Ethical Prescribing in a Post-Opioid World

On average, over 130 people in the United States die from opioid abuse every day. The abuse of such substances has become a national crisis, with the CDC reporting more than 700,000 deaths from 1999 to 2017. In 2017, over half of drug overdose deaths were due to opioid abuse.

This is significant for the pharmaceutical industry — the problem primarily comes from the doctor’s office, not the streets. While we may think of illegal drugs like heroin when the term “opioid” comes up, it encompasses many legal prescription medication, including painkillers or synthetics like fentanyl.

Statistically, most opioid deaths come from prescription opioids. These highly addictive prescriptions can cause users to become dependent on them. When the prescribing physician ends the regimen, these users often move on to illegal drugs. For medical professionals, this possibility increases their responsibility to be on the lookout for addicts and prescribe cautiously.

One of the basics of pharmacology is understanding how to administer medication — finding the right medication at the right dose and on the right schedule for each patient. Being alert and monitoring for addiction is an essential piece of this puzzle.

Recognizing the Signs

Medical professionals need to keep informed about addiction and be able to recognize the signs of it. If more prescribing physicians are able to detect symptoms of dependence early on or predict addictive behavior, then they could strike a severe blow to the opioid crisis.

What are some of the signs of opioid addiction? Well, some common traits of opioid addicts are changes in personality, behavior, and appearance. Behavioral changes present themselves in the forms of social withdrawal, notably poor performance at school or work, and getting into financial or legal trouble. Additionally, the physical changes that accompany opioid addiction are apparent in the individual’s actions. They may act clumsier or have slurred speech. But you may also see them displaying chronic flu symptoms, like a runny nose or bloodshot eyes.

If friends and family attend doctor appointments with those suffering from addiction, then physicians may want to warn them of other signs that they could recognize by being close to the patient. New friend groups, mood swings, and a need for money are all potential signs of addiction. As a doctor, nurse, or other medical professional, it’s important that you consider what happens when you aren’t there to see it.

Medical Professionals Holding Themselves Accountable

Medical professionals need to hold themselves accountable for the medications they prescribe to people. A patient’s medical history, personal chemistry, and the severity of their pain should always be considered before an opioid is prescribed to them. While these rules are nothing new and this is a common belief among medical authorities, they’re not always properly enacted due to compromised interests.

For instance, when prescribing a medication, it’s always wise to always consider the therapeutic objective to the drug. Further, a key part of ethical prescribing is to use full disclosure when discussing the risks of the drug. But money has sometimes overshadows one’s pharmacological knowledge.

In other words, doctors have sometimes forgone full safety measures due to what amounts to bribery from pharmaceutical companies. Recognizing how different drugs affect a person’s biology, keeping up to date on new findings, and documenting a patient’s history and journey with drugs is vital to ensure wise medical decisions. However, being in bed with Big Pharma has led some clinicians to turn a blind eye to what the best path of action is for patients.

Anti-Addiction Methods

Where there’s power to prescribe opioids, there is also power to subscribe drugs that combat dependency. For instance, drugs like suboxone now exist to work against short-acting opioid dependence. Heroin users can use suboxone to wean themselves off of their addiction. On the other hand, suboxone can also be addictive and displays opioid effects itself, so prescribing it requires care.

There are other drugs that are important in this fight as well. One of the most notable for fighting opioid overdoses is naloxone, sold under the brand name Narcan. Public training lessons exist for friends and families of users that teach individuals how to apply Narcan in the case of an emergency. Additionally, scientists are working on anti-opioid vaccines, though they’re not yet on the market. And of course, detox and therapy programs are always important.

But what the problem really comes down to is the unnecessary prescription of opioids in the first place. Alternatives to opioids include over-the-counter medication, exercise and physical therapy, and less dangerous prescription drugs. Doctors need to consider these before opioids and not let compromised interests influence their prescription decisions.

A Post-Opioid World

We can only hope that the future sees a decrease in opioid addiction, but in order for that to happen, there has to be change to the prescription systems we now have. Professionals, uncompromised by external influences, need to be on the lookout for patients prone to addiction, and opioid alternatives need to be widely adopted. A post-opioid world could be ours if we choose it, but at this point we require fundamental changes to the systems at play. To alter them means rethinking how the healthcare world works.

Are you a medical professional that’s dealt with an opioid abuser? How did you handle it? We’re curious to know, so please leave your story in the comments below!