Opioid Epidemic

Physicians face increased pressure to decrease the patient’s pain. Patients may have pain due to injury, from surgery, or from other conditions that cause pain. Pain is a common thing for most individuals.  One of the medications that doctors use to decrease the pain, especially if the pain is severe, is opioids. The use of opioids has increased significantly die to multiple factors. Opioid is a general term that represents opiates, for example morphine, which is derived directly from opium. The opioid can be semi-synthetic opiates such as oxycodone, which is derived from the extract of the opium poppy, and ti can be synthetic opiates such as Fentanyl.  Many people die or get hurt annually from the abuse of prescription opioids. The most powerful types of opiates include codeine, morphine, heroin, and fentanyl. Thousands of people visit the ER due to misuse of prescription pain medication. 75% of these people are using prescription drugs that were prescribed to somebody else. Opiate abuse is an epidemic in the United States. Prescription opiate misuse may lead to abuse and addiction to heroin and Fentanyl. There are some studies about pain and the effect of opioids. Some of these studies are sponsored by the pharmaceutical manufacturers, but most of these studies are short term studies that did not have a long term follow up. As a result, a 1% risk of opioid addiction is often cited. Studies have demonstrated that the risk of addiction to prescription opioids is 3% to 45% when used on a long term basis. In fact, when opioid use occurs beyond 12 weeks, 50% of the patients will still be taking the opiated beyond 5 years. The new laws limit the amount of opiate pills that can be dispensed from a single provider. In fact, it limits the time of dispensing and the number of pills to a single patient. Some studies showed that patient that are taking preoperative opioids are associated with increased length of hospital stay, increased morbidity, and a worse outcome. When you give opioids to the patient for a longer time post-operatively, this will impact the surgeon and the hospital when it comes to the patient reported outcomes, and it can also affect patient satisfaction. Pain it’s the cognitive, emotional, and behavioral response. Pain intensity varies from person to person which is related to stress, distress, coping abilities, and psychological factors. In general, the physician should work with the patient for better pain relief and for safer prescribing of medications. The best pain relief is self-efficacy and resilience.  Encourage the patient to recover and adapt during stressful situations. Depression and catastrophic thinking increases pain intensity. Encourage the patient to get back to a normal routine as quickly as possible. People who have resilience have a lower level of pain and set goals for recovery which enhances their functional ability. Opiate sparing strategies may prevent long term use of prescription opioids. Three categories of types of strategies are Physical, mental/cognitive and, medication.  Physical strategies include massage, TENS unit, acupuncture, ice, and heat. Mental/cognitive coping strategies include teddy bear therapy, meditation, yoga, biofeedback, cognitive-behavioral therapy, and music therapy. Medication strategies do not have to include opiate. This strategy can include a field or nerve block, NSAIDS, or gabapentin. We can utilize a combination of all of these three strategies. A combination of these strategies will definitely help to relieve the patient’s pain and anxiety, giving the patient confidence in the system.  A study on opioids following outpatient upper extremity surgery found that 77% of patients took 15 or fewer pills. Almost half of patients took 5 or fewer pills and the majority of patients used opiates for less than 2 days. A patient in the Netherlands leaves the hospital after an operation to fix the ankle with Tylenol, and these patients are satisfied with their pain medication. With the laws regulating pain medications, the doctor should have empathetic communication with the patient and explain why they cannot give more pain medications. Discuss with the patient about opiates and promote alternative pain management strategies. Get help from other people such as the nurses, physiotherapists, and occupational therapists. Discuss post-surgical pain management with the patient, and when the patient has a history of substance abuse, try to help them.Guide your patient to the best team that can help the patient. Send them to pain management. Get some help for your patient. Excessive post-surgical prescription of opiates is commonly reported as a contributing facture to diversion and abuse. It is better to use immediate-release opioids, instead of extended-release opioids. Pain blocks are effective and can reduce the need for opiates. Minimally invasive procedures can reduce the pain of the patient. It is better for the patient to have multimodal therapy. It is more effective and safer than narcotics alone.