The use of opioids is a major health crisis that has infiltrated mainstream America and has led to abuse, addiction, overdose, and death. The number of deaths that have been attributed to illicit opioid use increased sharply in 2015, according to the Centers for Disease Control and Prevention. State and government officials, as well as hospitals and clinics, face a growing challenge with prescription pain medications, which are considered to be the major driving force behind the opioid epidemic. In 2012, the National Institute on Drug Abuse (NIDA) reported that between 26.4 million and 36 million people abuse opioids around the world, and in the United States anestimated 2.1 million patients have a substance use disorder that is associated with an opioid pain reliever. The number of unintentional overdoses related to prescription pain relievers has affected and devastated communities and families across the nation, so it is with great urgency that the issue be placed at the forefront of conversations.
A population that has been particularly affected is middle-aged adults, who have chronic, and at times unrelenting, pain. If their pain is not adequately managed, they are likely to misuse opioids, similar to other populations. Healthcare professionals have the responsibility of providing safe and cost-effective pain management to middle-aged adults without further contributing to the increasing opioid epidemic. We are in the unique position to educate and counsel this population and influence strategies that are needed to provide effective pain control.
It will take a concerted effort and commitment to reverse the current state of affairs. Americans have become the world leader in the use of prescription pain medications. The United States spends about $635 billion on chronic pain, which can affect more people than cancer, heart disease, and diabetes combined.
The existence of severe and persistent pain has the potential to significantly impair mental, physical, and social functioning, and quality of life, but the abuse of opioids can also contribute to fatal overdoses. The ability to effectivelymanage the pain can be challenging for middle-aged to older adults due to comorbid conditions, disease states, and other potential vulnerabilities. But this epidemic must be addressed to prevent the loss of more lives.
With the increasing rate of opioid abuse, there has been a concerted effort to minimize or prevent inappropriate prescribing of this class of agents by regulators, payers, and other agencies. In the process, however, attention has not been paid to the consequences that can come from untreated pain. The goal is to achieve pain management without abusing opioids.
Education should start with primary prescribers, who prescribe about 50% of opiates. Also, education needs to be provided to patients who use these medications. The dose of opioids can be increased by clinicians who may not necessarily possess the formal training or practical background to do so. A multidisciplinary approach that may not require opiates should be applied.
There is still hope to understand this complex issue and how to better manage pain in middle-age adults. The advent of evidence-based recommendations can help guide providers to develop effective strategies for addressing chronic and persistent pain in this population. Middle-aged Americans should not have to suffer the consequences of a system that is currently focused on eradicating this epidemic and not receive appropriate pain management as a result.
Abimbola Farinde, PhD, PharmD, is a professor at Columbia Southern University in Orange Beach, Ala.