You’ve heard all about how the opioid epidemic has been affecting families, communities, and the whole country in general. Now, it’s reaching new and pregnant women in the state of Colorado. Opioid overdoses have caused more maternal deaths than car accidents, homicides, or illness. The increase in maternal deaths is linked to the increase in prescription drug abuse. The abuse is causing overdose and addiction.
Mothers and their doctors that are conscious of the opioid problems will use different alternatives. The new pill free method is a flexible catheter that administers a local anesthetic. This means that the mother in labor doesn’t have to rely fully on opioids for pain. This reduces the need for opioids. The new medical technology is a pump that drips a numbing medication to the incision site during a c-section. This alleviates the need for painkillers like opioids. The problem doesn’t just lie with opioids during labor, it’s the aftermath. The prescribing of strong painkillers the mother can take home. Some women are taking a stand against the opioid epidemic and looking for different options for pain. Perhaps the rest of the medical industry should begin to follow suit.
Mothers Sent Home with Percocet
Usually, new mothers will be sent home with about 30 Percocet give or take. Some will go back to the doctor for more, saying they’re still experiencing pain. This is where the process of abuse and addiction to opioids begins for many. This is the reason behind opioids becoming the leading cause of death for new mothers in Colorado.
What are Opioids?
Opioids are a pain reliever that is morphine-like. Opioid drugs include fentanyl, heroin, and the prescription painkillers doctors are giving out. They are good for short term pain relief that is moderate to severe. They are used during surgeries and after surgery to manage the acute pain. These medications are also important for those with cancer pain. This is the right way to utilize this highly addictive drug. The problem is, they’ve been prescribed for other types of pain. Around 50% of the opioid market is for chronic pain such as back pain, osteoarthritis, or neuropathic pain.
About 1 in 4 patients who are given long-term opioid therapy in primary care will experience an opioid use disorder. In 2014, almost two million Americans were dependent or abusing prescription opioid pain relievers. On a worldwide scale, opioid prescription pain killers that should help treat a patient are causing them to die. The recreational use of prescription painkillers are greater than heroin. Their high is similar and they have the same health risks, which includes addiction and overdose.
Statistics tell us that women are more likely to experience chronic pain, use prescription painkillers for longer and higher doses than men. Post surgery, 40% of women become persistent opioid abusers than men. With opioid prescriptions, women make up 65% of the users.
Furthermore, opioid prescription use is higher by a lot when it comes to Medicaid patient compared to individuals that are privately insured. A study found that people using Medicaid had a minimum of one indicator that revealed their abuse of prescription opioids. Women make up almost 70% of adults using Medicaid. Between the years of 2003 to 2012, the use of heroin in women doubled. Women still use heroin less than men but the fact is, there are far more women using today.
Opioids can be risky for a variety of reasons. They cause low oxygen in your blood which can cause you to stop breathing. This is especially a risk when you abuse opioid prescription painkillers with other antidepressants like Xanax or drink alcohol. Almost 80% of people who died from overdose relating to opioids had another substance in their system.
Opioid use and abuse can also morph into a full-blown addiction. First, you’ll experience tolerance, then physical dependency, eventually leading to an opioid use disorder. You may experience tolerance to pain which can cause you to need more of the drug to stop feeling the pain. Taking higher doses can cause you to need more over time and also puts you at risk of overdose. It doesn’t take long for physical dependency to occur, just a few weeks and you could be hooked.
Physical dependency will cause withdrawal symptoms when you try to stop using them or your prescription runs out. They include:
- Pain in the bones and muscles.
- Inability to sleep.
- Nausea and vomiting.
- Cold flashes.
- Involuntary muscle movement, especially in the legs.
How the Opioid Epidemic Began
This is a timeline of opioid prescription pain killers and how they became an epidemic.
1995: This is the year that the American Pain Society pushed the concept of pain (fifth vital sign). The medical community analyzed this and looked for a way to get rid of the pain as opposed to trying to control it.
1996: Purdue Pharma brings OxyContin to the market. They used an aggressive marketing campaign. They were highly successful and within five years, there had been 44 million opioid painkiller prescriptions written.
2000: Congress said that over the next decade, they were considering it to be the “Decade of Pain Control and Research.”
2002: There were 23 times more OxyContin being prescribed by doctors in 2002 than there was in 1996. The prescription sales increasing by over thirtyfold.
2009: The US was responsible for taking up most of the opioid painkiller market. They were consuming 99% of all the hydrocodone and 81% of oxycodone.
So it was, in the 1990s, the worldwide opioid prescription epidemic began. At the time, important decision makers in the US decided that the nation was dealing with an epidemic of pain going untreated. The American Pain Society advocated that the medical profession acknowledge that pain is the “fifth vital sign.” Many professionals and consumer groups agreed and pushed to find a drug that would manage pain.
Then the marketing of OxyContin(oxycodone) began for treating non-malignant pain. The reps for OxyContin went across the country, visiting doctors. They gave them gifts, free samples of patients, and fully paid vacations (to go to their symposiums). It’s believed that these actions had an impact on how much doctors would prescribe the drug. There was a major downplay on how addictive OxyContin was. This made it widely adopted by the medical community and primary care doctors would prescribe most of the opioid painkillers.
The Opioid Epidemic Today
It’s important to put numbers out there to back up the claims of the opioid epidemic. Opioid painkillers were meant to help those with severe pain. Now they are letting new mothers take it home with them after having their baby. The relaxed view the medical industry take on these drugs has caused a monster in the US and across the world. The CDC states that an average of 44 people dies from an overdose of prescription painkillers daily. There were millions of opioid prescriptions written in 2013. A small minority of physicians are responsible for prescribing most of the opioids.
Here are further statistics about the opioid epidemic.
- One out of five people who abused prescription painkillers got them from their doctor. Around 50% of people who abused them got them through a friend or a relative.
- In 2016, there was enough opioid painkiller prescribe to give every American 36 pills. Looking to states Alabama, Arkansas, and Tennessee, there were enough prescriptions there in 2016 to supply every resident with 70 pills.
- The high-risk group for opioid addiction those living in rural places in the low-income bracket.
Global Opioid Abuse Problem
The pain management movement began in 1996 and by 2012, global OxyContin sales had grown from $48 million USD to $2.4 billion USD. The global increase of OxyContin is similar to what was seen with morphine and codeine. They also experienced a major rise in production and sales. During the same time period, prescriptions for opioids rose in many countries. In the US, the increase was 300% between 1991 and 200. In Canada, the increase was 850% between 1991-2007.
The US has been leading on the prescription opioid front but it’s a global issue. There is a rise in abusing opioids in Canada, Australia, and Europe. In Europe, 5% of the people being admitted into drug treatment stated their primary drug of addiction was prescription opioids. These statistics are likely lower than reality. There is an absence of data being collected on a global scale.
The increase of morbidity and death that’s occurred as a result of opioid painkillers signifies how much they’ve been prescribed. The increase of admissions into addiction facilities, overdose deaths, and the sheer amount of prescriptions over the past 15 years. This is seen all over the world.
High rates of prescribing the drug can be attributed to:
- No real consensus of the right usage and dosing.
- Demand from patients who are dependent, addicted, or diverting opioids.
- Rise of clinics that will prescribe opioids when they don’t need to.
- The advertising of opioid pain relievers.
- Under-treatment of pain at its core.
How did the Global Opioid Epidemic Happen?
While it might seem strange, drug programs in places like England and Scotland were the source of their opioid problems. There was a lack of medicine consumption in their drug treatment programs. This caused a rising number of mortality rates from methadone. They were prescribed as an opioid substitution program. The UK started regulating methadone consumption to be given in supervised treatment centers and community pharmacies. There was a reduction in deaths after regulations began.
In New South Wales, a state in Australia, they had a similar problem. The regulations they had let patients leave their drug programs with a methadone prescription. During 1990 and 1995, over 50% of deaths related to methadone overdose were a result of patients there were enrolled in a maintenance program. The other percentage of methadone-related deaths happened due to the diversion of methadone from patients in the program. Other people got their hands on the methadone and as a result, died.
Sometimes, the consumption of prescription opioid painkillers will become popularized because other opioids aren’t available. In 2001, it was hard to find heroin anywhere in Europe. There was an illegal production of Fentanyl being manufactured in Estonia which was released to the European market. Similar stories include the heroin shortage and link of recreational use of buprenorphine in Finland. Addicts got the medication from their drug maintenance treatment program.
In the US, there is a high availability of prescription opioids and heroin. As opioid prescriptions got less, there became an increase in heroin abuse and addiction.
Every country with an opioid problem is experiencing drug diversions. Prescription opioids are being illegally transferred from pharmacy to the streets. This has been a major cause of the epidemic. The diversion may have happened from someone robbing a pharmacy, forging prescriptions, or stealing from someone’s medicine cabinet. Once they’ve obtained the opioids, they will be put on the black market.
Prescription Opioid Addiction and Heroin Abuse
In the last 15 years, the amount of opioids prescribed has quadrupled. There has not been an improvement in the number of pain patients feel. The rate of opioid deaths from overdose has grown with the amount of usage.
A concerning statistic is that people abusing prescription opioids are far more likely to become a heroin addict. Statistics say that 75% of people who have used heroin over the past 12 months have misused prescription opioids beforehand. Common opioid prescription drugs that people have died from an overdose on include methadone, oxycodone, and hydrocodone.
Connection Between Surgery-Related Opioids and Abuse
A recent report talks about how the PAP (Plan Against Pain) is looking at how opioid prescriptions for surgeries and addiction are connected. There were 12% of patients who reported addiction or dependency after their surgery. They were given a form of opioids after they had surgery. There are 7 common procedures that were tracked to see if patients would become addicted to their opioid prescriptions. It was narrowed down by demographics and geography. They also got information from a variety of databases. Over 200 surgeons were asked to assess the problem. Over 500 patients were studied in the study that had gone through surgery and been prescribed opioids.
The Slow Progression or Reducing Opioid Prescriptions in Surgery
In almost all areas of pain management, opioids have been reduced. Surgery is the slowest progression as it’s often the most acute pain. There was a slight drop in pills prescribed but not very significant. It’s believed the slow progress is because of the level of pressure surgeons have to give patients more opioids than they need. In the survey of surgeons, 66% of them said they felt pressured to prescribe opioids.
Fewer Pills, Higher Potency
It’s showing that the number of prescriptions have dropped. Reports don’t always mention that the pills are at a higher potency. This is especially the case with orthopedic patients. A study recently found that people going through surgeries were given opioids that are more than the CDC recommends. Post surgery patients were given 50 or more pills that had more milligrams than suggested. Statistics say that almost 1 in 4 patients got prescriptions that exceeded 90 morphine milligram equivalents a day. THe CDC suggests this amount is a risk for overdose.
Risk of Opioid Dependence and Addiction for Post Surgery
While the study found that 12% of patients became addicted to opioids while using them for pain management, it’s believed to be a higher rate of addiction. The highest incidence of later dependence to opioids was from those getting a colectomy which was 17%. A surgery like a rotator cuff experienced a lower dependence rate at 9.5%.
Millennial Woman at Great Risk of Opioid Dependency
The newest concern is how millennial women, in particular, are becoming more at-risk than before. Women are 40% more likely than men to become a “newly persistent” user of opioids after surgery. This is based on those who got opioids prescriptions after surgery for 90-180 days.
It was the millennial woman that was seen to be most at-risk. There were over 10% that reported persistent use while men were at 6%. In the 2018 PAP report, they stated there was a 17% increase in women abusing opioid prescriptions.
The people who created the report concluded that there need to be better guidelines. The number of opioids being given out for postsurgical pain isn’t being managed properly. There is progress but surgeons need to be relieved of the pressure they feel in prescribing. They are overprescribing when they should be setting patient expectations on the number of opioids they actually need.
With no real clear guidelines, surgeons are having to determine the amount and strength based on a patient’s pain. The lack of guidelines is creating a variety of patterns in prescribing so there’s a greater risk of overprescribing. This is what can lead to opioid addiction. Furthermore, the unused pills might be abused by others who have access to them.
patients’ pain,” authors write. “As this report reveals, the absence of clear guidelines has led to tremendous variation in prescribing patterns and a great deal of overprescribing that can lead to persistent opioid use, addiction and dependence among patients, as well as unused pills that can be misused or abused by others.”
Solutions to the problem
The epidemic took a decade to fully develop. It’s going to take some time to restore balance back in society and within the medical industry. The stakeholders still don’t want to look at the massive impact opioids have had on the world. The health plans, the FDA, pharmaceutical companies. They all act for their own best interests which contradict each other. The FDA has taken initiative over the past decade to make improvements on the risk/benefit of opioid use. Warning labels, educational campaigns, change the schedule to strong opioids like hydrocodone and issuing guidance to the pharmaceutical industry.
The efforts of the FDA have caused a decrease of prescription opioid use and abuse. The other statistic tells us that heroin use and addiction has risen. The connection between opioid decrease and heroin increase is obvious. Agencies have made it harder for patients to get the opioids they became addicted to. Heroin is easy to get and cheap.
Prescription Drug Monitoring Programs
Many countries have now implemented prescription drug monitoring programs. This means pharmacists and those who can prescribe opioids have access to a person’s prescription history. This is important when opioid prescription addicts have been known to “doctor shop” when their familiar doctor stops giving them the drug. This is an effort to curb the prescription opioid diversion too.
These programs haven’t been studied on how effective they are yet. There are some initial promising results, however. There was a survey conducted in the US recently that showed just 53% of doctors using the program. There were 22% of doctors that weren’t away the program was available.
How Insurance Companies Are Fighting Against Opioid Addiction
Insurance companies are now responding to the opioid epidemic. US health regulations have made it imperative for health insurance companies to offer insurers help for addiction. This is likely costing them a lot of money. They have created surveillance that gives them a real-time assessment of a person’s risk of abusing prescription opioids. They are meant to assist case managers so they can intervene. This can help prevent a dangerous situation before it can occur. The goal is to reduce the number of healthcare costs and improve outcomes of people’s lives. Opioid abusers cost healthcare over 6 times more than that of a non-abuser.
Treating Pain Without Opioids
Going back to the main point, how can pain be treated if not with opioids? The solutions being given for women having a c-section indicates that non-medicine solutions are out there. The cute and chronic pain existing throughout the world needs a better option than opioids. Morphine, oxycodone, and hydromorphone is largely consumed by the US. Yet, the pain issue in the US hasn’t improved. The pain needs to be managed much better than it is right now.
The belief is that the gap in pain management needs to be addressed. The main reason for the opioid epidemic is due to the wrong treatment for pain. The pain itself is undertreated while there is an overprescription of opioids. Chronic pain management can’t be done with opioids. The under-education along with misinformation of pain management needs to improve. Experts believe this is step number 1.
Pain Treatment Alternatives
Drugs like Tylenol might be all someone needs to get the pain relief necessary. It is recommended as treatment for pain, even for those with rheumatoid arthritis.
Drugs like ibuprofen, aspirin, and naproxen can help with pain. They are usually over-the-counter. Their addiction risks are extremely low, even with a higher dose if prescribed. There is a concern for your health however as they can cause kidney, liver toxicity, and ulcers when used constantly.
Many studies have come out about the efficacy of cannabis for pain. Certain properties with this natural chemical will ease your pain without the high. While there is a debate on dependency issues with marijuana, most believe it’s not physically addictive. States that have legalized cannabis have less opioid prescriptions and less opioid dosages being consumed.
Steroids can relieve pain but they do accelerate joint destruction and suppress the immune system. There are also psychiatric effects. This probably wouldn’t be the first choice for pain relief but it is an option for someone who is at risk of addiction.
Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs)
These are anti-depressants that can also be helpful for treating pain in nerves, muscles, and bone.
Exercise can relieve chronic pain. The likes of yoga has been helpful, especially for muscular pain. Also, breathing and meditation practices can help you manage your pain better. A more relaxed body means you experience less pain. You will have to be diligent about this but it will leave you much clearer in your mind, allow the body to physically heal, and make you stronger.
Opioids Shouldn’t Be Used for All Forms of Pain
While it’s going to take time for opioids to find their true place in pain management, there needs to be some guidelines on where it should not be used. For women going into labor, and after the baby is born, opioids are a risk. A woman taking home percocet for pain at a time where she may be dealing with emotions such as fear or depression is a recipe for disaster. The fact that opioid overdoses have caused maternal deaths says this isn’t the right pain management.
There needs to be a consciousness across the board on when it’s appropriate to prescribe opioids and when it isn’t. Alternatives like pill-free methods during a surgery is just part of the solution. As the opioid epidemic has come to the forefront, hopefully, more caring individuals will come up with similar ideas.
Meanwhile, we still have to manage those who are currently addicted to opioids. Like any addiction, there may be a need for an intervention. An addict doesn’t usually ask for the help they need. There is help however, in abundance. At Denver Women’s Recovery, we can assist you, or a loved one. We can verify your insurance to see what your coverage is for treatments. Contact us today so you can start your journey to recovery.