Prescription Drugs-Gateway to Street Drugs

It is a known fact that drug overdose deaths are on the rise. Based on research I have read, most addicts say they started with pills, turn to heroin and die from the synthetic opioid painkiller fentanyl. Opioids are too accessible; there are other effective alternative pain managements that are almost never discussed as a treatment option. Other medications like Ibuprofen (Motrin), Acetaminophen (Tylenol) and Naproxen (Advil) are good effective options. Discussing these options and implementing them would drop the rate of drug addiction to an all low. Unfortunately, many patients leave the post-surgery recovery room with a prescription for 30 or more highly addictive opioid pills (such as Vicodin, Hydrocodone and Oxycodone), and about 6 percent are still using them three months or longer after the procedure (asahq.com, 2018). Noticing the signs and managing the pill intake could also save their life. Too many lives are lost simply because their doctor prescribed them opioids after a certain surgery and they became drug dependent. We need to stop this epidemic at the source, and that source is prescription drugs.

We live in a world where opioids are prescribed just as easy as or easier than antibiotics are. Not since the HIV/AIDS epidemic has the United States faced as devastating and lethal a health problem as the current crisis of opioid misuse and overdose (Science Daily, 2018). The Drug Enforcement Administration found that most overdose deaths are caused by prescription drugs, including opioids. While opioid abuse continues to plague certain states more than others, each state is unique in how it attempts to stem the crisis and its effect on families (Science Daily, 2018). More than two dozen states have implemented laws or policies limiting opioid prescriptions in some way and insurance companies have done the same. The most common is to restrict a patient's first prescription to a number of pills that should last a week or even less. According to Dr. Grant, “Nobody needs a prescription for 30 or 50 opioids and even those who are in major pain and may benefit should only take them for a day or two,” said ASA President James D. Grant, M.D., M.B.A., and FASA. “There are effective alternatives and many people don’t need opioids at all or at least should drastically reduce the amount they take” (asahq.com, 2018). A few states have pledged to come after those responsible for the rising death toll (Science Daily, 2018). Although, two dozen states is almost half of the US, there are still two dozen states left without this implementation and that needs to change.

The full extent of the public health consequences of prescription opioids is further complicated by the increased availability and use of heroin, which is less expensive and stronger than prescription opioids. Many people who develop habits from prescription opioids eventually switch to heroin. In one study, about 80 percent of current heroin users reported that they began with prescription opioids (Rudd RA, Seth P, David F, 2010-2015). With this information, it is safe to say that the connection of the effects of prescription opioids and heroin are intertwined.

In the last decade, US deaths due to opioid-related overdoses have tripled. Between 2001 and 2011 the rate of heroin overdose deaths increased more than 2.5-fold among whites aged 18 to 44. The mounting effect is a 200 percent increase in opioid-involved overdoses from 2000 to 2014 (Rudd RA, Seth P, David F, 2010-2015). Only in more recent years, national initiatives to reduce opioid prescribing have decreased the number of prescription opioids distributed. However, many people who otherwise would have been using prescription opioids have transitioned to heroin use due to this restriction, which resulted in a three-fold increase in heroin-involved overdose deaths from 2010 to 2014 (Rudd RA, Seth P, David F, 2010-2015). As you can see, the overall frequency of heroin deaths has been speeding up since 2010 when restrictions to prescription medication started take place; but by then, it was too late. We need to stop this epidemic, starting with prescription medication.

People who become dependent on opioids may experience withdrawal symptoms when they stop taking the pills. These prescription opioids can cause hyperalgesia, meaning they can actually increase sensitivity to pain (asahq.com, 2018), which equals to more medication being needed to ease the pain. Dependence is often coupled with tolerance, meaning that opioid users need to take increasingly larger doses of the medication for the same effect. People who become dependent on pain pills may switch to heroin because it is less expensive than prescription drugs and has a stronger high. Other indicators suggest that prescription control may have contributed to a reduction in some prescription opioid problems, without clearly stunting the growth in heroin use. The National Institute on Drug Abuse estimates that half of the people who inject heroin turned to the street drug after abusing prescription painkillers, also that three in four new heroin users start out using prescription drugs (CNN.com, 2019). We need to stop the drug abuse at prescription medication before they go down an ever harder path. Alternative pain management needs to be prescribed more frequently. Instead of prescribing Vicodin or Percocet, Doctors should prescribe medications like Ibuprofen (Motrin), Acetaminophen (Tylenol) and Naproxen (Advil).

It is impossible to keep everyone safe from addiction; even when restricting prescription opioids but treatment to reverse this addiction should be readily and easily accessible. Over 2.5 million Americans are addicted to opioids but fewer than 50% of private sector treatment programs offer medications for Opioid Use Disorder and only one-third of patients in those programs receive them (CNN.com, 2019). At the first signs of addiction- rehabilitation and detox should be a plan of attack so that this addiction doesn’t grow. Traditional treatment, which begins with detox and relies on lifelong abstinence, is no match for today’s opioid addiction. Like other medical conditions, to stabilize and manage opioid use disorder requires a medical model, using one of three FDA-approved medications. These medications significantly diminish cravings and reduce the risk of relapse. As detoxification alone for Opioid Use Disorder is an ineffective and potentially dangerous practice, it should not be the choice for most patients. All patients with Opioid Use Disorder should have access to one of three FDA-approved medications (buprenorphine, methadone, XR-naltrexone) as their primary treatment and treatment should continue for a minimum of one year, without a predefined length of treatment, under a long-term medical model (CNN.com, 2019). Opioid addiction hits hard, we need to hit even harder with reversal treatments. People currently on prescription pain medication should be closely monitored to reduce the chance of addiction. Over several years, the US Department of Justice promoted Prescription Drug Monitoring Programs (PDMPs) (Stefan G. Kertesz, Adam J. Gordon, 2018) but these programs are not available nationwide nor are they public knowledge and they should be.

While no one has gone against the new legislation and rules to reduce the amount of opioids prescribed, not even pharmaceutical companies who gained money from this prescription medication surplus, there is the argument that pain still needs to be treated. That argument is indeed valid as there are many people suffering from chronic pain due to certain illnesses and diseases like cancer and musculoskeletal diseases. New rules have made it hard for these patients to get the appropriate amount of pain medication needed (Will Stone, KJZZ, 2018). For some, alternative medications are not enough to ease the pain and help them live regular lives. Patients and doctors are now being held accountable and this is causing doctors to limit their prescribing of opioids because they do not want the liability (Will Stone, KJZZ, 2018), therefore, patients with chronic pain suffer. The new laws should maintain monitored access for chronic pain sufferers and others who rely on these drugs. The new restrictions should only apply to new patients. Cancer, trauma, end-of-life and other serious cases should be exempt to avoid this problem that some patients view as dehumanizing and unfair.

We all know that knowledge is power, so we need to use that to our advantage. Educating yourself and others on the dangers of prescription and street drugs is just as important as staying away from them. As President Donald Trump stated, "The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place," President Trump continued by saying, “If they don't start, they won't have a problem. If they do start, it's awfully tough to get off"(CNN.com, 2019). In order for this to be successful, the proper education is needed. Reading stories online or the news isn’t enough because the real gruesomeness of it is covered up. I think people need to see actual pictures of overdose victims not just before death, but what they looked like when they were found because seeing them at their funeral isn’t scary enough. They are made up and look so peaceful then. People should also see what their surroundings looked like and what their life was really like. People need to see the nitty-gritty of it and most importantly, the truth of how it all began and how easy it is to get caught up in drug addiction. In an article in NY Times, a coroner went to a New York High School to speak on this very subject. The kids there were shown actual crime scene photos along with the story of the victims. That is powerful and effective education; it gives an actual visual which is always worse than what you have created in your head. As Mr. Whitehead stated in a statement to school officials, “Are you so afraid to expose students to the graphic and harsh reality in our community that you simply turn a cold shoulder to it and hope for the best?” (Foderaro). Hoping for best, as we know, it is not enough. This problem will not just disappear on its own.

Alternatives to prescription opioids like Ibuprofen (Motrin), Acetaminophen (Tylenol) and Naproxen (Advil), can help save lives and reduce not only the number of drug overdoses but the number of drug addicted Americans. The opioid epidemic was and is too great to be ignored. Drug addiction has a beginning and for many Americans that beginning was prescription pain medication. It was the introduction and gateway to cheaper, lethal street drugs like heroin. People that are in a situation where opioids are an option should not be afraid to ask questions and listen when being spoken to about alternative treatments and be an active participant in your own care! Opioid addiction can affect everyone and anyone. As Mr. Whitelaw stated as “he flashed slides explaining the ABC’s of addiction and the diversity of its victims: “gifted, smart, rich, poor, doctors, lawyers, cops, judges, moms, dads, bus drivers, pilots, nurses, financial planners…”(Foderaro). Your race, social status or income cannot protect you; only you can protect you. As previously mentioned, many states and even insurance companies have implemented new laws to restrict the amount and duration of prescribed opioids, but not all 50 states have. These new laws and policies need to be implemented in all 50 states, not just half as the opioid epidemic and the rise of drug overdose deaths are nationwide. Treatments for those addicted should be accepted by more insurance companies and more readily available to everyone in order to be effective. Chronic pain patients should be exempt and should not be placed under the same rules as non-chronic pain patients. With the new laws in place nationwide, this epidemic should not increase, but decrease. This Opioid epidemic should not have a future, we the people should and that future needs to be as drug-free as possible and with new laws, regulations and education in play, a drug and addiction free future is now a possibility for everyone.

Works Cited

1. “Impact of Opioid Epidemic on Children Varies by State.” ScienceDaily, ScienceDaily, 6 Nov. 2018, www.sciencedaily.com/releases/2018/11/181106104300.htm.
2. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Morbidity and Mortality Weekly Report. 2016; 65:1445–1452.
3. “Opioid Crisis Fast Facts.” CNN, Cable News Network, 17 Jan. 2019, www.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html.
4. Kertesz, Stefan G., and Adam J. Gordon. “A Crisis of Opioids and the Limits of Prescription Control: United States.” Addiction, vol. 114, no. 1, 2018, pp. 169–180., doi:10.1111/add.14394.
5. “Opioids Often Not the Answer to Post-Surgery Pain, Discomfort, Note Physician Anesthesiologists.” American Society of Anesthesiologists, www.asahq.org/about-asa/newsroom/news-releases/2018/01/opioids-often-not-the-answer-to-post-surgery-pain.
6. HealthLeaders. “Analysis.” Top 5 Differences Between NFPs and For-Profit Hospitals, www.healthleadersmedia.com/clinical-care/patients-chronic-pain-feel-caught-opioid-prescribing-debate.
7. Foderaro, Lisa W. “From Opioid Epidemic's Front Lines, Filling In the Brutal Back Story.” The New York Times, The New York Times, 19 June 2017, www.nytimes.com/2017/06/19/nyregion/from-opioid-epidemics-front-lines-filling-in-the-brutal-back-story.html.

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