dangers of prescription opioids and encouraging consumers to choose safer alternatives like physical therapy for most chronic pain management. The American Dental Association wants to drastically limit prescribing opioid medications. The American Medical Board has created its own Opioid Task Force (American Medical Association, 2018). This task force has produced a microsite specifically for physicians with abundant educational materials and resources for prescribing opioids, screening for opioid abuse, and other related materials (American Medical Association, 2018). To decrease opioid prescriptions, physicians are now using the Prescription Drug Monitoring Programs (PDMP), a database that allows them to make sensible decisions about prescribing an opioid during patient care. The approach has been working, as opioid prescriptions from 2016 to 2017 decreased by 19 million (American Medical Association, 2018). An article in the International Journal of Molecular Science pointed out: “Recent data from the National Institute on Drug Abuse noted that the prevalence of heroin abuse and dependence in young adults has increased significantly. In New York City, the mortality rate from drug overdoses tripled between 1990 and 2006; it is not limited to being an inner-city problem and widespread use of prescription drugs for non-medical use was noted among rural youth in the USA. In adults, approximately 5% reported nonmedical opioid use; about twelve million Americans have used opioids for nonmedical purposes and among these, many have been abusing more than one narcotic agent.” (Mallappallil, M., Sabu, J., Friedman, E., & Salifu, M. 2017) Of course, if someone is prescribed an opioid, they should continue to take the medication as prescribed, and just because someone is taking an opioid for pain relief most certainly does not mean they are abusing the drug or that they will become addicted. There is a long road to travel in developing an addiction. The journey usually starts with taking prescription pills and leads into something else. When taken as instructed, the opioid relieves pain and can also cause drowsiness. But when taken in abundance, it can lead to feelings of comfort and enjoyment. Opioids not only reduce pain signals but also release large amounts of dopamine, which causes feelings of pleasure. This reinforces the dependent user to continually repeat that particular experience—this leads to addiction (National Institute on Drug Abuse, 2018). But it can also control the heart and breathing rates—this leads to death. to use the same amount of drugs that they were used to before they were incarcerated or admitted. Instead of using a small portion to start with, they swallow, inhale, or inject a large quantity. The opioid receptors in the brain are not able to handle the amount and no longer inhibit pain, but now suppress the breathing rate and the heart rate (bradycardia). Once this occurs, the person is now in a full overdose. Troilo (2019) stated: “In the two weeks after their release, recently incarcerated people are almost 42 times more likely to die from an overdose than the general population. With such an apparent risk and dire consequences, states need to prioritize the widespread adoption of proven strategies to lower the risk of opioid overdoses among formerly incarcerated people.”
Physicians and oral surgeons often prescribe opioids for pain relief. Circumstances that may require these pain management medications include breaking a bone, sustaining a sports injury, or having a root canal. In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers, and healthcare providers began to prescribe them at greater rates (National Institute on Drug Abuse, 2019). But this is not the issue. The problem lies with the individual who uses more than what is prescribed and abuses the medication, deviates from the way it is prescribed, or changes the dosage other than instructed (National Institute on Drug Abuse, 2018). Many individuals start with pills, either swallowing them or crushing them into a powder form and inhaling the contents (Pearl, 2018). Over time, they find more effective and efficient ways to use—usually heeding the advice of their friends or other people who use opioids. This is when they move to intravenous injections because it is an immediate high and is less expensive. When snorting the crushed pills, a lot of the product is lost in the mucous membranes of the nares, and there is not an immediate high. The dependent user has found by crushing the pills or opening the capsule into water and letting it dissolve they are able to inject directly into the bloodstream. The user gets high instantly. It is also less expensive because the user is not using as much of the opioid. By snorting, one feels the effect in 15 minutes versus injecting, where the wait is only 8 seconds. Another issue is when the individual becomes addicted and takes someone else’s prescriptions, either by going through others’ medicine cabinets or by stealing medications from family or friends. As doctors are becoming more aware of the issue, they often are more reluctant to prescribe opioid medications. The patient then switches primary care physicians and tries to establish new prescriptions. This is called doctor shopping . Finally, there is the method to establish connections needed to receive the drugs on the streets. This can be as dangerous as the drug itself as people put themselves in precarious situations and meet individuals at all hours of the night to satisfy their cravings. As one can see, a gradual set of circumstances can lead to more dangerous behaviors. Over time, users develop a tolerance, which causes them to use a higher dose of the drug to retain the same effects as when they first began using. The issue has become so alarming that the American Physical Therapy Association is raising awareness about the Tolerance Individuals taking opioids repeatedly over an extended period generally develop some type of tolerance. The body no longer reacts to the same medication and amount in the way it did at first. With the continued presence of the drug in the bloodstream, the person has to take more of the substance to receive the same effects they felt before the tolerance developed. Overdoses are common in individuals recently released from prison or from a substance abuse rehabilitation center. Before they were admitted or incarcerated, they had built up a tolerance to the drug. Their brain receptors were accustomed to the high volume and strength of the opioid. Once they were admitted and the drugs left their system, the tolerance went back to the level it was before they began using drugs. In essence, there is no tolerance. However, once these persons are released, they often begin
Page 51
Book Code: FFL1225
EliteLearning.com/Funeral
Powered by FlippingBook