Pharmacists Have Key Role in Combatting Opioid Abuse

Gayle N. Scott, PharmD

Disclosures

April 07, 2016

A History of Addiction

The first recorded use of opium, a mixture of alkaloids from the opium poppy (Papaver somniferum) seed, was during the third millennium BC. Opium was later described in the Ebers Papayrus (around 1500 BC.). Paracelsus discovered that opium alkaloids are soluble in alcohol during the 16th century and popularized the use of his preparation, laudanum, for pain and insomnia. Descriptions of opium dependence first began to emerge in the early 18th century. Around the turn of the 19th century, Sertürner isolated the first opiate, morphine, which was used to treat pain and opium addiction. About 7 decades later, heroin was synthesized from morphine and was marketed by Bayer for cough and respiratory illnesses. (Tuberculosis and pneumonia were major health issues at the time.) Heroin was initially claimed to be a nonaddictive alternative to morphine and codeine.[1,2,3]

The misuse and abuse of opioids, a general term referring to all drugs that bind to opioid receptors, has since risen to epidemic proportions in the United States.[4] Although nonmedical use of prescription opioids (ie, diversion to people for whom the prescription was not written) actually decreased between 2003 and 2013, the prevalence of prescription opioid use disorders, frequency of use, and opioid-related mortality increased. Each day, 44 people in the United States die from an overdose of a prescription opioid.[5,6]

Ironically, the current issues with opioids are likely the product of efforts to improve patient care. The mid-1990s concept of pain as the "fifth vital sign" was quickly adopted by national healthcare organizations such as the Veterans Health Administration and the Joint Commission on Accreditation of Healthcare Organizations.[7,8,9] Assessment, documentation, and treatment of pain were pushed to the forefront of patient care. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, which is linked to government reimbursement for the care of Medicare and Medicaid patients, includes pain management as a determinant of patient satisfaction.[10]

Healthcare providers may feel pressured to prescribe opioids. A 2010 estimate suggested that enough opioids were sold in the United States for every adult to receive 5 mg of hydrocodone every 4 hours for 1 month.[11] In 2014 (the most recent data available), more people died from drug overdoses in the United States than during any previous year on record, with such deaths exceeding those from automobile accidents by 50%.[12]

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