Seppala Marvin D. - Prescription painkillers: history, pharmacology, and treatment

Eighty percent of the worlds supply of opioid medications is used in the United States, in a country with only 4.6 percent of the worlds population. This reveals the opportunity for both tremendous therapeutic advances using these medications, often simply called prescription painkillers, to address pain and suffering, as well as the potential for abuse. This quandarythat these medications are the best and basically the only available medications for moderate to severe pain and are highly reinforcing and potentially addictinghas driven clinical decision-making and government policy throughout U.S. history. The dramatic increase in prescription opioid abuse over the past fifteen years has received significant attention from diverse branches of the federal government. The Drug Enforcement Administration (DEA) has directed more resources to address issues of prescription opioid diversion; the National Institute on Drug Abuse (NIDA) has funded research to examine the appropriate treatment of prescription opioid addicts at the same time pain has become a vital sign to be used in hospitals accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) around the country; and the National Institutes of Health (NIH) has funded research into the use of these medications in the treatment of a growing medical problemchronic pain. Despite these efforts, opioid abuse has become commonplace, and opinions vary widely on the appropriate government response, medical care, and treatment of people who are addicted to opioids.

This book provides an overview of the major aspects of the tremendous dilemma associated with the prescription opioids in the United States. Here is a chapter-by-chapter outline of the topics covered:

• Prescription opioid abuse is the fastest-growing addiction in the United States. These medications are readily available, and many people naively believe they are safe for recreational use, because they are prescribed. All of the problems and tragedies associated with opioid abuse are increasing proportionally to the increased documents the chilling extent of the problem.
• The historical background of opioid use and public policy in the United States is examined in to provide a context for understanding our current status and make sense of the federal system as it pertains to current law, oversight, and control of these medications. The medical sciences have not provided the entire framework for our policiesfear and stigma have played a major role in federal decision making regarding these medications, and continue to do so.
• In , the availability and use of these medications will be described in a manner that links the extent of the problem to those contributing to the supply network. Some risk factors associated with the use of these medications are identical to all other drugs of abuse; others are specific to the prescribed opioids, such as treatment for pain. People obtain these medications in diverse ways. Some people see multiple physicians to obtain enough medication to maintain active addiction; others purchase medications from drug dealers who get their supplies by diversion at every step of the distribution path from the manufacturer to the physicians office. The network includes pill brokers purchasing opioids from older adults on fixed incomes, who sell some or all of their prescribed opioids, whether they need them or not, to supplement their income. Our access to these medications has changed dramatically with changing views of the treatment of pain.
• There are numerous opioids available in the United States and many routes of administration for which they are intended, resulting in many drugs available for abuse and multiple ways to use them to get high. The use of the drugs and those that are available in the United States are described in the case of OxyContin is used to reveal how a medication thought to have a lower potential for addiction was easily altered to provide an immediate, potent high. OxyContin is also used to examine not just illicit diversion of a new opioid, but also marketing of opioid medications and controversy associated with the treatment of pain.
• Treatment for opioid addiction completes the text, in . Opioid addiction, being the oldest drug addiction, has been treated for centuries, yet we do not have tremendous success rates (especially for heroin) and continue to have controversies. The prescribed opioids may require different treatment methods than heroin, but at this time, one can summarize by saying we have adapted treatments for heroin addiction to treat this rapidly growing problem. Perhaps that is reasonablewere talking about opioids, not different classes of drugsbut the research is not clear about this. Prescribed opioids are commonly taken orally, but can be used intravenously, like heroin. They are smoked like heroin, and have identical effects in the brain. Some say heroin is more potent, but prescribed opioids like fentanyl and sufentanil are tremendously more powerful. The common treatment methodsmaintenance and abstinenceand their attributes and shortcomings will be described. The availability of Twelve Step groups for opioid addiction is also discussed in-depth.

This book provides readers with a solid foundation regarding the multifaceted problems associated with prescription opioids in the United States. Although the United States uses the majority of the worlds prescription opioids, we are not the only country experiencing increasing problems with opioid addiction and all the regulatory questions associated with them. Knowledge of the problem provides the opportunity for healthy debate.

In my professional work, I oversee the care and treatment of people struggling with addiction, and I use that perspective to provide a broad examination of the current situation. I hope this book gives you an opportunity to learn more about this troubling, growing problem and even spurs you to become active in finding solutions.