New data was published on opioid dependence and opioid-related deaths by the Centers for Disease Control and Prevention’s (CDC) and National Center for Health Statistics (NCHS). nuviun looked at the problems of opioid dependence and also at solutions that might help to support change.
A painkiller, such as morphine, is essential for health care, no doubt. It’s even listed on the WHO Model List of Essential Medicines. But painkillers can also cause much trouble, since they can be highly addictive if not used appropriately.
According to WebMD, treating an addiction to opioid-based painkillers isn't a moral or mental weakness. It is a chronic medical condition resulting from changes in the brain in susceptible people. The article says that "once narcotic addiction has developed, escaping the cycle of detox and relapse is typically a long-term process.”
In cases of addiction, finding solutions to safely transition off of such medications can be quite a challenge. Gary Reisfield, a medical doctor and chronic pain and addiction specialist at the University of Florida comments on the subject in a WebMD post, and says that addiction means that the individual has lost control over the use of the drug. “The patient [is] using it compulsively, there are consequences to using the drug, and they continue to use it anyway."
Addiction means that there might be unpleasant withdrawal symptoms if a person abruptly stops taking a drug, writes Eric Metcalf, MPH in his post. Side effects of opiate-based painkillers can include dependence and tolerance, says a patient guide on the subject on Patient.co.uk. “Some people can become tolerant to opioid painkillers (you need to take more to get the same effect) and then depend upon them,” the patient guide explains.
With 3,380,000 search results for the term “getting off morphine medication” on Google.co.uk alone, it’s obvious that individuals are looking for solutions online.
New Data On The Subject
Last week, new data was published by the Centers for Disease Control and Prevention’s (CDC) and National Center for Health Statistics (NCHS) on opioid dependence and opioid-related deaths, a growing public health problem for the US as Steven M. Frenk et al. explain in the release.
Findings in the data show that from 1999–2002 to 2011–2012, the percentage of opioid analgesic users who used an opioid analgesic stronger than morphine increased from 17.0% to 37.0%, which is more than double. Opioid analgesic sales quadrupled from 1999 to 2010 (CDC. Vital signs: Overdoses of prescription opioid pain relievers). According to a CDC release from 2014, from 1999 to 2012, opioid-related deaths (per 100,000 population) more than tripled.
According to a CDC report, from 1999 through 2012, the age-adjusted drug-poisoning death rate nationwide more than doubled, from 6.1 (per 100,000 people) in 1999 to 13.1 in 2012. Drug poisoning involving opioid analgesics accounts for a large part of the equation.
In an article by the New York Times, the editorial board comments on the recently published findings by the CDC and says that more rigorous research into benefits and dangers of long-term opioid therapy is needed. “…doctors and patients must approach long-term opioid therapy with great care. Many patients with chronic pain do not get enough painkillers at high enough doses, meaning that their pain is undertreated. Many others are overtreated and harmed by doses they probably don’t need,” the New York Times notes.
Any Easy Solutions?
Unfortunately not. The problem is one of a more complex nature. Last year the US launched new restrictions on medications with addictive substances, to ensure appropriate use. But the effectiveness of this strategy has not yet been established. However, a few brave innovators are trying to find solutions for the problems associated with painkillers—and here we feature three.
According to the article, Steve Doberstein, chief scientific officer of Nektar, says that “Nektar’s approach is to add a side chain to a derivative of morphine, which changes the way the molecule behaves in the body. The addition slows the rate at which the compound enters the brain, in part by making it more difficult for it to cross the blood-brain barrier, the protective layers that surrounds blood vessels in the brain and regulates what can enter.”
However, even with the slower rate of drug delivery, Rob Medve, Nektar’s Chief Medical Officer says the benefits of pain relief can still be achieved. “We know you can get very good analgesia by having an opioid go in slowly to the brain and not produce the dopamine spike,” he says. “They are separable.”
OxyContin Pills That Can’t Be Crushed
OxyContin (oxycodone) is an opioid pain medication, a narcotic analgesic.
Oxycontin is a long-acting form of oxycodone, meaning that drug delivery is intended to be released over a longer period for sustained pain relief—in this instance, 12 hours. According to Leanna Skarnulis’s WebMD article it is the high content of oxycodone that makes OxyContin popular on the street. “People who abuse the drug crush the tablet and swallow or snort it, or dilute it in water and inject it. This destroys the time-release mechanism so that the user gets the full effects of the narcotic. Users compare the high to the euphoria of heroin”.
In 2010, the company that brought OxyContin to the market more than 20 years ago, Purdue Pharma, introduced a new formula that made it difficult to crush or dissolve the pill in water. The new pills were much more difficult to crush and dissolved more slowly. The idea, according to principal investigator Theodore J. Cicero, PhD, was to make the drug less attractive to illicit users who wanted to experience an immediate high.
Popular Science wrote about it, and reported that evidence is beginning to emerge that the new formula is helping to decrease rates of OxyContin abuse.
Despite all good intentions, it might have unfortunately triggered a negative effect. One study (the results were published in ScienceDaily) looked at the results of the changes for the drug's formula and found that it made many abusers switch to a drug that is potentially more dangerous, according to researchers at Washington University School of Medicine in St. Louis.
E-Health Solutions to Fight the Drug Abuse Epidemic
As reported by HealthITBuzz in 2013, pilot projects by the US Office of the National Coordinator for Health IT have provided evidence that by integrating Health IT systems with access to the Prescription Drug Monitoring Programs (PDMPs), clinicians can use such data sources to optimize decision-making when prescribing opioid pain medications. PDMP are state-run electronic databases and, according to the ONDCP fact sheet, can serve as a tool that can be used to address prescription drug diversion and abuse. According to HealthITBuzz, "PDMPs is an important clinical resource, which can help clinicians identify, intervene, and curb prescription drug abuse."
Started as the Enhancing Access to PDMPs using Health IT project, the 2013 update focuses on the S&I Framework that has been created to improve interoperability and enhance access to PDMPs when clinicians need it most — at the point of care. According to the article:
“When available at the point of care, PDMP information can help clinicians distinguish between patients who legitimately need opioid medications for pain treatment and those who may be seeking to misuse these powerful drugs. It also provides clinicians with an opportunity to intervene if there are signs of misuse and abuse. While PDMPs can serve as a valuable tool, most clinicians typically don’t use them. This is largely because they have been cumbersome or time consuming to access (especially when outside of a clinician’s normal prescribing workflow).”