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Running Header: CPR: PRESCRIPTION OPIOIDS

Community Problem Report (CPR): Prescription Opioids

Group 1: Paulina Torres, Desiree Nieto, Clarissa Legarretta, Natali Legarretta, and
Stevan Sifuentes
University of Texas at El Paso
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Abstract

This paper uses several different articles to examine the opioid crisis and explore the possible

reasons as to why it has developed into such a pressing issue in modern society. Through the

research conducted by Dirks, Kaplan, and other reputable medical researchers, the analysis of

opioids and their effects are noted, and the sources of the issue are located. One aspect that is

analyzed is that of a relationship between a parent who struggles with addiction and their child.

Dirks suggests that opioid use by a parent can began to affect the child from as early as

pregnancy and can last for the rest of the child’s life. This impact that opioids have on not only

the user but those around them as well, exhibits the need for an alternative. One less addictive

option according to Kaplan is the use of medical marijuana in conjunction with a lower dose of

opioids. This paper will examine the effects of postoperative opioids and the possible benefits of

replacing them with marijuana. Keywords: opioid overdose, opioid addiction, opioid crisis,

medical marijuana
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Opioids are prescription drugs intended to aid in relieving chronic pain.

However, these pain relievers also come with a serious side effect; people are becoming more

dependent on them and it results in very dangerous situations for both the user and those around

them. For this reason, the moderation and regulation of these drugs should be more enforced in

order for people to avoid being at risk of becoming victims to opioid abuse. Through the

knowledge gathered of where opioids come from as well as how and why they are used,

solutions can be created to help prevent the continuation of the misuse of prescription opioids.

This will also allow the overall destruction caused by these drugs to decrease drastically, as well

as help society gain better control over this epidemic that has become extremely serious.

Prescription opioids can have a lasting impact not only on the user but their families as well,

which demonstrates the urgent need for other pain relief options, such as medical marijuana, to

be explored.

One study that was examined was conducted with the intent to describe

the prescription and administration of opioids to a teaching hospital where these drugs are being

prescribed for both complicated and simple surgeries alike with doses varying between 1-2 times

a day as needed for pain. Oxycodone was the number one prescribed “pro re nata” (PRN), or “as

needed” opioid with Tramadol being the second, both of which had some of the highest addiction

rates in the U.S. (National Institute on Drug Abuse, 2019, p. 1). Between the years of 2010 and

2013 a study identified 44 cases of opioid overdose with in-patient hospitalization being a major

source for opioid prescription within patients 65 and older (Pain medicine, 2010, p. 58–66).

Medical staff who are responsible for administering opioids are now questioning physicians’
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orders and are hesitant in giving these medications to patients causing a division in healthcare

settings. Physicians are using opioids to suppress the pain that patients claim to be unbearable

which in turn causes the patients to become more and more dependent even though the pain

could have been managed with alternate, less addictive medication. Hospitalized patients usually

take the medication as given by their health care providers without any hesitation, simply

because they trust the medical professionals. Statistics state some patients can become addicted

within the first 2-3 days of taking their prescribed opioids (Mayo clinic staff, 2018, p. 8). This

crisis can be so harmful to not only the drug user but other people around them as well.

Looking specifically at the United States, it is still in a tug of war with the

abuse and misuse of opioids with evidence showing that prescribers are partly responsible for

this opioid issue because they are giving patients more than needed. According to “Opioids: The

Crisis Next Door”, in 2019, more than 2 million Americans are suffering from addiction due to

prescription opioids (Pierce GL. et al., 2019, p. 1). Due to this prescription opioid crisis there

have been possible cases that lead to the use of other recreational drugs such as heroin (Mayo

Clinic staff, 2018, p. 5). Some patients are in genuine, intolerable pain while others in less severe

pain develop an addiction to these serious drugs that could have been avoided. Unfortunately,

there is no way for physicians to measure a patient’s pain, which makes it difficult for them to

know what dose and to whom to prescribe these extremely addictive drugs to. Post-operative

pain can be hard to ignore, and physicians prescribing opioids can make it more likely for

patients to become addicted, furthering the separation between hospitals and patients on opioid

use. Recent efforts have been made by government agencies to help with this problem but other

options for physicians to help their patients who are experiencing post-operative pain are few to

none. Medical insurances are considering not providing medical coverage for those types of
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opioid prescriptions which will make it more difficult to obtain patient coverage needed for

opioids.

When considering the effects that people who have become addicted to opioids

can have on those closest to them, they become particularly worrisome when looking at a

relationship between a parent who is addicted and their child. These negative influences can

begin from as early as pregnancy and can last for the rest of the child’s life. Some women who

are pregnant and struggle with addiction may not only continue using opioids throughout

pregnancy but also decline prenatal care which can lead to negative effects within the child.

According to April Dirks et al. (2018) who is part of a social work program at Mount Mercy

University, one such effect is “a condition called Neonatal Abstinence Syndrome (NAS) that is

linked to birth defects and severe withdrawal symptoms” (p. 3). This exemplifies how addiction

can severely harm a life other than just that of the user. Parents who have become addicted are

also more likely to treat their children poorly and with no regards to how it will impact them

emotionally. These children will often struggle with mental disorders for the rest of their lives

and often fall victim to addiction themselves. Although this opioid epidemic is not something

that will be genetically passed on, the children of addicts will have easier access to the drugs and

will have grown up watching this habit firsthand which might very well influence them to also

begin abusing opioids.

It is evident that opioids can be dangerous and pose some risk factors that

result from people taking them long after they have already been cleared by their doctors.

However, there are some other aspects of the opioid crisis that should be considered in order to

decide what future actions should be taken. According to Michael Clark, an M.D at the Johns
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Hopkins Arthritis Center, there have been many positive aspects to the use of opioids. Pain, such

as in the lower back, post-herpetic neuralgia, and painful peripheral neuropathy were proven to

drastically be reduced and even improved function and movement for patients. Furthermore,

Clark (2019) noted that even though there is an addiction rate, out of a study of 12,000 patients,

only four without any substance abuse history were deemed “addictive” (p. 3). This knowledge

shows that even though there is addiction, it isn’t as drastic as people might believe, at least

according to this specific study. However, this still does not mean that opioids will always be

beneficial. There is still a serious over-prescription of these medications and a significant

addiction rate that needs to be addressed and solved. Opioids cannot continue to go unmonitored

and physicians should consider other possible alternatives that will not have such a lasting

negative effect on patients before prescribing these addictive drugs.

There are many arguments to legalize medical marijuana, however the focus is

on those specifically relating to pain. It is far too often where someone gets in an accident and

then becomes dependent on the drug they are prescribed, so to tackle that, alternative medicines

should be studied further, such as the medical benefits of marijuana. Cannabinoids are found in

marijuana and are non-psychoactive ingredients known for their healing properties. They have a

big effect on peripheral nerves that detect pain sensations and appear to block pain in

experimental animals. It has been shown that marijuana and opioids treat pain in different ways,

so if someone does need to use opioids, they can use a smaller amount while combining

marijuana for two different routes of pain management (J. Kaplan, 2019, p. 2). This also helps

with lowering addiction as marijuana has very slim addictive properties and has no recorded

deaths from overdose. The most encouraging clinical studies are studies that involved pain

treatment for patients going through cancer treatment. In one study, 10 cancer patients were
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given marijuana pills in varying doses and/or placebo pills (A. Mack, 1970, p. 3). The group that

took the marijuana pills reported significant pain relief during treatment. Another positive note

for marijuana comes from a separate study that compared marijuana to codeine (an opioid). The

patients reported having a more sedated feeling on the tetrahydrocannabinol, or THC, as well as

feeling a greater sense of well-being and less anxiety (A. Mack, 1970, p. 7). If marijuana could

be de-criminalized at the federal level, scientists might be able to do large scale studies that

could allow people with chronic pain to have a better quality of life, without the great risk of

addiction to or abuse of opioids.

The prescription of opioids for post-operative pain is a difficult decision for

physicians to make due to their high addiction rates and the lack of alternate, less addictive pain

relief options. The longer a person uses these drugs, the higher their tolerance becomes and the

higher the dosages have to be to have the same effect as when the patient first began using it. For

this reason, physicians have been prescribing opioids at a higher rate, causing more and more

people to develop a dependency on them. However, through research and medical studies, such

as those involving medical marijuana, the rates of abuse and overdose from prescription opioids

can be decreased.
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References

Clark, M. (n.d.). Benefits and Risks of Opioids for Chronic Pain Management. Retrieved March

28, 2019, from https://www.hopkinsarthritis.org/patient-corner/disease-

management/benefits-and-risks-of-opioids-for-chronic-pain-management/

Fortune Journals, A. D. (2018, January 15). The Opioid Epidemic: Impact on Children and

Families. Retrieved from

http://www.jpsychiatrypsychiatricdisord.com/articles/the-opioid-epidemic-

impact-on-children-and-families.html

Kaplan, J. (2018, March 29). How cannabis enhances the effects of opioids. Retrieved from

https://www.leafy.com/news/healthhow-opioids-marijuana-work-together-for-

pain-relief

Keast, S. L., Nesser, N., & Farmer, K. (2015). Strategies aimed at controlling misuse and abuse

of opioid prescription medications in a state Medicaid program: a

policymaker’s perspective. American Journal of Drug & Alcohol Abuse, 41(1),

1–6. Retrieved from https://doi.org/10.3109/00952990.2014.988339

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Mack, A. (1970, January 01). MARIJUANA AND PAIN. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK224384/

Mayo Clinic Staff. (2018, February 16). Am I vulnerable to opioid addiction? Rretrieved from

https://www.mayoclinic.org/diseases-conditions/perscribion-drug-abuse/in-

depth/jow-opioid-addition-occurs/art-20360372

Murnion, B. P., Gnjidic, D., & Hilmer, S. N. (2010). Prescription and Administration of Opioids

to Hospital In-patients, and Barriers to Effective Use. Pain Medicine, 11(1),

58–66. Retrieved from https://doi.org/10.1111/j.1526-4637.2009.00747.x

National Institute on Drug Abuse. (2019, March 29). Opioids summaries by state. Retrieved

from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-

state

Opioids: The Crisis Next Door [Web log interview]. (n.d.). Retrieved March 16, 2019, from

https://www.crisisnextdoor.gov/?utm_source=google&utm_medium=cpc&utm

_term=crisis next door&utm_campaign=Crisis Next Door-Brand