Opioids and Prescribing Patterns in Pain Management
Imagine yourself for a moment walking through your home. You make your way across a table and then suddenly you feel a sharp insurmountable degree of pain in your foot. Is it a staple? Thumbtack? Are you dying? You can be relieved to know my story ends with you simply stepping on a LEGO, although anyone who has done so would tell you it’s no fun (just check out all these memes on the internet).
Pain management is a highly fascinating and challenging area of pharmacy practice. It is typically based on subjective information which can be difficult to quantify, after all one person’s pain tolerance may be vastly different from another. Analgesics like acetaminophen or non-steroidal anti-inflammatory drugs are considered relatively safe options which usually do the trick in helping relieve pain; however, they may not be enough. Many patients with moderate to severe pain will still find themselves needing additional therapy and may therefore end up being prescribed an opioid.
There are two patterns that may arise at this point when we consider opioid management: under prescribing to the point patients might remain in pain or overprescribing to the point patients might misuse. Interestingly, there is evidence variability in opioid prescribing can be traced back to a physician’s specialty and level of training. For example, emergency medicine residents and attending physicians were found to prescribe opioids to a lesser degree as compared to non-emergency medicine providers in an acute care setting.3 Among emergency trained providers, residents were found to prescribe opioids to an even lesser degree than attendings.3
The opioid epidemic is one of the most important health crises we currently have on our hands. Here is an interesting read on how Walmart is currently being sued for supposedly fueling America’s opioid crisis. Furthermore, stigma surrounding substance abuse disorders remains as relevant as ever within our society and is often a cause for patients feeling ostracized or reluctant to seek help should they need it.4
Public health experts have since voiced concerns the current coronavirus pandemic may also further exacerbate the opioid crisis. Vital healthcare services have become interrupted or flipped virtually and this does not even take into account the already extensive degree of isolation patients may feel from their support systems at this time.5 In the figure above you will find ten common non-analgesic effects and properties of opioids, counselling patients on what they can expect from their opioid is understandably vital in making sure these medications are not only used appropriately, but also in mitigating the fear that surrounds opioids as a whole.
- Portenoy RK, Zankhana M, Ebtesam A. Prevention and management of side effects in patients receiving opioids for chronic pain. UpToDate. UpToDate; 2021. Accessed February 22, 2021.
- Rauenzahn S, Del Fabbro E. Opioid management of pain: the impact of the prescription opioid abuse epidemic. Curr Opin Support Palliat Care. 2014;8(3):273-278. doi:10.1097/SPC.0000000000000065.
- Leventhal EL, Nathanson LA, Landry AM. Variations in Opioid Prescribing Behavior by Physician Training. West J Emerg Med. 2019;20(3):428-432. doi:10.5811/westjem.2019.3.39311.
- National Institute on Drug Abuse. Addressing the Stigma that Surrounds Addiction. Published April 22, 2020. Accessed February 22, 2021. https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction.
- Williams B. Expert Perspective: The Opioid Crisis and COVID-19. Published January 26, 2021. Accessed February 22, 2021. https://www.psychiatryadvisor.com/home/topics/addiction/opioid-related-disorder/expert-perspective-the-opioid-crisis-and-covid-19/.