Page 120 nursing.elitecme.com Complete Your CE Test Online - Click Here (NIDA). Opioid withdrawal symptoms include severe flu-like symptoms, including muscle and bone pain; diarrhea; vomiting; insomnia; cold flashes; and involuntary leg movements (Hart & Ksir, 2013). Tolerance is the need to take a higher dosage of a medication to achieve the same effect and is often present with dependence (NIDA, 2016). It is a phenomenon that commonly occurs in patients receiving extended opioid therapy. It may be difficult to decipher if a patient is displaying aberrant drug-seeking behavior or simply requiring a higher dosage to function (NIDA). Addiction is the dysfunction of brain circuits characterized by an inability to abstain from the drug despite negative consequences. Discontinuation of the opioid will reverse tolerance and physical dependence, but the changes in the brain circuitry associated with addiction will remain far longer (NIDA, 2016). Over the last two decades, we have seen a sharp rise in the number of opioid pain medications prescribed. During the 1990s, chronic and cancer pain were recognized as being undertreated (Hansen, Noe, & Racz, 2014). Also during that time OxyContin was touted as being less addictive than other opioids by the manufacturer, which was a complete misrepresentation of the abuse potential of the drug (Van Zee, 2009). The use of OxyContin for chronic noncancer pain was promoted to primary care physicians who were led to believe it carried minimal risk for addiction, which resulted in a 10-fold increase in OxyContin prescriptions for chronic noncancer pain between 1997 and 2002 and higher rates of addiction to OxyContin (Van Zee). From 1999 to 2011, the use of hydromorphone more than doubled, and the use of oxycodone increased by almost 500% (Jones, 2013). In 2010, 29% of drug overdose deaths involved natural and semisynthetic opioids (morphine, codeine, hydrocodone, oxycodone); 12% involved methadone (National Center for Health Statistics [NCHS], 2017). By 2015, the percentage of these overdoses decreased to 24% and 6%, respectively (NCHS). Synthetic opioids other than methadone (such as fentanyl and tramadol) increased from 8% in 2010 to 18% in 2015 (NCHS). Heroin deaths increased from 8% in 2010 to 25% in 2015 (NCHS). According to a published report from Blue Cross Blue Shield, data from its subscribers showed a 493% rate of increase in opioid use disorder diagnoses from 2010 through 2016 (BCBS, 2017). Unfortunately, the treatment rate increase of 65% for opioid use disorder with medication-assisted treatment does not match the sharp increase in those with the disorder (BCBS). According to BCBS, data collected about its subscribers showed the following regarding the use of opioids (2017): ● ● Women age 45 and older have higher rates of opioid use disorder than men have. ● ● Males younger than 45 have higher rates of opioid use disorder than females have. ● ● Patients who fill high-dosage opioid prescriptions have much higher rates of opioid use disorder than those who fill low-dose prescriptions, both in short-term and long-term regimens. ● ● An opioid use disorder diagnosis is 40 times as likely in patients who fill high-dose, short-term regimens than those who fill low- dose, short-term regimens. Nursing consideration: In 2016, in response to an increase in opioid prescribing rates, CDC issued new practice guideline recommendation for the prescribing of opioid use in adults experiencing chronic pain in outpatient settings. Nurses can find the specific recommendations here: https://www.cdc.gov/mmwr/ volumes/65/rr/rr6501e1.htm. Long-term use of opioids for chronic pain should be considered carefully and monitored often. Self-assessment question 10 Which of the following statements is FALSE regarding opioid addiction? a. The Internet is the main source for those who misuse opioid prescription medication. b. Deaths secondary to unintentional overdose of pain medication have quadrupled since 1999. c. Opioids are similar to heroin in chemical makeup and act on the same reward centers in the brain. d. Changes in the brain circuitry in someone addicted to pain medication remain even after the person is no longer taking the drug. Opioid addiction prevention According to CDC (2014), health care providers can use the following suggestions in their effort to combat opioid addiction and overdose: ● ● Use prescription drug monitoring programs to identify patients who might be misusing their prescription drugs and putting them at risk for overdose. ● ● Use effective treatments, such as methadone or buprenorphine, for patients with substance abuse problems. ● ● Discuss with patients the risks and benefits of pain treatment options, including ones that do not involve prescription painkillers. ● ● Follow best practices for responsible painkiller prescribing: ○ ○ Screening for substance abuse and mental health problems. ○ ○ Avoiding combinations of prescription painkillers and sedatives unless there is a specific medical indication. ○ ○ Prescribing the lowest effective dose and only the quantity needed, depending on the expected length of pain. CDC’s recommended guidelines for prescribing opioids can be found here: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. Following is a checklist for guidelines on the prescribing of opioids for chronic pain. EBP alert! Each day 46 people die from an overdose of prescription painkillers in the United States (CDC, 2014). In 2012, more than 259 million prescriptions were written for painkillers, equivalent to a bottle of painkillers for every adult in the United States (CDC). The rise in addiction and overdose rates has resulted in new recommendations for the prescribing of opioid medication.