Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).
A doctor may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some doctors prescribe them for chronic pain.
Mismanagement of Opioid Use Disorder
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Other risks of using prescription opioids include dependence and addiction. Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm. The risks of dependence and addiction are higher if you misuse the medicines. Misuse can include taking too much medicine, taking someone else's medicine, taking it in a different way than you are supposed to, or taking the medicine to get high.
Opioid misuse, addiction, and overdoses are serious public health problems in the United States. Another problem is that more women are misusing opioids during pregnancy. This can lead to babies being addicted and going through withdrawal, known as neonatal abstinence syndrome (NAS). Opioid misuse may sometimes also lead to heroin use, because some people switch from prescription opioids to heroin.
The main treatment for prescription opioid addiction is medication-assisted treatment (MAT). It includes medicines, counseling, and support from family and friends. MAT can help you stop using the drug, get through withdrawal, and cope with cravings. There is also a medicine called naloxone which can reverse the effects of an opioid overdose and prevent death, if it is given in time.
To prevent problems with prescription opioids, be sure to follow your doctor's instructions when taking them. Do not share your medicines with anyone else. Contact your doctor if you have any concerns about taking the medicines.
In 2020, the age-adjusted rate of drug overdose deaths increased 31% compared to 2019. Adults aged 35-44 experienced the highest rates of drug overdose deaths while young people aged 15-24 experienced the greatest percentage increase in deaths. We must continue our efforts in all aspects of our fight against substance use disorder and the opioid epidemic.
As of March 2021, the Centers for Disease Control and Prevention noted that drug overdose death rates continue to rise in both rural and urban areas. In five states, California, Connecticut, North Carolina, Vermont, and Virginia, the rate of drug-overdose deaths in rural counties were higher than those in urban counties. In addition, a December 2017 survey by the National Farmers Union and the American Farm Bureau Federation found that as many as 74 percent of farmers have been directly impacted by the opioid crisis.
At a time when overdose deaths, driven primarily by illicitly manufactured synthetic drugs, have reached a record high, the Biden-Harris Administration took action through its first-year drug policy priorities to significantly expand access to evidence-based prevention, treatment, harm reduction, and recovery support services, as well to reduce the supply of illicit drugs like fentanyl. The opioid epidemic is devastating to its victims and their families. It has a compounding ripple effect throughout communities, affecting quality of life, economic opportunity, and rural prosperity. No corner of our country has gone untouched by the opioid crisis, but the impact of this issue on small towns and rural places has been particularly significant.
The crisis of prescription opioid (PO) related harms has focused attention toward identifying and treating high-risk populations. This review aims to synthesize systematic reviews on the epidemiology and clinical management of comorbid chronic pain and PO or other substance misuse.
Of 1908 identified articles, 18 systematic reviews were eligible for final inclusion. Two meta-analyses estimated the prevalence of chronic non-cancer pain in individuals using POs non-medically to be approximately 48% to 60%, which is substantially higher than the prevalence of chronic non-cancer pain in general population samples (11% to 19%). Five systematic reviews estimated the rates of PO or other opioid use in chronic pain populations with substantial variation in results (0.05% to 81%), likely due to widely varying definitions of dependence, substance use disorder, misuse, addiction, and abuse. Several clinical assessment and treatment approaches were identified, including: standardized assessment instruments; urine drug testing; medication counts; prescription drug monitoring programs; blood level monitoring; treatment agreements; opioid selection; dosing and dispensing strategies; and opioid agonist treatment. However, the reviews commonly noted serious limitations, inconsistencies, and imprecision of studies, and a lack of evidence on effectiveness or clinical utility for the majority of these strategies.
Across North America, the devastating crisis of prescription opioid (PO) related addiction and overdose has led to escalating mortality rates that have surpassed national mortality rates due to motor vehicle accidents and HIV-related mortality [1, 2]. As such, increased attention is being focused toward understanding the scale of the current epidemic and implementing risk mitigation strategies. In particular, individuals demonstrating concurrent chronic pain and opioid misuse are considered to be at high risk for opioid-related morbidity and mortality [3] given the high risk of opioid dependence among individuals on POs for chronic pain [4] and, conversely, the potential for increased pain severity and decreased pain thresholds among chronic opioid users [5].
Following the PRISMA guideline [7], we searched for systematic reviews related to chronic non-cancer pain (CNCP) and PO or other opioid misuse that were published in the following databases from January 1, 2000 to October 1, 2016: Medline, Cochrane Library, PsycINFO, Web of Science, EMBASE, and Google Scholar. Search terms were combined using appropriate Boolean operators and included subject heading terms or key words for three key aspects: chronic pain (e.g., pain OR pain management) AND analgesics (e.g., opioid OR opiate OR painkiller OR analgesic) AND abuse (e.g., misuse OR non-medical OR aberrant OR addiction).
Two reviewers independently screened the search results to identify eligible systematic reviews. Reviews were eligible for inclusion if they were: peer-reviewed; systematic reviews related to CNCP and PO or other illicit opioid misuse; focused on adult populations; and published in English. Studies were excluded if they were: non-systematic reviews; reviews of non-primary research (e.g., reviews of clinical guidelines); specific to acute or specialized pain (e.g., cancer pain, terminal or palliate pain); specific to non-adult or specialized settings (e.g., surgical or intensive care units) or populations (e.g., pregnant women, adolescent, elderly, or palliative care populations); or focused on evaluating a specific analgesic brand.
Morasco et al. was the only review that estimated rates of substance use disorder. Across 21 studies of CNCP patients, the authors found varying prevalence estimates for substance use disorder (not restricted to opioids), ranging from 3% to 48% for current substance use disorders, and 15% to 74% for lifetime history of substance use disorder (Table 2) [19]. The highest rates were observed in individuals seeking opioid prescriptions from emergency departments (74%) [20], individuals with AIDS comorbidity (48%) [21], and individuals who were screened for any substance use using urine toxicology (35%) [22]. However, the authors deemed the quality of the studies to be generally low, and there was substantial heterogeneity in the study settings (e.g., inpatient versus outpatient) and definitions of chronic pain and substance use disorder across studies.
Analyzing data from 14 studies, Morasco et al. did not find any demographic factors that were consistently different between CNCP patients with versus without comorbid substance use disorder [19]. Specifically, among CNCP patients, the authors found inconsistent results related to the relationship between substance use status and gender, age, employment, race or ethnicity, marital status, or education status. Conversely, both Chou et al. and Turk et al. found that younger age appeared to increase the risk of opioid misuse [16, 25]. Regarding sex, Turk et al. also found that while female sex did not appear to be a predictor for opioid misuse, there were mixed findings for the effect of male sex [25]. Furthermore, while Turk et al. found mixed results for the effect of race on opioid misuse [25], Cintron et al. found that racial and ethnic minorities (e.g., African Americans, Hispanics) were less likely to misuse POs compared to Caucasian populations, and yet these same racial and ethnic minorities were more likely to experience undertreated pain and less likely to be prescribed opioid analgesics from clinicians [26]. Turk et al. suggest that such mixed findings may be due to inconsistent reporting of demographic variables and underrepresentation of women and racial and ethnic minorities in studies of chronic pain populations [25].
Several of the reviews found that CNCP patients with a past or present history of opioid or other substance use disorder appear to be at greater risk for PO misuse [12, 16, 19, 25, 28, 29]. Further, the use of multiple substances may be correlated with PO misuse [25, 28]. In individuals with opioid use disorder, Dennis et al. found two studies in which chronic pain had no significant effect on illicit opioid use [27].
A number of standardized instruments have been developed to predict or identify opioid misuse in chronic pain patients (Table 3). Four reviews concluded that there is insufficient evidence to confidently support the accuracy or efficacy of any of these instruments [16, 25, 30, 31]. Specifically, there is a limited number of studies evaluating these instruments, and existing studies tend to be of low to moderate quality with key methodological flaws, such as cross-sectional designs that are unable to determine causality between observed clinical behaviors and subsequent opioid misuse [16, 25, 30, 31]. The validity and reliability of these instruments have been found to be either generally weak or not well evaluated, and potential biases related to patient selection and assessment timing may contribute to inflated estimates of diagnostic accuracy [25, 30]. Furthermore, there is a lack of literature evaluating the comparative utility of these instruments, and the definition of problematic or aberrant behavior varies across each instrument [25, 31]. 2ff7e9595c
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