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Opiates rate of prescription opiate use and

Opiates have been used for thousands of
years but unfortunately are a growing concern with the global population. Since
approximately 3400 B.C, Opiates have been used for the treatment of minimal and
chronic. The Sumerians were the first to utilize the opium poppy and they
referred to the crop as the “joy plant”. The use of opiates has always been a
form of treatment for pain but throughout the last few decades, the rate of
prescription opiate use and abuse dramatically increased. According to Brady,
McCauley and Back (2016), prescription opiates have become one of the most
commonly initialized drug with a close second of Marijuana who has
approximately 1.9 million new users a year. Prescription opiates used to be
more readily available then they are now. Before 1990, physicians were
criticized for under acknowledging and undertreating pain. However, during the following
years, pain was considered the fifth vital sign of symptoms and therefore the physicians
were encouraged to prescribe more opiates which as contributed to the increase
in opiate misuse and abuse today (Brady, McCauley and Back, 2016). Brady, McCauley
and Back (2016) reported that in two-thousand and twelve, the total number of
prescriptions that were written for opiates, which was two hundred and fifty-nine
million prescriptions, was the equivalent to the United States adult population.
This fact is alarming because it is a clear depiction how severe this epidemic
really is. In two-thousand and fourteen, over 10.3 million people reported
using a prescription opiate for nonmedical use (Compton, Jones, & Baldwin,
2016). Healthcare providers are now aware of the negative side effects and
complications of prescription opiates and are fighting against the epidemic by
restricting prescriptions and implementing more forms of treatment.

There are multiple forms of prescription
opiates such as Fentanyl, Hydrocodone, Methadone, Morphine and oxycodone. In two-thousand
and eleven, hydrocodone was the most commonly prescribed opiates with over
136.7 million prescriptions. Alarmingly, prescription opioids are now reported
as being responsible for more deaths than the numbers of suicide and motor
vehicle accidents combined (Manchikanti et. al, 2012). According to Manchikanti
et. al (2012), most the deaths reported occurred when they were prescribed
based on legitimate medical guidelines. Surprisingly, approximately forty percent
deaths occurred in individuals were abusing the drug(s) and obtained them
through multiple prescriptions, drug diversion and doctor shopping. Drug
diversion defined as the transfer of a legally prescribed substance to an
individual that it was not intended for to use illicitly. Between, two-thousand
and nine and two-thousand and ten, fifty-five percent of individuals who
reported using pain relievers for nonmedical use reported that they obtained
the drugs from a friend or a relative with no cost or payment (2012). Alarming,
out of the remaining population, more individuals reported that they bought
them from their friend or relative where a small portion stated that they stole
them from said parties (2012). On the other hand, only 17.3 percent reported
that they legally obtained a prescription from a physician. These statistics
show the different means that one will go through to obtain a prescription
opiate. Clearly, the individual has reached a state of dependence that they are
willing to steal drugs from their friends and/or relatives. However, one can
only assume that individuals are willing to steal from other parties such as strangers,
doctors and even pharmacies to feed their addiction. According to Manchikanti
et. al, (2012), the National Survey on Drug Use and Health and the Substance
Abuse and Mental Health Services Administration estimated that 22.6 million or
roughly 8.9 percent of Americans, aged twelve and older, were illicit drug
users. Surprisingly, 5.1 million of those individuals who were current users
had used pain relievers. In addition to this alarming statistic, the average
age for the onset of an opioid problem was twenty-eight years and the average duration
of opioid abuse was approximately five years (Weiss et. al, 2014).

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Multiple forms of opiates have been used
for treatment of acute and chronic pain disorders. Short-acting opioids that
tend to be orally administered are generally used for acute pain (Brady, McCauley
and Back, 2016). Examples of short-acting opioids are hydrocodone, oxycodone, fentanyl
and codeine. These drugs typically have a rapid onset which can take between
ten to sixty minutes to reach full effect and last for approximately two to
four hours. On the other hand, extended-release opioids tend to have a slower
onset of approximately thirty to ninety minutes and their full effects can last
for up to seventy-two hours.

Unfortunately, the use of prescription
opiates can and has been shown to lead to the use of heroin. When an individual
is unable to obtain their preferred dosage of prescription opioid, whether it
is through an actual prescription or drug diversion, they are more prone to try
heroin to try and reach the same effects as their prescription (Weiss et. al,
2014). Heroin is very similar to opioids and can deliver the same high and
euphoria effect. Heroin is a serious drug because it is easier to obtain and is
cheaper than prescription opioids. Heroin can also be viewed as being a more
potent drug which can give the user a better, quick and more intense high. According
to Weiss et. al (2014), 914,000 individuals reported using heroin what was a
one-hundred and forty-five percent increase from two-thousand and seven. Alarmingly,
rates mortality for heroin overdose has more than quadrupled within the last
fourteen years. These facts clearly show serious prescription opioid abuse is
and how strongly correlated it is with heroin use. On the other hand,
prescription opiates such as oxycodone, fentanyl and morphine can have the same
potential for abuse as heroin but can also potentially have higher rates of
abuse with heroin.

However, nonmedical use of prescription
opioids has been viewed as a transitioning point for heroin. According to Weiss
et. al (2014), heroin users were 2.9 times more likely to meet the criteria for
a substance use disorder or at the least have a dependence on opioids. Per Weiss
and colleagues article, they located data recorded from Ohio that showed approximately
fifty percent of individuals, aged eighteen to thirty-three years, who had
begun to use heroin had reported that they abused opioids previously before initiating
their heroin use (2014). As stated previously, the use of prescription opioids
has a high potential to push the individual into other drugs to attempt to
reach the same type of euphoria. According to Weiss, individuals tend to start
taking opioids orally and then progress to more drastic means of administration
to reach a high quicker (2014). Such forms of administration may include
injection as well as smoking the substance. Per Green et. al’s study, males
tend to have a higher rate of nonmedical intentional abuse such as injection
and inhalation with the mean age of thirty years old (2017). Unfortunately, as one’s
tolerance for the drug builds, the more they seek the drug and how costly their
habits can become. Heroin is a drug that does not discriminate and can affect anyone
and everyone. Surprisingly, increases of heroin use have observed in both large
urban areas as well as rural areas. However, women tended to have an increase
in heroin use over men and non-Hispanic white individuals tended to have an
increase than other ethnic groups as well. Additionally, individuals who enter
treatment tend to have white, middle class and tend to be from nonurban areas
(Weiss et. all, 2014).

Another severe complication with individuals
who use or have used prescription opioids who now use heroin is that they are faced
with the increased rate of heroin mixed with fentanyl. According to Macmadu and
colleagues, between two-thousand and thirteen and two-thousand and fourteen,
the death rates of those who overdosed on heroin and synthetic opioids
increased by approximately eighty percent (2017). Per Macmadu and colleagues
study, approximately fifty-nine percent of two hundred participants stated that
they were unaware that their heroin was contaminated with fentanyl before they
used the drug. This is a common occurrence within the opioid epidemic because
it is leading to more overdoses and many are unaware that their drug is
contaminated and can be extremely fatal. There are not many screening
assessments and treatments that can combat fentanyl contaminated heroin.
However, programs designed to educate younger individuals as well as the
community about the overdose risk are needed to help inhibit the prevention of
overdose. Another form of treatment that is needed is to increase to increase
the distribution of Medication-Assisted Treatment such as Naloxone so that it
is readily available to all.

There are multiple factors that have
contributed to the increase in opiate prescriptions. Such factors include the
aggressive marketing campaign by the pharmaceutical industry, promotion of opioids
by doctors and the encouragement to use opioids for pain treatment by countless
organizations (Manchikanti et. al, 2012). Manchikanti and colleagues (2012)
reviewed the legal guidelines that were believed to constrict and control the
use of the substance seemed to promote the increase in the prescribing of
opiates. According to the guidelines, “No disciplinary action will be taken
against a practitioner based solely on the quantity and/or frequency of opioids
prescribed”. The wording of the guidelines has made it easier for physicians to
continue prescribing opiates without the risk of being held responsible.

As previously mentioned, healthcare
systems are now aware of the negative consequences of prescription opiates and
have begun to implement new processes to help control the epidemic. As a
result, federal, state and other forms of legislation have implemented a
variety of policies and procedures such as creating educational programs to
help educate the healthcare system and the public about the appropriate use of
opiates as well as creating efficient drug monitoring programs. Another beneficial
program that could help control the rate of abuse and drug diversion is to
create programs where one can dispose of the unneeded and leftover
prescriptions instead of supplying them to other individuals which in turn
continues the epidemic.























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