According to the Center for Disease Control and Prevention, since the year of 1999, the number of deaths involving prescription opioids have quadrupled. In the United States, the Food and Drug Administration (FDA) works diligently to assure that the prescription drugs available to consumers are safe. According to the Food and Drug Administration site, in conjunction with the FDA’s Center for Drug Evaluation and Research (CDER), brand and generic drugs are tested and evaluated to assure their health benefits outweigh the risks. The protocol for production of prescriptions are claimed safe, however, prescriptions such as morphine and oxycodone have contributed to the increase in opioid overdose.
Over the past four years, the availability of opioid prescriptions has increased tremendously. The United States currently accounts for 81 percent of the world’s oxycodone and 100 percent of hydrocodone (Volkow, 2014). As a leading producer of opioids, there is a priority to determine the factors that are influencing opioid overdose.
During the year of 2014, 1.9 million Americans used prescription opioids (Chopra and Marasa, 2017). The very entity that was synthesized to alleviate pain is now causing an opioid epidemic.
The purpose of this study is to identify aspects that have decreased the safety of prescription opioids but increased the risk of opioid overdose and deaths. Such factors that will be considered consist of physiological, socioeconomic, and psychological aspects. It is hypothesized that by providing effective monitoring tools to healthcare professionals, more emphasis will be placed on developing risk assessment tools and preventative treatment plans to use while treating patients on long-term opioids.
History
Opioids and opiates are used interchangeably, however, there are distinct differences. Opiates are natural substances derived from Opium. Opium is obtained from the poppy plant and contains the alkaloid Morphine. Opioids are synthetic substances of opiates. Opiates and opioids are prescribed to treat acute and chronic pain. Opioids’ mechanism of action provides and detailed understanding of their function.
Opioids act on four specific receptors in the human body. These receptors consist of the Mu receptor, the Kappa receptor, the Opioid Receptor-like 1 (ORL 1), and the Delta receptor (Contet et. al, 2004). Opioids are capable of reacting on neurons that provide both inhibitory and excitatory responses to the peripheral and central nervous system (Chahl, 1996). The activation of the Mu receptor pathway demonstrates the analgesic function of opioids which act on nociceptive and neuropathic pathways. The binding of opioid ligands to mu-receptors initiates a coupled G-protein reaction (Cooper et al., 2017). Subsequently, this inhibits sensory pathways, such as pain pathways, that are distributed throughout the human body (Chahl, 1996). Researchers have demonstrated the known correlation between mu-receptors and the therapeutic components of opioids.
In a study performed by Matthes et al. (1996), mutant mice lacking mu-receptors were placed in a morphine-designed compartment. Behavioral observations, such as the mice flickering their tails as a response to a thermal sensation, were noted in the mutant mice, however, the sensations were absence in the wildtype mice (Matthes et al., 1996) In a clinical setting, the analgesic effect of morphine is vital in understanding the effectiveness of using opioids for chronic pain management.
Opioids have been used for medicinal purposes dates back to 3400 BC when the poppy plant was first used by the Sumerians (Rosenblum et al., 2008). Historically, there were an array of medical advances that resulted in the evolution of opioids to treat pain. During the 19th century, morphine was provided by pharmacist and physicians to treat medical conditions such as colic and dysmenorrhea (Ballantyne et al., 2003). As opioids became more readily used for acute pain, researcher inquired about the ability of opioids to alleviate non-cancer chronic pain. Numerous studies were conducted to support the findings that opioids were beneficial for non-cancer chronic pain management.
Literature review
Moulin et al. (1996) research investigated the benefits of oral morphine in patients who reported non-cancer chronic pain. The participants reported experiencing chronic pain categorized as rheumatic, musculoskeletal, or muscular in nature for a least 6 months (Moulin, 1996). During the study, participants were provided oral morphine or a placebo for an extended timeframe. Findings of the study concluded that participants taking oral morphine reported a decrease in pain intensity compared to those taking the placebo (Moulin, 1996).
Caldwell et al. (2002) studied the effect of morphine on osteoarthritis pain. The study consisted of 296 participants who had underwent radiological studies and were provided medical diagnosis of moderate-to-severe chronic osteoarthritis pain. The patients were placed in treatment groups in which they were provided one of the following morphine extended release: Avinza or MS Contin or a placebo (Caldwell, 2002). The study monitored the patients’ pain intensity and physical functionality at baseline and for the duration of the study. In comparison to the placebo, the morphine extended-release reported a decrease in their osteoarthritis pain. In addition, trends toward improvement were noted for physical function and stiffness assessments in the morphine extended-release group when compared to the the placebo group (Caldwell, 2002).
A similar study performed by Jamison et al. (1998) also placed patients’ in treatment groups in which they received: “1) naproxen only, 2) set-dose oxycodone, 3) titrated-dose oxycodone and sustained-release morphine sulfate” (Jamison et al. 2002). Each participant had a medical diagnosis of chronic back pain which was assessed throughout the study. Participants in the opioid groups reported less pain than the anti-inflammatory group (Jamison et. Al. 2002). Repeatedly, numerous studies have demonstrated that opioids are effective in chronic pain management, however, there are limited studies that address additional adverse effects caused by long-term use of opioids. By evaluating the additional adverse effects that are presented from long-term opioid use, one is able to identify factors that play a role in the recent opioid crisis.