Annotated Bibliography on Decreasing Opioid-Related Deaths - Paper Example

Currently, the United States is faced with the challenge of dealing with the prevalence of opioid-related overdose and fatalities. This phenomenon may mainly be attributed to the complex interaction that surrounds the pain management and the resultant opioid use disorders or opiate addiction. The advent of this deliberation may be associated to the fact clinicians are often in a dilemma especially in the application of chronic opioid therapy (COT) and the interactions with substance use disorders (SUDs) (Chou et al. 115). Moreover, studies propose behavioral symptomatology of chronic pain and addiction are interrelated such that if one disease is left untreated, the efficacy of treatment in the other is virtually impossible. In essence, the incomplete comprehension this unique interaction coupled with the inadequate management of both conditions culminated in the under-treatment of pain and premature discharge of SUD patients from pain treatment. Consequently, in a bid to realize optimal physical functionality and pain relief, both conditions ought to be considered for treatment (Shah et al. 130). The proper management of pain in the population of patients with SUDs is critical since poor administration may result in dire consequences such as compromised medical care, relapse to addiction, and the likelihood of grace toxicity as a result of mistaken tolerance or drug addictions (Dart et al. 243). The stigma that is associated with addiction also serves to compound on the pain management techniques to be applied to the faction of patients with SUDs. This occurrence may lead to the discontented interaction between an addict and the healthcare system. Consequently, pain management through the use of opioids raises more questions than answers in the sense that no single solution exists for opioid addiction. In the long run, this predicament has culminated in the disproportionate impact of the opiate epidemic in hospitals, communities and individual residents. As the menace of opioid-related deaths continues to prevail, the underlying question would be: What improvements can be made to the medical system to decrease opioid-related deaths in the U.S?

Chou, Roger, et al. "Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain." The Journal of Pain10.2 (2009): 113-130.

The use of chronic opioid therapy for chronic non-cancer pain management has increased exponentially over the years. The American Academy of Pain Medicine and American Pain Society directed that a systemic review on chronic opioid therapy be conducted including the formulation of a multi-disciplinary expert panel whose responsibility was to scrutinize the evidence and develop complementary recommendations. Despite a limited pool of evidence, the selected group of professionals concluded that opioid therapy is an ideal intervention that is applicable in a carefully selected and supervised patients with chronic non-cancer pain.

Nevertheless, the use of opioids is associated with opioid-related adverse health outcomes that result from the abuse potential of opioids. Accordingly, the recommendations presented in this study offers guidance regarding patient selection; risk stratification; achieving an ideal dosage of methadone; assessing patients on chronic opioid therapy, and obtaining informed consent to support opioid management plans. These approaches have supported the perspective that; the achievement of a safe and effective chronic opioid intervention necessitates the need of clinical proficiencies and comprehension the guiding principles of opioid prescription and management of risks that are related to opioid abuse.

Shah, Nina G., et al. "Unintentional drug overdose death trends in New Mexico, USA, 19902005: combinations of heroin, cocaine, prescription opioids, and alcohol." Addiction103.1 (2008): 126-136.

The aim of this study is directed towards determining the contribution prescription opioids, heroin, alcohol and heroin combinations in evaluating the total overdose death rate including the identification of alterations in drug overdose patterns amongst residents of New Mexico. Research design involved the analysis of medical examiner data of the total accidental drug overdose deaths in New Mexico during 1990-2005. Equally important is the fact that race and sex determined age-adjusted drug overdose death rates.

Results from the study indicate that the total unintended drug overdose death rate in New Mexico increased from 5.6 per 100,000 in 1990 to 15.5 per 100,000 in 2005. The deaths that occurred as a result of a combination of opioids and complementary drugs ranged from between 89 percent and 98 percent of the total number of deaths. Most deaths during 1990-2005 may be attributed to heroin with a remarkable rate increase in prescription opioid overdose. Moreover, the increment of 196 percent in a single drug category overdose death was spearheaded by prescription opioids. Additionally, the multi-drug category overdose death represented a 148 percent increase represented by heroin/cocaine and heroin/alcohol combinations. Hispanic males recorded the highest overdose death rate the followed by white males, white females, Hispanic females and American Indians respectively. In essence, approaches geared towards preventing drug overdose deaths should target individuals based on their use patterns in vulnerable populations. Consequently, a comprehensive plan is required to address the needs of both prescription and illicit drug users including those individuals who use these drugs concurrently.

Gaston, Romina Lopez, et al. "Can we prevent drug-related deaths by training opioid users to recognize and manage overdoses?." Harm Reduction Journal 6.1 (2009): 26.

Naloxone has emerged as an evidence-based measure that is directed towards diminishing the mortality that results from an opiate overdose although its administration to drug users is not widespread. Perhaps this is because drug users are the most likely people to be available to administer naloxone at the scene. This study represents a build-up on national training evaluations through assessment of 6-month outcome data that is collected primarily in the participating centers. The research methodology involved seventy patients with opioid dependence syndrome who were subsequently trained on the recognition and management of overdoses including a 6-month follow up after receiving naloxone. At the end of training, participants were given a supply of 400 micrograms of naloxone to take home. The focus of the study was to assess whether the participants possessed their dose of naloxone, had witnessed an overdose incident and whether the user was ready to use naloxone in such circumstances.

The findings presented mixed results in the sense that although most drug users had retained naloxone, their retention knowledge was directly proportional to overdose recognition and intervention. This implies that the majority of the users did not carry their dose of naloxone consistently hence it was unavailable if an incident of drug overdose occurs. In essence, training of drug users constitutes a valuable resource in the management of opiate overdose. Nonetheless, obstacles such as transportability, police involvement, stigma and prescription laws are likely to curtail such an intervention.

Dart, Richard C., et al. "Trends in opioid analgesic abuse and mortality in the United States." New England Journal of Medicine 372.3 (2015): 241-248.

The use of prescription opioid medications amongst U.S citizens has increased over the years in the last two decades. In 2010 alone, there were over 16, 651 opioid-related deaths and such trends have stimulated a series of interventions at federal, state, and local levels. This study utilized five programs from Research Abuse Diversion and Addiction-Related Surveillance (RADARS) System to describe trends between 2002 and 2013 in the deviation and abuse of all products and formulation of six prescription opioid analgesics hydrocodone, oxycodone, fentanyl, morphine, hydromorphone, and tramadol. The RADARS program gathers data from drug-intervention investigators, substance-abuse treatment centers, poison centers and college students. The systems programs recorded massive increases in the rates of opioid diversion and abuse from 2002 to 2010 followed by a decrease from 2011to 2013.

The post-marketing surveillance illustrates that although the rates of diversion and abuse of opioid medication between 2002 and 2010, the rates reduced between 2011 and 2013. These results imply that the US is making progress in controlling the abuse of opioid analgesics. Some of the interventions adopted by the government include improvements in opioid prescription, limiting questionable practices by pain clinics and reducing doctor-shopping practices. Moreover, educational initiatives and prescription-monitoring programs have been designed to decrease experimentation with opioids. Equally important is the fact new opioid analgesic formulations, which resist tampering, have been introduced. A comprehensive legislative framework has also been formulated with the objective of curtailing the activities of the so-called pill mills.

Cochella, Susan, and Kim Bateman. "Provider detailing: an intervention to decrease prescription opioid deaths in Utah." Pain Medicine 12.suppl_2 (2011): S73-S76.

The state of Utah embarked on a multi-pronged effort to reverse the adverse health effects resulting from opioid use, which ultimately culminates in death. This study incorporates an analysis of six recommended prescribing practices that were developed and presented to health care workers. The participants of the study were encouraged to use the state prescription database to complete surveys, which evaluate the behavioral changes and confidence at intervals of 0, 1, and six months post-presentation. Continued medical education credits were also included as an incentive.

The findings indicate that Utahs medication-related overdose deaths dropped by 14 percent in 2008 as compared to the previous year following the implementation of the program. A total of 581 clinicians and various non-physician healthcare workers were consulted during 46 presentations. The follow-up studies on the extent of adoption practice alterations were completed by 366 participants at 0 months, 82 participants at one month and 29 participants at six months. The combined results from all the three assessments indicated 60-80% of the responding providers registered no longer prescribing long-acting opioids for acute pain or with sedatives; 50 percent using Utahs database for controlled substance database experienced lower starting dosages and slower escalations during patient care, and 30-50 percent reported as having obtained sleep studies and EKGs on the ideal candidates, implementing the states prescribing guidelines and using patient education tools. In essence, provider detailing was related to a decline in Utahs prescription opioid death rate and improvement in provider self-reported prescription practices.

Rockett, Ian RH, et al. "Leading causes of unintentional and intentional injury mortality: the United States, 20002009." American journal of public health 102.11 (2012): e84-e92.

The past two decades have seen primary care physicians increase their frequency of prescribing long-term opioid therapy. Nonetheless, the rise in opioid prescriptions has outpaced the evidence that supports opioid use for pain management. The augmentation in opioid availability has been followed by the epidemic of opioid abuse and overdose that has contributed to a significant number of deaths. Although the rate of opioid addiction amongst patients receiving long-term opioid therapy is vague, research posits that opioid misuse is not uncommon. This may be evidenced by increased risks for...