Commonly prescribed opioid pain medications used to treat acute and chronic pain are a significant cause of death in America. In 2014, The Center for Disease Control and Prevention (CDC) reported a total of 47,055 drug overdose deaths in the United States, 61% were directly attributed to opioids. Drug overdose deaths are the leading cause of injury death in the United States, beating out motor vehicle deaths. So how exactly did America get here? In an effort to improve pain treatment for patients, a national initiative called Pain as the 5th Vital Sign (P5VS) was rolled out in the late 1990s, requiring a pain intensity rating (0 to 10) at all clinical encounters. P5VS was meant to help improve the health and well-being of the 34 million patients in this country that suffer from chronic pain. In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a 5th vital sign. It required healthcare providers to ask every patient about their pain level. Since that time, the United States has experienced a surge in opioid prescriptions, and an increase in opioid overdose deaths.
One problem with assessing pain as a vital sign is, unlike blood pressure and oxygen saturation, it’s completely, 100% subjective. Based on a scale of 1 to 10, patients have been known to say “my pain is an 11” or even a “100”. Thus leaving the physician in an impossible predicament. Is this patient really experiencing pain far beyond the scale of 1-10? This is a leading cause for an overflow of prescription painkillers being written on a daily basis.
Another issue with the initiative is that the goal was to get the patients pain to a zero out of ten. The goal should be getting a patient to the point where they can manage their pain in their daily routine. Being functional in society and being a productive member of their family. Unfortunately for those with chronic pain, the concept of being pain-free may be unrealistic. Some with chronic pain must be completely sedated before you experience zero out of ten pain. Over prescribing of opioid pain medication will not improve your life, it has the potential to erase it, and for an opioid addiction to kick in.
The tug of war match between acute and chronic pain has effect millions. Acute pain patients are becoming addicted to opioid pain medication and those with chronic pain are finding it harder to obtain their needed prescriptions due to the crack down on opioid prescribing. Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014. CNN recently released an article detailing the extend of the opioid dependence. They found that much of the increase in opioid dependence occurred since 2011, a period marked by increased attention to the problem and advocates calling on doctors to reduce the number of opioid prescriptions. Those who depended on their monthly opioid painkiller medication were switching to more powerful and cheaper street heroin to get their fix.
As America scrambles to fix the opioid epidemic currently rattling their country, new policies and laws have passed. In 2014, federal health officials reclassified certain drugs containing opioids, making refills harder to get. Last month, President Obama signed the Comprehensive Addiction and Recovery Act of 2016, which aims to make prevention and treatment more available. Most states have begun utilizing prescription drug monitoring programs, which aims to help identity and track people who are “doctor shopping “, in order to get multiple prescriptions for opioid painkillers. Pharmacists or physicians can check those databases to see if a particular patient already has a prescription for narcotics before dispensing another. Ending the epidemic is going to be an uphill battle. Millions are already addicted and needing treatment, to may be years before we see a large decrease in opioid addiction.
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