The Cause and Effect of Opioid Overprescription

The Problem of Overdosing with Opioids
Introduction
By definition, any incident of overdosing is a problem, but the problem is especially severe in the case of opioids since these can be life-threatening. Moreover, the United States has experienced a veritable epidemic in opioid abuse in recent years to the point where many police departments across the country routinely furnish their officers with Narcon (Naltrexone), a life-saving drug used for opioid overdoses, as part of their law enforcement equipment. Nevertheless, the number of deaths attributable to opioid overdoses continue to increase, and these trends can be reasonably expected to continue unless and until something is done. To determine how opioid overdoses pose a serious public health threat and a discussion concerning how the problem became so pronounced today is followed by a summary of the research and key findings about these issues in the conclusion.
Review and Analysis
Innovations in modern medicine have resulted in the introduction of a number of powerful opioid-based analgesics that are far more effective at relieving pain than any drugs that were available in the past. For example, Dineen and DuBois report that, “Opioids play a unique role in society. They are essential medications [which are] the most effective drugs for the relief of pain and suffering” (1). During an era when effective pain management has assumed new importance and relevance for health care practitioners and consumers, these advances in pharmacology have been countered by the addictive properties of opioid-based medications. In this regard, Dineen and DuBois stress that opioids are “widely feared compounds which are associated with abuse, addiction and the dire consequences of diversion” (1).
Not surprisingly, some physicians have grown increasingly wary of prescribing opioids for pain management, but the above-mentioned emphasis on pain relief together with relentless lobbying efforts by the pharmaceutical industry have caused many to continue overprescribing these medications (1). The reluctance of some physicians to prescribe opioids is readily understandable in view of the alarming statistics that have been compiled by the U.S. federal government and private sector organizations concerning the number of overdose cases that have assumed epidemic proportions in recent years.
Although the precise number of opioid overdose cases remains unknown, statistics aggregated by the National Institute of Drug Abuse show that around 16,000 Americans died as a result of nonmedical opioid overdoses in 2010 alone (2) while figures reported by the Centers for Disease Control place the figure much higher at around 37,000 deaths in 2010 due to opioid overdosing (3). These significant differences may be attributable to the manner in which these respective organizations categorize opioid-related deaths as well as differences in reporting criteria.
More troubling still, though, as shown in Figure 1 below, the rate of opioid overdoses has continued to increase since 2010 due in large part to the continuing over-prescription of these drugs and their propensity for abuse by legitimate prescription holders as well as illicit users.

Figure 1. Drugs involved in overdose deaths: 2000 to 2016 (U.S.).
Source: https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/overdosedeaths1.jpg
As can be discerned from the trends depicted in Figure 1 above, there was a total of more than 64,000 opioid-related overdoses in 2016 that resulted in death, with the largest increases being related to the synthetic opioids, fentanyl and fentanyl analogs, that accounted for more than 20,000 overdose deaths. The total number of deaths due to opioids and a gender breakdown of these fatalities are depicted in Figure 2 below.

Figure 2. Number of deaths involving opioid drugs: 2002 to 2015
Source: https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/ods2016-slide02.jpg
As can be readily seen from the steady progression of opioid overdose deaths during the period from 2002 to 2015, both male and female rates increased and the trends continue to accelerate. Indeed, the editors of American Nurse report that, “The total U.S. overdose deaths involving all drugs, opioid drugs, opioid analgesics (excluding non-methadone synthetic, the category dominated by illicit fentanyl), heroin, heroin and non-methadone synthetics (to capture illicit opioids), benzodiazepines, or cocaine showed the largest increase in the number of deaths involving heroin, with a 6.2-fold increase from 2002 to 2015” (3).
Taken together, it is clear that health care practitioners and consumers in the United States are faced with a double-barreled dilemma. The need to effectively management pain has become the focus of international accrediting organizations such as the Joint Commission and this need has become even greater as the American population continues to grow older in terms of average age with a corresponding increase in the number of age-related disabilities this trend entails. Given the well documented addictive properties of these pharmaceuticals, though, it is equally clear that like gun control, something drastic must be done in order to turn this ugly tide and growing threat to the American public’s health.
Conclusion
The research showed that there are several major problems with opioid overdosing, including most especially the threat these events represents to people’s lives but also the enormous economic costs that are involved. In a day and age when public health officials feel compelled to furnish law enforcement authorities are with a drug to counter the effects of opioid overdoses, it is reasonable to conclude that the problem has become sufficiently well documented to invoke more aggressive responses on the part of the federal and state governments. Despite the need, though, it is also reasonable to conclude that the problem will continue to intensify in severity as long as health care consumers demand pain relief and the pharmaceutical industry continues its deep-pocket efforts to convince practitioners of the efficacy and safety of these drugs.



References
(1) Dineen, Kelly and DuBois, James M. “Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction?” American Journal of Law & Medicine, Vol. 42, No. 1, January 2016, pp. 7-11.
(2) “Overdose death rates.” 2018, https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
(3) “Opioids Drive Increase in Drug Overdose Deaths.” American Nurse, Vol. 45, No. 2, March/April 2001, p. 8.
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