Individuals in Pain Who Receive Opioid Analgesia - Essay Example

Running Head: Opioid Analgesia vs. Addiction Individuals in Pain Who Receive Opioid Analgesia. Name Institution Date Opioid Analgesia vs. Addiction Analgesics are a group of drugs used to relieve pain. These drugs act in various ways on the peripheral and central nervous systems. They include; on- steroidal anti-flammatory drugs (NSAIDS) such as salicylates, paracetamols, and opioid drugs. Analgesics have been used continuously throughout the ages for a variety of perception altering purposes. It would be impossible to relieve suffering of many patients were it not for these drugs. The choice of the analgesic to use is greatly influenced by the severity, type of pain and response to other medication. However this benefit to humankind has come with a price. There is augmented awareness of the risks associated with exposure to these analgesics and their situational predispositions toward abuse and addiction. This is a major challenge especially in this era characterized by the growing outrage over the under treatment of pain. There is a critical need to identify and then nurture the proper balance between expanded access and a proactive effort to limit misuse, abuse, addiction and diversion of the analgesics .There is a compelling need to implement the principle of balance with analgesics to avoid addiction and abuse. This is used by worldwide for instance by the Federation of states Medical Boards of the United States (Pereira J 2001). Opioid analgesics are used to relieve pain perception and cool emotional pain response of a victim by decreasing the numbers of signals of pain send by the nervous system and the reaction of the brain to the pain signals. The sense of euphoria occurs when the opioid drug affects the parts which control what we perceive as pleasure. An opioid is a chemical agent that binds to opioid receptors in the body. The receptors are found in two organs, that is, the gastrointestinal tract and the central nervous system and control the beneficial effects and the side effects. . Some opioid drugs such as codeine and diphenoxylate are additionally used to treat coughs and diarrhea. Opioids are needed in order to reduce mild to severe chronic pain whereby it may work better in high doses although more side effects can be caused by the higher doses. It is advisable that, the Doctor should prescribe a different opioid for treatment of chronic pain incase one kind of opioid fails to reduce the pain. This is because having a large single dose of the drug there are possibilities of causing severe respiratory depression that can be very fatal. There are suggestions by pain specialists that patients should be given an opportunity to have different available opioids drugs for them to get the drug that gives the most preferred balance between pain relief and side effects. Use of opioid has side effects which may include difficulty urinating, confusion, mouth which is dry, body weakness, sedation, dizziness and difficult bowel movement. It has side effects like allergic reactions (throat swelling), low blood pressure, hallucinations, tremors, seizures among others. In case of risk of constipation, for a person who needs long term course of opioids, he/she should consider to add roughage amount in the diet as well as drink more water (Rowbotham MC 2003). Remember that Stool softener or laxative should be taken under the doctor’s prescription. While opioid analgesics are restricted substances, they are also indispensable medications and are absolutely necessary for relief of pain. As a result, they should be made accessible to those who require them for relief of pain. Therefore governments are bound to take steps to guarantee sufficient availability of opioids for medicinal and scientific use. However, a method of management is vital to prevent abuse and addiction. This system of control is not meant to interfere with the rightful medical use of protecting the public health. When misused Opioids pose a great threat to the society (Kornick CA et al 2001). As a result clinicians face a great challenge of supporting the therapeutic use of opioids and to address the abuse and addiction to minimize the societal harm resulting from drug abuse, addiction and trafficking.Occurence of opioid abuse and addiction have increasingly undermined public health. Evidently from this there is an urgent necessity for rational and unswerving policies, education of healthcare professionals, and application of principles of assessment, treatment and administration. The statement that individuals in pain who receive opioid analgesia are at increased risk of addiction is incorrect. This is because there are external factors which induce addiction effect to the opioid users hence opioid alone does not increase risk of addiction. For instance, a person becomes depended physically on opioids if he or she takes them regularly whereby the physical dependency is not referred to as addiction because it is as a result of a gradual change in response to the opioids in your body. According to WHO Expert Committee on Drug Dependence, problematic consequences and determinants of drug dependence may be psychological, social, biological and interactive. Likewise, in case a person decides to stop the opioids abruptly, there is possibility of developing withdrawal symptoms such as nausea, shaking, sweating, chills and diarrheal. The half- life of the opioid determines the speed and the severity of the withdrawal symptoms (Matsumoto AK et al 2005). However, the withdrawal symptoms and physical dependence is not fatal but the withdrawal symptoms can be avoided if a person stops taking them gradually over a specific period of time according to the doctor’s prescription .The withdrawal symptoms extend for at least 4 days and a maximum for 14 days. Opioids like methadone and subutex are long acting and when used for a longer period the physical withdrawal symptoms are able to last for up to two months and can be sometimes be followed by other symptoms such as a very prolonged period of depression, feeling exhausted, and having trouble sleeping which sometimes lasts for up to two years and it with long acting opioids is more severe and occurs more frequently. This is referred to as Post Acute Withdrawal Symptom. Some drugs cause physical dependence and not addiction. Interestingly for instance, in this case it is true that opioid analgesics are potentially addictive; however, the risk is reduced when the external factors are controlled. Those who become addicted to opioids they don’t take it according to the doctor’s prescription or they take it illegally. Clinicians are supposed to do a proper prescription. A person who has a history of substance abuse and is using opioid analgesia, the risk of addiction is slightly increased. Addiction is a biopsychosocial disease whereby individuals who are addicted to opioids are probably predisposed and they develop the addiction problem when they have access and take it in such a way that it leaves the individuals vulnerable. The individuals have desire to use opioids uncontrollably on regular basis. Abuse of opioids is caused by the euphoria feeling produced by opioids whereby physical dependence together with this effect encourages people to have opioids for recreational use which is illicit. Frequent use of opioids can have increased tolerance to the drug hence higher doses are needed to have the euphoric feeling. This is referred to as psychological addiction which occurs in people taking opioids recreationally whereby it is very rare for those taking it for pain relief (Strumpf M et al 2000). However, some patients continue to obsessively use the drug even after treatment is offer. The individuals with history of substance use should not be denied opioid for pain treatment but the clinician prescribing and monitoring the therapy must be very careful. There are unreasonable fears of addiction that doctors should not put in to considerations hence avoid this therapy or the individuals refuse to take it. The withdrawal symptoms encourage individuals to have the urge to take more opioids which can be controlled through slow reduction of intake may be for weeks which reduces or eliminates the withdrawal symptoms. Other medications for treating the withdrawal symptoms but with low efficacy are such as benzodiazepines, clonidine and antidepressants. There is a need for elimination of the stigma, the misconceptions and the myths that surround the opioid drug which should be given a priority by pain specialist and more doctors who have started to consider a trial of opioid therapy. .Unrelieved pain destroys a person’s quality of life and mostly calls for a physician –assisted suicide and euthanasia. For instance, Cancer pain is a serious public health problem. WHO indicates that cancer pain can be relieved by opioids. The fear of opioids addiction is prevalent through out the world. However this fear is not warranted and hinders sufficient management of pain in cancer patients (Jovey RD 2003). This fear is based on the prevalent misperception of physical dependence being similar to addiction. Physical dependence is as a result of chronic use of a drug that has produced tolerance and adverse symptoms result from abrupt discontinuation of the drugs. It is mainly manifested by increased heart rates and blood pressure. It can be controlled by a slow dose decrease for a certain period depending on the dose, drug and the individual. An addiction is a psychological problem characterized by behavior pattern of drug abuse which include; craving, overwhelming involvement in obtaining drug, using it for other reason other than pain control, using the drug despite negative physical, social, legal or psychological consequences. Therefore it is clear that physical dependence and This fear traces back from years of misinformation about opioids and has been aggravated by national antidrug campaigns in some countries that ignore the benefits of opioids(Joranson DE 2000).In the past, WHO definitions of drug abuse terms equated addiction and drug dependence with physical dependence(Niemann T 2000). Despite the fact that physical dependence is common in the treatment of cancer pain, definitions have failed to consider that physical dependence can occur independently within a therapeutic setting. Clearly these terms are intended to refer to undesirable drug –related states that are harmful to the individual and society. This inaccurate use of terms in both professional education and narcotic control laws has triggered a lot of research and discussion. However, there have been attempts to clarify definitions of drug abuse phenomena. For instance in 1969 the WHO Expert Committee on Drug Dependence produced a revised definition of “drug dependence” which is in effect today. This defined the compulsive use of a drug for its psychic effects to be the only characteristic that is both necessary in defining drug dependence. Physical dependence and tolerance alone were dismissed and conclude insufficient to define drug dependence. Some of the characteristic features to be exhibited in definition of drug dependence diagnosis according to WHO and DSM-IV-TR clinical guidelines include:- a strong feeling of compulsion to have the drug, uncontrollable behavior in taking the drug in terms of its beginning, levels of use and termination, when the drug use is terminated there is physiological withdrawal state, tolerance state is reached whereby higher doses of the drug are required for achieving the same effects as when produced by lower doses, and, use of the drug persistently despite the harmful consequences experienced(Benitez-Rosario MA et al 2004). This was a critical and an important change in WHO drug abuse nomenclature which received very little attention. It was evident that WHO recognized that there are some situations in which physical dependence may occur in the absence of significant psychic dependence. The WHO Committee on Cancer Pain Relief reviewed current data indicates that the medical use of opioids is rarely associated with the development of psychological dependence. Clinical experience supports that opioid addiction is rare among pain patients, including cancer patients. In conclusion, failure to distinguish between addiction and physical dependence increases the risk of cancer patients suffering unnecessarily due to lack of receiving adequate pain relief. It is very unjust to confuse patients who gain from the medicinal use of opioids with drug abusers. Since uncorrected knowledge about addiction and opioids would impede the kind of aggressive opioid therapy that some patients need, there is an immediate need to enlighten people about opioids. Concerted efforts to assure that the definitions used to describe drug abuse do not inappropriately affect treatment of pain should be made. This would prove that the statement that individuals in pain who receive opioid analgesia are at increased risk of addiction is incorrect. REFERENCES Kornick CA et al (2001). A safe and effective method for converting cancer patients from IV to TD fentanyl.Canada: University of Columbia.  Matsumoto AK, et al (2005). Oxymorphone extended-release tablets relieve moderate to severe pain and improve physical function in osteoarthritis.U.S: University of Wisconsin Niemann T, et al (2000). Opioid treatment of painful chronic pancreatitis. Britain: Oxford University Press. Pereira J et al. (2001).Equianalgesic Dose ratios for Opioids: a critical review and proposals for long term dosing.Canada: University of Columbia Rowbotham MC, et al (2003). Oral opioids therapy for chronic peripheral and central neuropathic pain. San Francisco: University of California. Strumpf M, et al (2000) Role of opioid analgesics in the treatment of chronic non-cancer pain. U.K: CNS Drugs. Wall R, et al (2000). Social costs of untreated opioid dependence.canada: J Urban Health. Read More