Opioid dependence

Characterized by physical dependence, drug tolerance, withdrawal, inability to control opioid use and behavioral problems and social dysfunction.

Prescription of opioids remains an important driver of the opioid epidemic in the US.

Limiting opioid prescriptions for a supply of three or fewer days with no compromise, in patient recovery from surgery and results in a significant reduction in chronic opioid use in post surgical patients.

In 2003 estimated 31.7 million Americans utilized narcotics for no medicinal reason sometime in their lives and 11.7 million were users in the previous year.

Each year 48 million US individuals udergo surgical procedures and 5-9% of these patients may develop new persistent opioid use.

Chronic relapsing condition affecting more than 1 million persons in North America.

An estimated 2.1 million Americans had an opioid use disorder in 2016.

Rate of opioid overdose deaths has increased by 500% since 1999.

Individuals recently released from prison or 129 times more likely than the general population to die of an overdose of opioids.

When opioids are discontinued by detoxification or incarceration, the risk of death rises abruptly owing to tolerance if they resume drug use.

In 2004 6.2% of 10th graders and 9.3% of 12th graders used hydrocodone while 3.5% of 10th graders and 5% of 12th graders used oxycodone.

Opioid addiction presently (2014) affects 40 million Americans or 15.9% of the population: more than heart conditions, diabetes, or cancer.

Prescriptions of opioids to patients before the 12 grade is independently associated with a 33% increase in the risk of non-medical opioid use by the age of 23 years.

Opioid use disorders represent the fastest-growing type of drug problem in United States.

Opioid addiction follows a predictable path of progression and is altered by vulnerability of addiction based on genetics, environmental factors, and exposure.

Commonly individuals are exposed to painkillers, through medical treatment or experimentation and their continued use transitions from euphoria to tolerance and withdrawal.

Death from drug overdose can result along with continuing from medical recreational use to addiction.

Estimated 115 Americans die from opioid overdose daily (2018).

An overdose epidemic that has killed more than 72,000 Americans in 2017.

Opioid overdose is in the US are responsible for almost 2000 lives lost monthly.

Since 2012 opioid prescriptions have declined by more than 1/4.

Most commonly manifested as heroin dependence.

More common than previously believed and has been estimated to affect more than one third of patients with chronic pain.

In opioid naïve patients, mini surgical procedures are associated with increased risk of chronic opioid use in the postoperative period (Sun EC et al).

Drug treatment consists of detoxification and maintenance therapy.

Detoxification agents help to decrease withdrawal related problems and complications.

Drugs utilized for maintenance therapy refer to the use of drug substitutes for heroin or narcotic analgesics such as methadone or buprenorphine.

Risks include fatal overdoses, infections, HIV infections, Hepatitis C, social deterioration, violence and crime.

Methadone is the standard opioid substitution treatment.

Methadone reduces major risks in patients willing to undergo treatment with this drug, although 15-25% of patients do not have favorable outcomes.

Diacetylmorphine, the active ingredient in heroin.

Use of injectable diacetylmorphine more likely to keep patients in treatment and reduces the use of illegal drugs and other illegal activities than patients assigned to methadone (Oviedo-Joekes).

Lofexidine (Lucemyra) a central alpha-2 adrenergic agonist that mitigates the symptoms of opioid withdrawal.

Efforts to promote opioid tapering for patients receiving long-term opioid therapy is based on the assumption that removing a treatment without proven benefit and known harms would improve outcomes.

Such opioid tapering is approached with caution as rapid or abrupt discontinuation of opioids should be avoided.

Goals for tapering opioids include minimizing risk,  yet also improving pain and function which require individual care and evidence-based approaches.

Leave a Reply

Your email address will not be published. Required fields are marked *