The Pharmaceutical Industry's Role in the Opioid Crisis
Drug addiction continues to be one of the major health issues that any country is facing today. Along with the increase in the number of individuals using illicit substances is the surge in the number of deaths caused by opiate overdose. In this article, we will look into the impact of the pharmaceutical industry on the growing opioid abuse epidemic.
The Real Scenario on Drug Abuse
News reports are worsening as each day unfolds, as young individuals start getting hooked early in life. Apart from that, a large majority of the workforce are regular users of illicit drugs, costing companies so much money because of lower productivity, higher absenteeism and higher health care expenditure.
The opioid abuse dilemma has been a longstanding problem in the U.S. For the past couple of decades, the rate of opioid abuse has increased significantly. One report said that the amount of opiate prescription filled in 2010 was already enough to provide for each American – healthy or not – for one month. Just imagine how much money pharmaceutical companies have earned over that time!
The most common opiate drugs abused are heroin, morphine and prescription painkillers. About 2.1 million Americans succumbed to substance abuse related to prescription painkillers in 2012. Meanwhile, about 467,000 were found to be addicted to heroin. These growing numbers are linked to unintentional overdose and an increased in recreational use.
With these facts on hand, the world needs to put all efforts in facing the negative impact of opioid abuse. There is a need to revisit the role of opioids in terms of healing and reducing the suffering of those who are experiencing chronic pain from varying health conditions. The government, together with the pharmaceutical companies, need to come up with scientific insights on how to strike a balance between providing optimum relief from pain while reducing the associated risks and untoward effects that could lead to addiction.
What is pain management?
Pain management is a specialized medical treatment that deals with the pain of different origins – spinal, neuropathic and musculoskeletal pain disorders. It is the primary concern of doctors to provide immediate intervention to reduce the severity of pain being experienced by individuals. Physicians may recommend or prescribe different kinds of techniques for pain management.
What is the primary role of pain management physicians?
Pain management physicians, as the name implies, are specialized doctors who help manage pain that individuals may be suffering from.
A physiatrist – and yes, that’s not a misspelling of “psychiatrist” – is a rehabilitation medicine physician who helps alleviate pain suffered by any patient, may it be related to nerves, muscles, or bones. These doctors can help treat injuries or other illnesses that may affect the normal movement of an individual.
Meanwhile, an anesthesiologist is a trained health professional who treats patients suffering from chronic pain by using a wide range of procedures or medications.
Physicians may undergo specialize training on pain management to have an in-depth knowledge of the physiology of pain and to be able to properly diagnose patients through specialized tests.
Pain Management Procedures and Techniques
Pain management covers a wide variety of procedures that patients suffering from mild to severe pain may receive. Apart from medically prescribed opioid medication, doctors may have the following options to help alleviate pain, such as the following:
- Regenerative therapy
- Radiofrequency ablation and treatment of various nerves
- MRI device implantation
- X-ray-guided spinal and joint injections
- Spinal cord and peripheral nerve stimulation
Highly skilled physicians are the only ones who can perform these techniques.
Proper pain management approaches
Giving the proper pain management involves being able to determine the cause of the pain being experienced by the patient. With an appropriate review of the case, the best pain management option may be provided as soon as possible.
Managing pain should not be focusing solely on treating the body, but it should also include the treatment of the mind. There are a lot of pain medicines that may be prescribed to patients suffering from pain. Some of these include the following:
- Anti-seizure medications
NSAIDs (non-steroidal anti-inflammatory drugs)
Other pain management options are as follows:
- Heat and cold therapy
- Visual imagery
- Transcutaneous Electrical Nerve Stimulation Therapy
Prescription Opioid Abuse: Truths, Facts, Figures
Among the three categories of medications that are prone to abuse, prescription opioids have a more severe impact as they are the most commonly abused substances susceptible to long-term and recreational use.
The increase in the rate of drug abuse may be brought about by several factors:
- Increase in the number of prescriptions written and dispensed
- Increased social acceptability for using medications for various purposes
- Aggressive marketing of pharmaceutical companies
These factors have allowed opioids to be accepted and available. Individuals who use it recreationally can even get access to opioids from relatives or friends who have been medically prescribed for chronic pain treatment.
The increase of opioid availability has been accompanied by a drastic increase in the negative consequences related to abuse. The number of emergency cases involving the recreational use of opioid analgesics increased. From an estimated 144,600 ER cases related to opioid abuse in 2004, the number ballooned to 305,900 in 2008.
Deaths related to prescription opioids have increased in the early part of the 21st century. It was reported in 2002 that opioid analgesic poisoning was the leading cause of death among all other illicit drug overdose cases.
The effects of prescription drug abuse become more dangerous and addictive by crushing pills and then snorting or injecting the powder, or by combining the opioid with alcohol and other drugs. It poses a higher risk to individuals who take more than what is prescribed.
Meanwhile, another group of individuals who may become opioid dependent is people taking a prescription opioid for longer periods. An estimated 100 million Americans are suffering from chronic pain, while approximately 38 million suffer from chronic back pain conditions and at least 17 million suffer from osteoarthritis. Scientists are still in the process of observing the appropriateness of long-term opioid use in outweighing the benefits over the risks associated with chronic use.
The National Institute on Health and the Food and Drug Administration decided in 2002 to require companies who manufacture long-acting and extended-release opioid formulations to organize a post-marketing research on the safety of their products.
Substance abuse is costing world governments a huge sum of money. With regards to illicit drugs alone, the U.S. government spends roughly $11 billion for health care costs.
The most commonly abused opiates include the following:
It is unfortunate how some teenagers have gained access to prescription opioids from their own parents who may have been prescribed to take the medication. Some reports say that some clinics have been robbed of these specific drugs, which are sold in the streets.
Effects of Opioid Abuse
Opioids such as Oxycontin and Vicodin are the most commonly prescribed medication to treat moderate to severe pain. When these drugs attached to the receptors, they help reduce the perception of pain and can result in a sense of well-being.
However, apart from the relief that individuals may experience after taking these medications, opioid use may also exhibit other signs and symptoms such as:
- Mental confusion
- Nausea and constipation
With continuous administration of opioid chemicals in the body, the production of endogenous opioids is obstructed. This results in the discomfort being felt when the drug is discontinued. These are the withdrawal symptoms experienced by an individual who stops opioid abuse immediately.
The use of opioids has two positive effects: the relief from pain, and a sense of well-being and pleasure that triggers the happy house of the brain. Individuals using opioids may somehow at a certain point feel that they need to intensify their experience, thereby taking the drugs in an unconventional manner.
Opioids are produced in the form of extended-release tablets, which are supposed to be slowly absorbed into the bloodstream over a certain period of time. By crushing the tablet and snorted or injected with an aqueous solution, this may increase the effect, resulting in a higher risk of medical complications such as:
- Respiratory arrest
Non-medical use of opioids has become popular among the youth. They are able to access opioids and similar medicines from friends or from people selling them on the streets. They are most often distributed in parties and musical events wherein drugs have become part of the event.
In 2012, it was reported that more than 5 percent of opioid users aged 12 years and older were taking opioids for recreational use.
Prescription opioid abuse is very costly. Insurance companies spend billions of dollars in health care costs for treating individuals who are taking opioid pain relievers for nonmedical purposes. The rate of admission for treating prescription pain relievers has also increased tremendously.
Tolerance to opioids is likely to happen when an individual would no longer feel the same effect with the usual dose that he commonly takes. This would lead the individual to take larger doses until he is able to reach the desired effect. This, in turn, would lead to a possible overdose.
A contributing factor to opioid overdose is when individuals would take them in combination with benzodiazepines and/or other CNS depressants. Therefore, individuals who are under such medications should practice safe administration and should be closely monitored.
Signs of Opioid Abuse
Opioids are painkillers that are most commonly prescribed to help treat pain. However, when these drugs fall into the wrong hands, there is a high risk of being abused.
The short-term effects of opiate use are the following:
- Feeling of euphoria
- Pain relief
Opiates initiate the release of dopamine in the brain, thereby creating a feeling of extreme pleasure. Unfortunately, opiate use may produce unfavorable effects on certain individuals, which include:
- Intermittent nodding or loss of consciousness
- Respiratory depression
- Social withdrawal
One of the very common signs of prolonged opiate use is having smaller-sized pupils.
Meanwhile, long-term use of opiates can cause the following:
- Abdominal distention
- Brain damage
- Development of tolerance
- Liver damage
Some users would crush opiate pills, mix them with water and alcohol, and then inject the concoction into their bloodstream. This practice may cause heart problems as well as pulmonary embolism. Additionally, if the injection site is infected, it may result in gangrene.
Other effects of opiates abuse include a lower immune system, risk of gastric problems, and potential development of cumulative hypoxic end-organ injury.
Teen Opiate Abuse
Vicodin and Oxycontin are two of the most common opioid medications abused by teenagers. According to a report by the National Institute on Drug Abuse (NIDA) in 2014, about 8 percent of high school seniors have used Vicodin. It also said that teens are likely to combine opiates with alcohol to heighten the effect, which leads to more dangerous effects such as severe respiratory depression.
Continued use of opiates may lead to tolerance, which may force the user to take more doses than usual.
Just like taking any kind of illicit drug, habitual use of opioids may lead to dependence. Dependence on the drug may be confirmed through the following signs:
- The user ignores the consequences despite knowing them.
- The individual starts stealing from others just to be able to buy the drug.
- Relationships may be affected.
- Performance in school or at work may be observed to be poorer than usual.
Failure to stop drug use may warrant the help of a rehabilitation center.
It is important to note that there is a possibility for opiate overdose. For this case, some emergency centers administer Narcan, a nasal spray that is primarily used to help the patient recover from difficulty in respiration. However, it is not considered a treatment for opiate overdose; it is used only as an emergency aid before the actual medical intervention.
Treatment for Opioid Addiction
When dealing with addiction treatment involving opioids, physicians and rehab centers may ask for the following information:
- The length of time that the drug has been taken
- The last intake of the drug
- The source of the drug
Treating any type of drug addiction may involve detoxification, a process of reducing the abused drug until the individual no longer experiences withdrawal symptoms. This process usually takes several weeks to a few months, preferably in a rehabilitation center under the supervision of professionals.
Pharmacological treatment may be another option. The drug of choice to help opiate users to get over the addiction is either buprenorphine or methadone. The dose will be decreased each day until the effects of the abused drug wear off.
Withdrawal symptoms are likely to happen when a drug user has stopped taking the illicit substance. Such symptoms include:
- Inability to sleep
In the treatment of a recovering addict, residential rehab or outpatient therapy may be offered. The choice would depend on the individual’s level of opiate use, the amount of insurance coverage, the presence of family support, and any previous attempts to recover.
During the therapy treatment, recovering users are taught a number of coping skills so that they can resist the temptation of getting hooked on the drugs again.
In the event that the individual has recovered from opioid addiction, it is highly recommended that the person undergoes an extended form of therapy such as counseling and support group sessions. This can help the individual to easily get back to his normal life.
More importantly, this kind of therapy can be made more successful when family members participate. In cases of addiction recovery, there is a need for loved ones to understand the kind of journey that the individual has gone through.
Pharmaceutical Companies Involved in the History of Opioid Abuse
All eyes are on drug companies that develop and sell opioid medication. They are allegedly to blame for the opioid epidemic mainly because they have promoted their products in a way that only the positive effects are highlighted while leaving out the risks of these drugs.
Some of the big-branded pharmaceutical companies that have sold the majority of prescription opiate drugs include the following:
- Abbot Labs
- Endo Pharmaceuticals
- Johnson & Johnson
- Purdue Pharma
- Watson Pharmaceuticals
Purdue Pharma was able to generate at least $3.1 Billion in 2010 from Oxycontin sales. The pharma giant advertised that Oxycontin is a suitable, non-addictive medication for treating all types of pain most especially cancer-related pain symptoms. The company was found guilty of misleading the public, leading them to pay a penalty of $635 million.
Between 1995 and 2001, the number of oxycodone-related deaths increased to 400 times and the number of Oxycontin prescription has increased 20-fold, according to the Drug Enforcement Agency.
According to the Organic Consumers Association (OCA), the drug industry is one of the big reasons behind the opioid abuse problem. The consumer group claims the following situations:
- Opioid painkillers have become the first choice for treating lower back pain and other pain conditions, which were then treated with other drugs with milder adverse effects.
- The long-acting opioid pain reliever can be snorted or injected with a combination of an aqueous solution. This has made drug addicts prefer them over other drugs because it can provide them with a different and better kind of “high”.
- Oxycontin became extremely popular because of its eerily similar action as heroin.
Long-term use of opioids has been gravely promoted without much evidence to prove how it would affect the overall health of individuals.
Health professionals were made to believe that these long-acting drugs can provide pain relief of up to 12 hours. In reality, however, the effect wears off less than the number of hours indicated. Therefore, patients would have to endure painful withdrawal symptoms, which lead them to take more of the drug to relieve them from discomfort.
What Pharma Companies Should Do to Help Address Opioid Abuse
While it’s true that pharmaceutical companies have every right to earn, this mindset of profit should not come at the expense of public health and safety. In fact, with the gravity of power and privilege that pharma companies have with their extensive range of medical products, they need to be more responsible in releasing products so as not to trade remedies for long-term illnesses.
What pharmaceutical companies should do is carefully develop drugs that would provide more benefits rather than risks. It may be inevitable for cancer patients to take pain medication, which is why the development of such drugs should revolve around the long-term use of the drugs. Proper and complete information about the action of the drug/s should be made open to the public.
Such aggressive marketing tactics may drive health professionals to choose a particular brand of medications, in the hope that they could provide the relief that patients suffering from chronic pain need. However, much of the work should start from the pharmaceutical companies, as they are the ones that create and develop these drugs.
Alongside this is the need for extensive physician and patient education with regards to the use of such substances, which should include following the guidelines in taking the medication at the right time and the right dose. Information about the possible adverse effects of long-term use of the drug should also be well-discussed to patients.
Physicians should also come up with other options on how to treat pain wherein there should be a limit on the number of doses that a patient should take. By doing this, patients can avoid possible dependence on the drug.
The battle against opioid abuse is far from over. However, aside from the constant fight of the general public against this kind of drug abuse, pharmaceutical companies should be at the forefront of maintaining public safety and health.