Abuse of Drugs Prescription in a Primary Care and Its Prevention - Research Paper Example

? Running head: Abuse of Narcotics in Primary Care Abuse of Prescription of Narcotics in Primary Care and Its Prevention Introduction   In the UnitedStates, about 50 million individuals have been estimated to suffer from chronic pain which attributes to almost $70 billion of over-all expenses. Through the years, cancer patients have gradually been reduced of their pain affliction by the introduction of many medications addressing such needs; however, non-malignant chronic pain has not been equally fortunate (Schneider, 1998). As a result, medical practitioners and their respective patients have been in a constant limbo as to the trend that may bridge their status quo to future developments. This then has often resulted in the usage of narcotics primarily intended for malignant pain to chronic pain associated to either non-malignant cancer or even to some extent, primary care (Schneider, 1998).    According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the improper prescription and usage of drugs has remarkably increased from 2008 to 2009 (Cullen et al., 2009). From an over-all rate of 8.0% in 2008 for individuals aged 12 and above, the National Survey on Drug Use and Health (NSDUH) noted a 0.7% increase in 2009. The Survey maintained that the significant increase is attributable to the prevalent usage of marijuana in teens and partly to the loose prescription of these narcotics of health practitioners to their patients.   Abuse of Prescription of Narcotics in Primary Care   Serious Threat of Opioid Abuse In the medical field, pain has been categorized in two. That is, the pain associated with malignant cancer on the one hand, and the pain allied with non-malignant cancer and other chronic pain. The current trend in treating chronic pain has been largely differentiated as a wide variety of narcotics is available and is constantly being developed (Schneider, 1998). However, the pain associated with malignant cancer has been more difficult to address and as such, it has encouraged the utilization of opioid analgesia. With the relative acceptance in the medical field of opioids as pain suppressant, opioids likewise became available to the second category of pain – the pain set off by non-malignant cancer and the chronic pain (Schneider, 1998). Following the medical prescription of opioid analgesics, misuse and abuse of the said narcotic have been the concomitant consequences. That is, according to the National Survey on Drug Use and Health (2009 Report) and the Drug Abuse Warning Network (2010), the United States is now faced with an alarming threat of opioid abuse. Chronic Non-Cancer Pain in Primary Care and Use of Opioids It is estimated that about 50 million Americans experience non-cancer chronic pain and a significant 41% of that population or approximately 20 million patients state that their prescriptions do little to alleviate the pain (Becker et al. 2011). Chronic pain associated with conditions other than cancer is usually treated in primary care clinics (Cullen et al., 2009). Extent of Opioid Misuse in Primary Care and Causes   Von Korff, Kolodny, Deyo and Chou (2011) stated that empirical evidence that would ascertain the degree of drug abuse and misuse among primary care patients are not available, but the surveys conducted to that effect have significantly shown the frequency of prescription ranges from a low of 4% to a notable 26%. However, this increase in opioid misuse and abuse is not singularly attributed to its widespread recognition (Wilsey et al., 2009). Primary Care Givers’ Need for Adequate Knowledge on Preventing Opioid Misuse The widespread abuse of opioid pain suppressants is not to be singularly attributed to the medical acceptance given to the said drug. Salloum (2010) stresses the importance of the said drug and maintains that the public should not let certain consequences of its prescription to obscure its advantages. However, certain parameters must be enacted so as to delimit and control its use and somehow combat the abuse and misuse associated with it (Salloum, 2010).   Prescription Opioid Abuse   Definition Prescription Opioid Abuse has been defined as the intentional usage of a medicine or narcotic outside or with a prescription in a manner dissimilar from what it is initially intended or for the singular reason of the main enjoyment of its effects absent its supposed causes (Wilsey et al., 2009). It is also referred to as the Non-medical Use of Prescription Medication (NUPM) which has been defined by Ries, Miller, Fiellin and Saitz (2009) as “the use of a scheduled prescription medication without the prescribing clinician’s knowledge” (p. 454).   Characteristics of Abuse of Prescription Narcotics   Liebschutz, Saitz, Weiss, Averbuch, Schwartz, Meltzer, Claggett-Borne, Cabral and Samet (2010) maintained that health practitioners who are currently treating individuals suffering from chronic paint must endeavor to look at the possible existence of other substance abuse disorders before they prescribe opioid analgesics. Caregiver Knowledge and Attitude on the Prescription of Narcotics for Non-Cancer Chronic Pain   The current misuse in opioid analgesics, as mentioned, has likewise been attributed to the failure of the caregivers to properly administer or prescribe the narcotics to non-cancer patients (Wilsey et al., 2009). In a study conducted by the Albert Einstein School of Medicine of Yeshiva University, it was found that primary care physicians are incapable of assessing the usage of prescription drugs of their patients (Wilsey et al., 2009). Patients' Perspective on the Prescription of Narcotics for Non-Cancer Chronic Pain Most patients believe that the problem in opioid abuse lies in the inability of the health practitioners to monitor the usage of their patients of the said drug. As such, it also becomes the duty of physicians to recommend opioids to individuals whom they adjudge to be capable of handling the said narcotic and that the physicians must likewise educate their patients as to its proper use and possible consequences for abuse (Srivatsava, 2007).  Theoretical Considerations   To the individuals suffering from malignant cancer, opioid analgesics have been a constant prescription (Becker et al. 2011). On the other hand, the chronic pain associated to the second category, a wide variety of medications is available (Potter et al., 2001). As a result, opioid analgesics were initially confined to the malignant cancer patients. However, following the renowned advantages allied with opioids, health practitioners have taken it upon themselves to prescribe the same to chronic pain sufferers (Potter et al., 2001). As a result, there now exists a comparative pervasiveness of opioid analgesics to all sorts of patients. This then invariably leads to problems such as NUPM and the necessary regard for PUPD (Liebschutz et al., 2010).   Review of Related Literature The literature abundant on this topic has been largely about the resulting abuse of opioids. As such, a categorization of the previous writings has been undertaken. The literatures reviewed in this paper are mostly written in 2006 or onwards. This is to ascertain that all information would be the most current and relevant. The Epidemic of Prescription of Narcotics (Spitz et al., 2001; Sullivan et al., 2006; Boscarino et al., 2010) Chronic Pain Management with Narcotic Analgesics (Spitz et al., 2001) Also, Spitz et al. (2011) found in a recent study they have conducted that a greater number of physicians prescribe opioids to treat their older patients suffering from chronic pain but they also found that opioids are only recommended after other narcotics have been exhausted. This is due to the fact that there still exists a negative stigma attached to opioid analgesics and that the public is still not receptive to its medical use despite its noted benefits (Spitz, 2011). High-Risk Patients (Sullivan et al., 2006) In a study, patients receiving opioid treatments were found to be two to three times more likely to need medical help (Sullivan et al., 2006). However, it was also found that these same patients were less likely to be treated for substance abuse (Sullivan et al., 2006). This particular study conducted by Sullivan and his colleagues (2006) centered on patients receiving opioid treatment from the years 1998 to 2001 and they further found that their subjects had a higher propensity to suffer mental disorder and not drug abuse problems. Lack of Education of Primary Care Providers about Pain Management (Upshur et al., 2006; Sullivan et al., 2006; Ahles et al., 2006) Satisfaction of the Treatment of Chronic Pain (Upshur et al., 2006) Upshur et al., (2006) recommended a total re-organization and revitalization in the area of opioid treatment focusing mainly on the need to have educational sessions, trainings or similar lectures to inform primary care providers as to the proper manner of managing and treating chronic pain and other matters.  Need for Effectiveness of Pain Management in Primary Care (Ahles et al., 2006) In a study conducted of Ahles et al., (2006), it was found that patients suffering from pain and psycho-social issues were able to cope with their pain after being subjected to opioid treatment. Also, there was a significant improvement in their physical well-being and emotional affairs (Ahles et al., 2006). Opioids in Management of Chronic Pain (Bhamb et al., 2006; Spitz et al., 2007; Edlund et al., 2007) Poor Confidence of Prescribing Narcotics Among Physicians (Bhamb et al., 2006) In primary care clinics, Bham et al. (2006) was able to narrow down the narcotics being dispensed as pain relievers at that level. These are: codeine, hydrocodone, oxycodone, morphine continuous release, and oxycodone extended release. This study further maintained that there is a grave concern of health practitioners in the prescription of opioids as they directly blame it as the source of drug abuse. Chronic Pain Condition and Barriers to the Use of Opioids (Spitz et al., 2011) Spitz et al. (2011) noted that there is a doubt as to the efficacy of opioids as a pain reliever in patients. The said study also listed several factors that cause this hesitancy to prescribe opioids. These are: (1) causing more harm to the patient; (2) the subjective nature of pain that precludes exact assessment; (3) lack in sufficient education on the drug; (4) issues associated with converting opioids; (5) social stigma attached to the drug; (6) reticence of family members to let their ailing relative to use the drug; and, (7) tendency of abuse (Spitz et al., 2011).  Predictors for Opioid Misuse or Abuse (Edlund et al., 2007; Boscarino et al., 2010;  Becker et al., 2011) Prescription Drug Abuse and Mental Disorders (Edlund et al., 2007) A study conducted by Edlund et al. (2007) reveals higher rates of opioid misuse, illicit non-opioid use, non-opioid drug use, and problem alcohol use with takers of prescription opioids as opposed to non-users of prescription opioids. This them proves that there is a clear indication that users of prescribed opioids have greater tendencies of suffering from opioid abuse (Edlund et al., 2007).  Side Effects of Opioids (Boscarino et al., 2010) The study conducted by Boscarino et al., (2010) illustrated the factors that highly add to drug abuse tendencies of opioid users. These are: (1) age, the younger the patient, the more likely it is to be addicted; (2) level of pain discomfort, the more severe the pain, the greater the chances a patient has to become addicted; (3) higher severity of drug dependence; (4) more frequent opioid orders in EHR; and lastly, (5) history of anti-social behavior. Additionally, the study made mention of the fact that a combination of any of these risk factors increases the chances of drug abuse in patients (Boscarino et al., 2010). Monitoring, Documentation and Support (Krebs et al., 2011; Wilsey et al., 2009; Mangione et al., 2008) Deficiency in Documented Guideline-Recommended Processes (Krebs et al., 2011) In the study conducted by Krebs et al. (2011), they were able to note remarkable numbers in the participants where 57% of the patients received prescriptions for long-acting opioids and that the potential for opioid misuse is at a high 33% of the total number of patients. The tendency of opioid abuse was attributed to the laxity in documentation processes and lack of definite guidelines in its usage (Krebs et al., 2011).  Personal History and Prediction of Drug Abuse (Wilsey et al., 2009) A comparative study was conducted by Wilsey, Fishman, Casamalhuapa, and Gupta (2009) where it was revealed that computer-assisted surveys have the greatest probability of garnering important clinical information in the most efficient and timely manner. This then connotes that in evaluating the patients' medical history, it is necessary to have an access to such facilities as this would permit health practitioners to make the appropriate decisions with regards their patients (Wilsey et al., 2009). Consequences and Mitigation Strategies (McCowan, 2009; Clark and Upshur, 2007; Ives et al., 2006) Need for Long-Term Chronic Opioid Therapy (McCowan, 2009) From McCowan (2009), it was found that three factors offer protection in all cause mortality. These are: (1) a longer duration of use of methadone; (2) elevated interval in filling of last methadone prescription; and, (3) history of urine testing. The study also illustrated several vital ingredients in the process of care when using methadone as maintenance as this has the tendency of affecting the patient’s mortality risk. Need to Improve Pain Management in Primary Care (Clark and Upshur, 2007) Clark and Upshur (2007) delineated four major themes in improving the management of chronic pain in primary care clinics. These are: (1) improvement in practice and more stringent policies in prescription; (2) improvement in health facility management; (3) implementation of chronic care models; and, (4) education of primary care personnel. Interventions and Implications for Clinical Practice (Krebs et al., 2011; Wilsey et al., 2009; Mangione and Crowley-Matoka, 2008;  Edlund et al., 2007; Boscarino et al., 2010;  Becker et al., 2011) Implications for Practitioners (Upshur et al., 2006)  As the public trusts their physicians to provide them with the proper remedy for their illnesses, they also place their belief that what their doctors are giving them as the appropriate cure. The prescription of opioids, though not widely accepted, is rendered as valid as its benefits to the user erase any pitfall that may be associated to the drug (Upshur et al., 2006). While addiction is said to be a high probability, the usage of opioids remains vital as it alleviates pain associated with different illnesses. To this, education is necessary to the health practitioners who are at the forefront of its dispensation (Upshur et al., 2006). Initial Comprehensive Assessment Before opioid analgesics are prescribed, the physician must make a careful assessment of the patient as to whether the usage of the said drug with gives him more benefits than harm. If the patient is demonstrating high propensities of drug dependencies, then the physician must be hasty is dispensing opioids as abuse is likely to occur. That is, there must be an identification of risk factors such as a history of addiction and emotional illness so as to prevent the misuse of the drug (Edlund et al., 2007) Triaging Patients into Different Categories in Term of Addiction Liability   The patients who are targeted as recipients of the opioids must be assessed and screened for addiction so as to properly address drug addiction tendencies (Becker et al., 2011). Guidelines for Patients (Edlund et al., 2007) The usage of opioids is still relatively young as there is still no wide acceptance of it from the public. However, the benefits seen from the drug may qualify as sufficient justification to continue its prescription to patients. What then remains to be done is the continued education of the public as to the nature of the drug and what should be done to combat or prevent its consequences (Edlund et al., 2007). Non-Opioid Therapy The prescription of opioids must only be taken as secondary remedies and not the initial answer to alleviate pain. Education must be provided for so as to ascertain the proper distribution of the drug. Alternative Methods in Treating Pain Pain, as a construct is subjective. As such, there are a variety of ways with which to combat its effects. The patients must be informed of other means with which to cope with pain and not to primarily resort to pain medications.  Side Effects of Narcotics A patient about to use opioids must be given a detailed lecture as to its side effects due to the fact that the long-term use of opioids has been associated with addiction.    Over all, the literature on the subject matter signifies the need to utilize opioids to help alleviate the pain caused by illnesses not associated with malignant cancer (Olsen & Daumit, 2002). However, the current trend illustrates the obvious need to revitalize the manner by which the said drug is being dispensed by primary care clinics (Olsen & Daumit, 2002).   Summary   Pain has been the primary cause of people of proceeding to primary care clinics (Sherratt & Jones, 2003). The distribution of drugs to stop or alleviate the pain felt by the patients has been the primary responsibility of physicians in these clinics (Cullen et al., 2009). However, with the onslaught of opioids used primarily to ease the pain felt by malignant cancer patients, physicians have likewise opted to issue the same to chronic pain feelers. To this, an attendant drug abuse and misuse have been generated where only the implementation of restrictive policies or the outright banning of the narcotic is seen (McCarberg, 2011). Conclusion   The utilization on opioids is arguably beneficial as it significantly eases the pain felt by most patients. While opioids have been initially intended for malignant cancer patients, the relief it brings to its users have caused for a wider range in prescribing the same. As such, patients suffering from illnesses other than malignant cancer have been permitted access to experience its benefit (Potter et al., 2001).   Failure of physicians and other medical personnel in primary care clinics to ascertain the proper usage of the drug of their patients has been relegated as the prime cause of the substance abuse (Barry et al., 2010). Additionally, the non-implementation of primary care clinic regulations on the religious monitoring of the patients has triggered this so-called abuse (Sherratt & Jones, 2003).   Accordingly, an all-out information drive must be launched in order to combat the problem of opioid abuse on the primary care level (Sherratt & Jones, 2003). While chronic pain is a duly authorized reason to recommend the intake of medications, opioid analgesics is not of primal import (Potter et al., 2001). There are is a varied array of drugs that may result in the alleviation of pain. Health practitioners could do well to prescribe these relatively “weaker” medicines before taking out their pads and jotting opioids as an answer (Potter et al., 2001). However, when a certain case calls for the prescription of opioids, the physician must endeavor to inform the patients of the pitfalls and guidelines in taking the said narcotic (Barry et al., 2010). The health practitioner must not be hasty in prescribing the drug as time has shown how a pain suppressant could likewise cause more pain.   Implications   The current trend in medical schools pertaining heavily on their curriculum must be changed (Liebschutz et al., 2010). The medical students must be apprised of the importance of alleviating pain as much as they must be notified of the consequences of giving in to the practice (Barry et al., 2010). Also, the students must be given specific instructions in pain management and pain alleviation (Barry et al., 2010).   Suggestions   In the societal level, the health department should initiate programs of reform to better control the prescription of opioid analgesics in primary are clinics (Salloum et al., 1998).   Adequate reforms in medical practice must also be endeavored (Barry et al., 2010). This sector would definitely gain from the introduction of additional personnel to observe opioid prescription and use.   Summary   While the alleviation of pain has been the primary goal of health practitioners, the much needed relief sought for by their patients must not force them to lend a deaf ear to the attendant drawbacks of prescribing opioids (Salloum et al., 1998). 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