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The Opioid Epidemic: Limiting Prescriptions through New Guidelines

A deep analysis on the Opiod Crisis.

Drug addiction has long been a topic warned against in health classes around the country. The horrifying stories told in such classes, and even the media, of the slippery slope leading to hospitalization have influenced people to stay away from the debilitating effects of drugs. However, one type of drug—opioids, or better known as painkillers—is so prevalent that it has contributed to the deaths of 116 people per day, a colossal total of 42,249 deaths in 2016.

Opioids are a class of drugs that are presented in three subclasses: prescription opioids, highly addictive opioids including heroin, and synthetic opioids. According to the figure below, the opioid usage and corresponding deaths in all three subclasses have skyrocketed in the 21st century.

3-waves-of-the-rise-in-opioid-overdose-deaths
Figure from Centers for Disease Control and Prevention (CDC). Prescription opioid deaths are shown in purple.

While the number of deaths relating the prescription opioid usage is the lowest of the three waves of opioids, the significance lies in the idea that those drugs were obtained through accessible means. For example, patients who undergo surgery and post-operative care are subject to being prescribed medication, some of the most common being oxycodone, hydrocodone, etc. Eventually, the medication can easily be given to others second-handedly, creating a multiplying effect on the range the opioids reach. Over 50% of opioid misusers obtain the opioid through personal connections. Because of its addictive repercussions, it is highly important for health-care providers to prescribe the correct dosage and intake to prevent inappropriate intake of unused pills.

image_file_2466_BlockImageOne_271370712
Figure from Substance Abuse and Mental Health Services Administration (SAMHSA). Shown above is the distribution of places opioid misusers obtain prescription pain relievers.

Current Protocol for the Prescription and Disposal of Opioids

The current protocol for administering prescription opioids for patients is rather nebulous; according to one observation by the American Society of Anesthesiologists President James D. Grant, M.D., M.B.A., FASA., “Many patients leave the post-surgery recovery room with a prescription for 30 or more highly addictive opioid pills” and such a volume is unnecessary. Moreover, the number of prescriptions given vary widely state-to-state. The uneven distribution of opioid prescriptions largely contributes to the excess volume and, correspondingly, increased amounts of opioid misuse.

map_570px
Figure from Centers for Disease Control and Prevention (CDC). Illustrates the uneven distribution of opioid prescriptions among the United States.

Another large part of limiting the opioid epidemic is the safe disposal of unused drugs. There are many easy ways for patients to dispose of the drugs; some of the most common include sending the medication back to pharmacies and flushing the medication down the toilet (as long as it is listed in the FDA Flush List). Bringing patient awareness to some of the disposal methods will decrease the amount of second-hand obtainment of the addictive pain relievers.

New Study Provides More Comprehensive Guidelines for Opioid Distribution

In 2017, research done by the Dartmouth Hitchcock Medical Center studied 333 inpatients after receiving bariatric, benign foregut, liver, pancreas, ventral hernia, and colon surgery. Of the 85% of patients who were prescribed an opioid, 38% of the prescribed pills were taken. Based on this group of people, a guideline was created for home opioid usage. Specifically, the guideline related to the opioid usage prior to discharge.

Day before discharge:                                                 Number of pills for prescription:

0                                                                                                   0

      1-3                                                                                                15

      4 +                                                                                                30

According to the study, the implementation of this guideline will decrease the number of prescribed opioids by 40%, thereby relieving a part of the issue regarding the opioid epidemic.

While the opioid epidemic is certainly a massive issue that has a far-reaching impact, there are many precautions and efforts people can do. By safely disposing of one’s pain medication, the effects of opioid redistribution can be curbed. In addition, spreading awareness about the dangers of opioid addiction and researching alternatives to pain-relieving mechanisms can significantly reduce the amounts of opioids entering the outside world. With the 11.5 million opioid misusers and the $504 billion economic strain, it is time to begin action against the opioid epidemic.


For more information on how to help stop the opioid epidemic, please visit https://www.end-opioid-epidemic.org/.


References:

  1. Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017/ CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov
  2. Hill, M V, et al. “Guideline for Discharge Opioid Prescriptions after Inpatient General Surgical Procedures.” Advances in Pediatrics., U.S. National Library of Medicine, June 2018, http://www.ncbi.nlm.nih.gov/pubmed/29198638.
  3. “Disposal of Unused Pain Medications.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Dec. 2017, http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/opioid-disposal/art-20381382.
  4. “Opioid Overdose.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 July 2017, http://www.cdc.gov/drugoverdose/data/index.html.
  5. Public Affairs. “What Is the U.S. Opioid Epidemic?” HHS.gov, HHS.gov, http://www.hhs.gov/opioids/about-the-epidemic/index.html.

     

Cover Photo from: https://www.aarp.org/health/drugs-supplements/info-2017/opiates-prescription-pain-medication-information.html

My name is Michelle Mai and I am a rising senior at Century High School. My passion in the various STEM fields, most notably being science research, has driven me to be a sixth-year participant in the regional, state science fairs, and the 2018 Intel ISEF conference this past May. While science fair and research projects are large parts of my scientific career thus far, I also am the president of my high school's STEM Society, a volunteer at the Mayo Clinic, and the founder of the Run for Ronald community fundraiser. In the near future, I hope to pursue a career in medicine and medical-related research to explore the exciting discoveries in the medical field for the improvement of the human quality of life.

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