The opioid crisis could also spread to lower- and middle-income countries, where opioids are rarely prescribed for pain associated with surgery, cancer or the end of life. Such countries therefore have a genuine need for improved pain treatments in the same way as did the United States in the lead-up to its epidemic.
Is There a Pain Killer Addiction Epidemic in America
Prescription drug addiction also impacts much of the public on a personal level, with 44 percent saying they personally know someone who has been addicted to prescription painkillers, including 20 percent who say the person was a family member and 2 percent who say they themselves were addicted.
Smaller shares say three other strategies would be at least somewhat effective: encouraging people who are prescribed painkillers to dispose of any extras once they are no longer needed (63%); reducing the social stigma around addiction (60%), and putting warning labels on prescription bottles that explain the risk of addiction (49%).
Prescription opioids are painkillers. Codeine, morphine, hydrocodone and oxycodone are the best known. Hydrocodone and oxycodone are also known by brand names Vicodin and OxyContin or Percocet, respectively.
Opioids should only be prescribed for severe pain that does not respond to other pain relievers, and only prescribed under the direct supervision of a healthcare provider. Still, opioids are one of the most commonly prescribed medications by primary care, oral surgery and emergency medicine physicians. According to the CDC report, one-fifth of patients who see a physician for non-cancer pain symptoms receive an opioid prescription. This is in part due to the wide availability of generic versions of the drugs, which are therefore more affordable than new alternative therapies. Milder pain relievers such as ibuprofen and acetaminophen can have long-term damaging effects when prescribed in the higher doses chronic pain would require and are therefore not recommended either.
While part of this has been due to a drastic increase in the number of prescriptions written and subsequent sales, there has also been an influential rise in the social acceptability of taking prescription painkillers for different purposes. Both of these factors have put opioids in the hands of more and more people who are at risk for developing dependency or addiction.
Prescription opioids may be the easiest and most affordable pain management option for many patients, but there are alternatives that can be worth pursuing before turning to medication. Physical therapy, relaxation exercises and behavioral therapy are just some of the pain relief options that people are turning to instead of opioids, though the effectiveness varies and not all patients experience the same success. New medication to offer an alternative to opioids is also being developed.
Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576. doi: 10.1097/01.j.pain.0000460357.01998.f1. PMID: 25785523.
Opioid addiction is a long-lasting (chronic) disease that can cause major health, social, and economic problems. Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief. Some opioids are legally prescribed by healthcare providers to manage severe and chronic pain. Commonly prescribed opioids include oxycodone, fentanyl, buprenorphine, methadone, oxymorphone, hydrocodone, codeine, and morphine. Some other opioids, such as heroin, are illegal drugs of abuse.
Many of the genes that are thought to play a role in opioid addiction are involved in the endogenous opioid system, which is the body's internal system for regulating pain, reward, and addictive behaviors. It consists of opioid substances produced naturally within the body (called endogenous opioids) and their receptors, into which opioids fit like keys into locks. Opioids introduced from outside the body (called exogenous opioids), including opioid medications and heroin, also exert their effects by acting on these receptors. Variations in the genes that provide instructions for making opioid receptors have been studied extensively as genetic risk factors for opioid addiction. Researchers suspect that differences in the receptors' structure and function influence how the body responds to opioids.
Opioid receptors are found in the nervous system, where they are embedded in the outer membrane of nerve cells (neurons). When endogenous or exogenous opioids attach (bind) to the receptors, the interaction triggers a series of chemical changes within and between neurons that leads to feelings of pleasure and pain relief. The mu (μ) opioid receptor, which is produced from the OPRM1 gene, is the primary receptor for most opioid drugs. Common variations in the OPRM1 gene appear to influence how the body responds to opioids, including the amount of an opioid medication needed to achieve pain relief. At least in some populations, these variations have also been associated with the risk of opioid addiction.
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. In 2012, U.S. health care providers wrote more than 259 million prescriptions for opioids, twice as many as in 1998 1. Rates of admission to substance use disorder treatment programs for misuse of prescription opioids more than quadrupled between 2002 and 2012 2 3, and rates of death associated with opioid analgesics rose nearly 400% between 2000 and 2014 4. Along with the increase in misuse of prescription opioids, there has been a sharp rise in rates of heroin use. Overdose deaths that involve heroin increased more than 300% in less than 5 years, from just above 3,000 in 2010 to more than 10,500 in 2014 5.
He explained that someone's genetic makeup, the amount of enzymes and specific receptors they have, contribute to how a person can metabolize medicine. So a genetic test that breaks down that information for him, makes prescribing painkillers a lot easier. Before the Proove test, he said, it really was just a guessing game.
Drug overdoses are a leading cause of unintentional death in the United States. The major force behind this epidemic is prescription and non-prescription opioid drugs. All ages and communities everywhere are affected by opioid addiction.
People who have started to develop an addiction to prescription opioids may start buying counterfeit pills or try another opioid, such as heroin or fentanyl, to treat pain and prevent withdrawal symptoms. Statistics show that 4 out of 5 new individuals consuming heroin started by taking prescription painkillers for nonmedical purposes.
"The deaths of older people are an untold part of it," says Jeremiah Gardner, public affairs manager of the Hazelden Betty Ford Institute for Recovery Advocacy. Gardner speaks from personal experience: His mother died two years ago from an overdose after becoming dependent on painkillers prescribed for chronic pain and a surgery. She was 59.
So beginning in the late '90s, when older patients suffering from chronic conditions like arthritis or back issues asked for pain relief, their doctors innocently wrote prescriptions for OxyContin, Vicodin, Percocet and other opioid painkillers.
It did not help that in 2009 the American Geriatric Society encouraged physicians to use opioids to treat moderate to severe pain in older patients, citing evidence that they were less susceptible to addiction. Though the society revised those guidelines, the myth persists. "Many doctors still think seniors can't get addicted," Kolodny says.
U.S. Representatives Debbie Dingell (MI-12) and Fred Upton (MI-06) today introduced legislation to address the opioid epidemic by spurring urgently needed research on new non-addictive pain medications. Twenty-five million Americans suffer from pain every day, and it is essential that non-addictive medications are available to them.
Developing new non-addictive pain medications is essential to combating the opioid epidemic. During Congressional hearings Dr. Francis Collins, Director of the NIH, requested the agency be given more flexibility, known as other transaction authority (OTA), so the agency could better partner with innovative companies doing research to address the opioid epidemic and other public health threats. Under the ACE Research Act, the NIH Director will be able to more quickly support research on new, non-addictive pain killers and other emerging technologies that can offer hope to those suffering from an opioid addiction.
At last week's meeting of the American Chemical Society here, Neel Anand, a senior director for medicinal chemistry at Nektar Therapeutics, a biotech firm in South San Francisco, California, described an approach that might help. Nektar's drug, called NKTR-181, is a version of oxycodone to which researchers have linked a molecular tail called polyethylene glycol, a common pharmaceutical strategy for extending the life span of medicines in the blood. Anand reported that in animal studies, NKTR-181 crosses the blood-brain barrier 70 times more slowly than oyxcodone. Instead of a sharp spike in both pain relief and euphoria, caused by an upsurge of the neurotransmitter dopamine in brain regions tied to addiction, NKTR-181 triggers a slower release of dopamine that produces flatter, more sustained pain relief and less euphoria. In clinical studies of more than 600 patients taking the compound, Nektar researchers found far fewer signs of addiction than in patients given oxycodone, as well as fewer side effects.
"It clearly works" as a painkiller, says Steven McKerrall, a medicinal chemist with Genentech in South San Francisco. "They've built [a timed release] into the drug itself." But McKerrall and others caution that opioid addicts have devised strategies to defeat other abuse-resistant formulations, for example, by crushing pills that have timed-release coatings. "Addicts will always find a way," Bohn says. 2ff7e9595c
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