Opiates are one of the oldest medicinal drugs used to treat pain. In China, the opium poppy provided pain relief beginning in ancient times, and the poppy was used to treat pain in the Middle East as early as the eighth century. Although this historic medicine is very useful to treat some medical conditions, opiates are addictive substances that have created an epidemic in the modern world. One way health care providers are fighting the ever-expanding issue of opiate misuse is by limiting opiate prescriptions when treating acute conditions.
The opiate crisis is a term that is frequently used to describe the recent surge in opiate use and addiction in the United States. Pain medications like hydrocodone and morphine are prescribed to treat moderate to severe pain in both acute and chronic illnesses. Many modern prescription medications are made with semisynthetic or synthetic ingredients, but the medicines produce many of the same effects as opiates that are derived from natural sources.
The shared side effects of synthetic and naturally derived opiates have significantly contributed to the increased use of heroin in the United States. The side effects of opiates include feelings of euphoria, drowsiness and respiratory depression, and physical dependence is very common when opiates are prescribed for long periods of time.
Sometimes, people use heroin instead of opiate medications when the medication is unavailable, resulting in a significant increase in heroin use. Cities are particularly affected by increased heroin use, but the issue has expanded to affect a variety of rural areas throughout America. Increasing heroin use has also contributed to the rise in fatal overdoses.
Midwestern states like Ohio are among the hardest hit with nearly 3,000 fatal overdoses occurring in 2015 alone.
Overdoses may be most prevalent in cities, but dependency on opiates affects people of all ages and backgrounds. The unpredictable pattern of opiate use has made preventing dependence and overdoses more difficult at both state and federal levels.
Opiate use has risen significantly within the past several years, leading to a range of alarming statistics. For example, HIV and hepatitis C diagnoses that are related to opiate use are rising, and neonatal abstinence syndrome has increased by 5 percent in just under two decades. Some other statistics to consider include the following:
- Twelve states have a greater number of opiate prescriptions than residents.
- Nearly 80 percent of overdoses treated in the emergency room were linked to opiate use.
- Opiate-related fatalities have increased by nearly 400 percent since 1999.
- Emergency room visits related to opiate use have increased by over 80 percent from 2016 to 2017.
- The use of Fentanyl, a powerful opiate that is sometimes added to heroin, has increased heroin overdoses significantly in some regions.
- Opiate use is so severe that the President declared a national state of emergency.
- Per capita opiate prescriptions increased by over 7 percent between 2007 and 2012.
Although opioid prescriptions are now more common than ever before, Americans aren’t reporting more pain than in previous years. In an effort to reduce opiate use, some physicians are now participating in a prescription limiting program that is designed to reduce overprescribing opiates when treating acute conditions.
A recent study by the University of Pennsylvania suggests changing the default settings for opioid prescriptions to just 10 pills. In order to prescribe more pills, the physician must manually change the default amount. The act of manually changing the default number may only take a few seconds, but it allows physicians to become more aware of their prescribing habits and can help prevent overprescribing medications.
Although the opiate epidemic may be perpetuated by a variety of factors, the Penn research team suggests the key to reducing opiate misuse lies in prescribing enough medication to treat acute conditions but not prescribing enough pills to have “leftovers” sitting in the medicine cabinet after the illness resolves.
Finding this middle ground is one of the goals of the Penn study, which began with two local hospitals and is now expanding to an additional 50 hospitals in locations throughout the country.
The “Nudge” Program
Nudge is a multifaceted program that is designed to promote better patient care by offering physicians choices in a new format that encourages actively making decisions when ordering tests, recommending treatments and prescribing medications.
Although Nudge outlines strategies to promote overall health and wellness, the program also emphasizes changing the way that medications are prescribed. For instance, that recent Penn study mentioned above suggests that making 10 pills the default for opiate prescriptions can reduce the risk of overprescribing medications. A lower default setting requires physicians to manually change the result setting to prescribe more or fewer pills.
Manually entering the number of pills to prescribe allows physicians to actively consider how much medicine is needed to treat the condition rather than simply accepting a standard amount. Nudge also provides physicians with recommendations for suggesting lifestyle changes, such as getting more exercise, in a new way that encourages patient participation.
Nudge is just one of the programs established across the nation to combat the growing opiate epidemic. Other programs include those designed by government organizations like the Centers for Disease Control and Prevention and the Department of Health and Human Services.
Why Limiting Prescriptions Works
Limiting prescriptions offers a variety of benefits at the federal, state and local levels and is easily implemented alongside drug monitoring programs. State-level drug monitoring programs are designed to help identify potential opiate misuse by tracking a person’s current number of prescriptions and providing that information to pharmacists.
Drug monitoring programs help identify areas where prescription totals are higher than average, allowing officials to pinpoint issues related to overprescribing. While the programs offer distinct advantages, the information in drug monitoring databases isn’t always updated in real time.
The delay in reported prescriptions can make it difficult for pharmacists to identify problems soon enough to prevent issues like duplicate prescriptions. A limited prescription approach tackles the issue of overprescribing opiates at the source by automatically reducing the number of opiates provided to treat acute conditions.
When used with drug monitoring programs, limited prescription programs have the potential to quickly pinpoint problems like overprescribing. Other tools are also available to reduce opiate use. For instance, the CDC has developed prescribing guidelines for physicians. The guidelines include a variety of alternate therapies to use with, or in place of, pain medicines.
Nationwide Strategies to Reduce Opiate Use
A variety of treatment methods are now recommended by the CDC to help control pain. For instance, physical therapy and non-opiate pain medications are now suggested to help control chronic and acute pain. These therapies can be used along with a reduced dosage of opiate pain medications, or alternatives may be used without the addition of opiate painkillers.
The Department of Health and Human Services has introduced a three-pronged approach that operates on a state level. The plan includes using drug monitoring programs, training local medical professionals to properly administer naloxone products and providing prescription training to physicians.
Naltrexone is a medicine that fights addiction by blocking the effects of substances, including alcohol, heroin and prescription pain medications. The medicine is administered orally or taken in pill form as prescribed by your physician. Other medications, such as buprenorphine and naloxone, are also available.
Treatments for Substance Use Disorder
Buprenorphine and naloxone are usually taken together to reduce cravings and provide relief from withdrawal symptoms. The combined medicines are particularly effective when combined with non-medicinal treatments like therapy.
One side effect of the opiate epidemic is a dramatic rise in overdose fatalities. Naloxone is available to treat overdoses, but the medicine is historically reserved for use by medical professionals. In an effort to cut fatalities, programs like Nudge encourage doctors to prescribe naloxone to patients where possible.
Naloxone is available in an auto-injection form that is easier to use outside of a medical setting. The limited prescription model has also been adopted by organizations like the Centers for Disease Control and Prevention.
CDC Prescribing Guidelines
CDC prescription guidelines allow physicians to more easily determine whether opiate medications are necessary to treat acute or chronic pain. The recommendations state that opiates are better suited for end-of-life and palliative care while non-opioid prescriptions are better suited for other acute and chronic conditions. Some prescribing recommendations found in the guidelines also include the following:
- The benefits of prescription opiates should outweigh the risks, and physicians should discuss the risks of opiates with their patients.
- Opiates should be combined with therapies like exercise to treat the illness or disease causing the pain.
- Immediate-release medications are preferred over extended-release opiates when treating chronic pain.
- Physicians should work with each individual to set treatment goals when developing a plan to manage chronic pain.
- Begin with the lowest dose and adjust medications as needed when treating chronic pain.
The comprehensive guidelines are designed to improve patient awareness but also help physicians decide whether opiate pain medications are the best option for each individual’s treatment plan. In acute pain treatment, the CDC recommends using the lowest possible dose for the shortest amount of time possible to help prevent dependency.
Limiting opioid prescriptions using the lower default setting as recommended by the Penn study is a simple way to follow the basic recommendations provided by the CDC. The CDC also recommends that physicians and patients develop a good rapport to find the best treatment options for conditions that cause chronic pain. Excellent patient-physician communication is essential to decide whether the benefits of using opiates outweigh the risks.
The Prognosis for America
Limiting prescriptions is a step toward a healthier future. Both federal and state governments are working to provide more thoughtful decisions regarding patient care, and guidelines are in place to help reduce the effects of opiate medications on future generations.
In an effort to find safer medicines, researchers are developing a number of non-opiate pain relievers to treat a variety of chronic and acute medical conditions.
The focus is to develop medications that effectively reduce pain without causing physical dependency or to develop medicines that have a reduced risk of physical dependency. While these medications are still being developed, advances may eventually eliminate the need for opiate-based medicines.
Treatment options like methadone and naloxone are also available to help you overcome a substance use disorder, and these medications are usually covered by insurance. Although the opiate epidemic has affected every state in the nation, initiatives like the Nudge program are changing how opiates are prescribed to fight the current opiate epidemic. If you or a loved one is struggling with opiate addiction, don’t hesitate to call us.