al., 2021). In addition, individualized tapering plans minimize symptoms of opioid withdrawal while maximizing pain treatment with nonpharmacologic therapies and nonopioid medications
(CDC, 2022a). Understanding patient-specific risk factors and prescribing strategies for chronic pain management is also critical in preventing the misuse and abuse of opioid analgesics.
OPIOID USE DISORDER
● Recurrent opioid use leads to failing to fulfill significant work obligations. ● Continued opioid use despite having persistent recurrent social and interpersonal problems caused by opioids. ● Important social, occupational, or recreational activities are given up or reduced because of opioid use. ● Recurrent opioid use in situations that is physically hazardous. ● Continued opioid use despite knowledge of persistent or recurrent psychological or physical problems. ● Tolerance develops, meaning there is a need for a markedly increased amount to achieve intoxication and markedly diminished effect with continued use of the same amount of opioids. ● Withdrawal. second wave started in 2010 with rapid increases in overdose deaths involving heroin. Finally, the formed wave began in 2013 with synthetic opioids, like fentanyl, which is responsible for hundreds of thousands of deaths (CDC, 2022). factors reduce an individual’s risk of substance use. They include (1) self-efficacy affected by personal and home situations, (2) parental monitoring and support, (3) positive relationships, (4) extracurricular activities, (5) antidrug policies at school, and (6) neighborhood resources (NIDA, 2020). One of the most significant changes during adolescent development is the maturing prefrontal cortex, which is responsible for assessing situations, making sound decisions, and controlling emotions and desires (NIDA, 2020). A prefrontal cortex that has not yet fully matured puts the adolescent at a greater risk of substance addiction. The interruption of the development of neuronal connections, which are affected by environmental forces that determine how these connections operate as the individual ages (NIDA, 2020). medications can lead to diversion, addiction, and overdose (Kiang et al., 2019). Pharmaceutical companies Direct-to-physician marketing by pharmaceutical companies can impede medical care (Hadland et al., 2019). Research has shown that over a three-year period, 1 in 12 physicians received direct marketing, and 1 in 5 received opioid marketing (Hadland et al., 2019). In addition, a thought-provoking U.S. study found that marketing of opioids to physicians (at the county level) was linked with more opioid prescribing and, subsequently, elevated mortality from overdoses (Hadland et al., 2019).
Opioid use disorder (OUD) can occur at any age but is usually first identified in the late teens or early 20s (American Psychological Association [APA], 2013). It is considered a problematic pattern of opioid use leading to clinically significant impairment or distress , with at least two of the following in a 12-month period (APA, 2013): ● An individual takes opioids in more significant amounts over a more extended period than intended. ● A persistent desire or unsuccessful efforts to cut down on opioid use. ● A great deal of time is spent in activities necessary to obtain opioids. ● An individual has a craving or strong desire or urge to use opioids. Epidemiology of opioid use disorders From 1999 to 2020, more than 564,000 individuals died from an overdose involving opioids (CDC, 2020). The rise in opioid overdose deaths is outlined in three distinct waves. The first wave began in 1999 with increased opioid prescribing. The Risk factors in opioid use disorders In general, individuals take substances for a variety of reasons, including (1) pleasure; (2) an escape from social anxiety, stress, and depression; (2) increased performance; and (4) curiosity and social pressure (National Institute on Drug Abuse [NIDA], 2020). Therefore, no single factor—whether biological or environmental—determines whether an individual becomes addicted to drugs (NIDA, 2020). Biological influences include genetics, gender, and mental disorders, while environmental influences include home situations, parental use and attitudes, peer influences, community attitudes, and low academic achievement (NIDA, 2020). Risk factors for substance abuse include (1) aggressive behavior in childhood, (2) lack of parental supervision, (3) peer refusal skills, (4) drug experimentation, (5) availability of drugs at school, and (6) community poverty (NIDA, 2020). Protective Root causes of opioid use disorder There are several likely root causes of the current opioid epidemic (Kiang et al., 2019). Some of them are discussed in the following sections. Prescribers At the root of the opioid epidemic is the pain epidemic. It has been acknowledged that during the mid-1990s, to better treat pain, healthcare providers prescribed opioid medications in the absence of adequate attention to negative consequences. From 1999 to 2010, opioid prescribing in the U.S. quadrupled (Kiang et al., 2019). While opioid prescribing remains an essential tool for healthcare providers, inappropriate prescribing of these
CONTROLLED SUBSTANCE ACT (CSA)
The Comprehensive Drug Abuse Prevention and Control Act of 1970 , the Controlled Substance Act (CSA), regulates pharmaceutical and illicit controlled substances in the United States, 2010 Statement of Policy: Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies (DEA, 2010b). The CSA requires registration, outlines specific rules about dispensing pharmaceutical controlled substances, and determines the legality of these substances (DEA, 2018a). The U.S. Drug Enforcement Agency (DEA) was formed in 1973 to enforce the CSA. The DEA is responsible for preventing the diversion and abuse of pharmaceutical controlled substances. The agency also ensures that an adequate and uninterrupted supply of pharmaceutical controlled substances is available to meet legitimate medical, scientific, and research
needs. Along with state and other federal agencies, the DEA regulates the registration of manufacturers, distributors, and dispensers of controlled pharmaceutical substances and the import and export of these substances. The DEA prosecutes anyone who violates this law (DEA, 2020a). Evidence-based practice! The U.S. federal agencies involved in scheduling controlled substances include the Drug Enforcement Agency (DEA), the Food and Drug Administration (FDA), and the Department of Health and Human Services (HHS).
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