prevent it from worsening.

Background

Several programs have come up to deal with the issue, such as the National All Schedules Prescription Electronic Reporting Act (NASPER), which sought to reduce opioid prescriptions and deaths. Despite the reduction in the number of opioid prescriptions, many people are still dying due to overdoses, with 60,000 people dying in 2916, a 20% increase from the previous year (Jones et al. 2018). Before the 18th century, physicians did not recommend any medication to deal with pain. Instead, pain was regarded as an existential phenomenon that arises due to aging. There was no regulation to guide the use of opioids and cocaine, leading to widespread prescription and marketing of the medication for different ailments ranging from toothache to diarrhea.

A major step occurred in 1914 with the passing of the Harrison Narcotic Control Act, which responded to the rising number of street heroin abuse cases and morphine dependence, influenced by patients and physicians alike to reduce the use of opiates (Hah et al. 2017). During the 1920s, patients who had unexplained pain were regarded as abusers, malingering, or deluded. Cancer patients were also advised to reduce their medication intake (Manchikanti, et al. 2012). The perception continued into the twentieth century, whereby there was a common phobia towards opioids, even in contemporary literature.

The common problem is that patients with severe pain were often treated with an inadequate dosage of opioids. The American Pain Society started a campaign in 1995 called “pain as the fifth vital sign” to encourage standardized, effective treatment and evaluation of pain symptoms. This was one of the national response efforts to improve pain treatment and deal with the opioid epidemic (Jones et al. 2018). The rapid adoption of strict rules for pain management in hospitals resulted in unwanted outcomes. The physicians now had the authority to determine the pain medications, leading to an increased reliance on opioid medications.

Many hospitals were keen to meet the standards set by the Joint Commission in 2000 regarding pain management. This meant that hospitals were keen on prescriptive options since they had a higher satisfaction rate among patients (Jones et al. 2018). Pharmaceutical companies also started to manufacture and make opioids more readily available as a humane treatment option for patients undergoing pain. They also began to finance physicians to expound on the benefits and risks of opioids.

Physicians who did not prescribe opioids were labeled as inhumane, sometimes even getting sued for under-treatment of pain. Trainees in the healthcare field were also trained to depend on opioids for treating pain (Patrick et al. 2015). At the same time, pharmaceutical companies started to manufacture new formulations for treating pain, such as the extended-release version of oxycodone, which was regularly prescribed due to the belief that it was less prone to abuse. Between 1997 – 2002, oxycodone prescriptions increased from 600,000 to over 6 million (Jones et al. 2018). The overall consumption also increased from a low of 47,000kg in 2000 to over 170,000kg by 2012 (Jones et al. 2018). The trend is persistent as health care providers continue to prescribe opioids.

Impact

The push for additional measures to control opioid prescriptions proved useful. However, the problem started to arise due to the overzealous treatment using opioids. For instance, the number of over sedations doubled, and it became clear that there was a relationship between overzealous treatment for pain and instances of sedation and fatal respiratory conditions. The culture that was emphasized in the past to treat people with opioids has led to new problems. Physicians were now more willing to prescribe opioids for treating pain even for cases where it was not necessary. This means that opioids became more common, and it was easier for people to abuse it.

The developments in the past 14 years have led to an increase in the amount of opioids being prescribed and higher mortality rates in both females and males. Besides the rise in mortality, no study proves that opioid therapy can have a long-term benefit and that it is effective and safe in improving function and reducing pain (Gostin et al. 2017). Instead, most studies reveal that opioids have negative effects such as increased disability, psychosocial co-morbidities, hyperalgesia, and other problems linked with using opioids. The opioid epidemic also led to ethical issues since physicians are not forced to prescribe drugs after considering if it is the right thing to do and that the patient will not abuse it (Rachels & Rachels, 2019). Physicians now have to optimize the pain management approaches after surgery and limited the use of opioids. Data shows that chronic ad persistent opioid use after surgery can lead to problems for the patient.

In conclusion, the opioid epidemic is a good topic since the drug has led to many problems rather than acting as a solution. Initially, the use of opioids was encouraged as an effective option to treat pain and any physician who declined to prescribe it was regarded as inhumane. Then opioid epidemic is a major problem that needs to be resolved before it escalates and becomes worse. It is important for care providers to reconsider opioid prescription and that it would not harm the patients in the long term. The lack of scientific evidence to prove the long-term efficiency and safety of opioids also means that the best option would entail avoiding the medication.

References

Gostin, L. O., Hodge, J. G., & Noe, S. A. (2017). Reframing the opioid epidemic as a national emergency. Jama, 318(16), 1539-1540.

Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E. (2017). Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesthesia and analgesia, 125(5), 1733–1740. https://doi.org/10.1213/ANE.0000000000002458

Jones, M. R., Viswanath, O., Peck, J., Kaye, A. D., Gill, J. S., & Simopoulos, T. T. (2018). A brief history of the opioid epidemic and strategies for pain medicine. Pain and therapy, 7(1), 13-21.

Manchikanti, L., Helm Ii, S., Fellows, B., Janata, J. W., Pampati, V., Grider, J. S., & Boswell, M. V. (2012). Opioid epidemic in the United States. Pain physician, 15(3 Suppl), ES9-ES38.

Patrick, S. W., Dudley, J., Martin, P. R., Harrell, F. E., Warren, M. D., Hartmann, K. E., ... & Cooper, W. O. (2015). Prescription opioid epidemic and infant outcomes. Pediatrics, 135(5), 842-850.

Rachels, S., & Rachels, J. (2019). The elements of moral philosophy (9th ed.).