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 (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) are considered relatively safe options that usually do the trick in helping to relieve pain; however, they may not be enough. The reality is 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 issues that may arise at this point when we consider opioid management: under prescribing to the point that patients may remain in pain or overprescribing to the point that patients may misuse. A review of opioid pain management concluded although efforts have been made to address the opioid epidemic by monitoring prescriptions electronically or increasing education among patients/providers, there has been limited evidence of significantly improved health outcomes2. In addition, there are valid concerns that tighter regulations are causing providers to under prescribe or undertreat pain even in advanced stages of cancer2. 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 (among emergency trained providers, residents prescribed opioids to an even lesser degree than attendings!)3.
In the figure above you will find ten common non-analgesic effects and properties of opioids that may help you remember important information to go over the next time you find yourself educating a patient on what they may expect from their opioid. As a whole, the opioid epidemic is one of the most important and relevant 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. Even in the case where opioid management is appropriate, you may still come across people who refuse an opioid out of fear for addiction. It makes sense when understanding the degree to which 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 from providers4. Public health experts have since voiced concerns regarding how the current coronavirus pandemic may also further exacerbate the opioid crisis, especially as vital healthcare services have become interrupted or flipped virtually (this does not even take into account the already extensive degree of isolation patients may feel from their potential support systems at this present time)5. With this in mind, 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. I hope you have found this post an interesting read and the best of luck with your studies!
- Portenoy, R. K., Mehta, Z., & Ahmed, E. (2021, January 06). Prevention and management of side effects in patients receiving opioids for chronic pain. Retrieved January 30, 2021, from https://www.uptodate.com/contents/prevention-and-management-of-side-effects-in-patients-receiving-opioids-for-chronic-pain
- Rauenzahn, Sherri; Del Fabbro, Egidio Opioid management of pain, Current Opinion in Supportive and Palliative Care: September 2014 – Volume 8 – Issue 3 – p 273-278 doi: 10.1097/SPC.0000000000000065
- Leventhal, E. L, Nathanson, L. A, & Landry, A. M. (2019). Variations in Opioid Prescribing Behavior by Physician Training. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 20(3). http://dx.doi.org/10.5811/westjem.2019.3.39311 Retrieved from https://escholarship.org/uc/item/6r515181
- NIDA. 2020, April 22. Addressing the Stigma that Surrounds Addiction. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction on 2021, February 15
- Expert Perspective: The Opioid Crisis and COVID-19 … (2021, January 26). Retrieved from https://www.psychiatryadvisor.com/home/topics/addiction/opioid-related-disorder/expert-perspective-the-opioid-crisis-and-covid-19/