Contemporary Social Problem

Abstract
Opioid is a misused prescription drug that is causes problems in today’s society by interfering with everyday life living among children and adults. As I begin to think about prescription opioids and how it is abused, I wanted to know more about how it is being abused among and in society in today’s usage. I did not know what opioid means until I went on the internet and looked for the definition to the word opioid. On the website: www.webmd.com, the WebMD stated, “Opioids are a type of narcotic pain medication. They can have serious side effects if you don’t use them correctly. Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body. They reduce the sending of pain messages to the brain and reduce feelings of pain. Opioids are used to treat moderate to severe pain that may not respond well to other pain medications” (www.webmd.com).

A. Opioid drugs users gain an addiction while being for pain. V.Prescription Opioid Abuse in Chronic Pain: A Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse A. Opioid users abuse prescription drugs due to chronic pain, co-occurring substance use disorders, and mental health disorders. VI.Prescription Opioids, Overdose Deaths, and Physician Responsibility A. Finding out information on how using prescription opioids can cause death when over used by taking a lot of pills. VII.Prescription drug abuse: Problem, policies, and implications A. Finding out how fast the abuse uses of prescription drug are affecting society. VIII.Medically-induced opioid addition reaching alarming levels A. The increase of opioid addition has changed for the worse that is causing a bad habit in which people are breaking the law.

In my research paper, I will be quoting throughout my paper different information stated by different people who actually have studied about opioid drugs and have it affects society a whole. I have do not know much about the substance of opioid, so that is why I quoted some materials that knew exactly how to prove the correct information about opioid drugs abuse. Beard, Cicero, Inciardi, & Surratt mentioned, “In the opinion of police, prosecutors, and regulatory personnel, the major prescription drug subject to diversion and abuse was hydrocodone, and the biggest diverters were doctor shoppers, followed by students bringing drugs in from out of state.

These agency individuals were unable to provide any additional information, given the focused nature of their investigations. This estimation of who the diverters are might be contrasted with the contentions of the focus group participants, who also included the elderly and pain patients as major sources of their drugs. Other sources included pill brokers and dealers, doctor and (emergency room) shoppers, open air drug markets, family and friends, “script docs” (physicians who knowingly violate the law by writing prescriptions for opioids and other drugs for a fee and without a physical exam), and nurses. Although a handful of participants had some form of medical insurance, virtually all of the drug purchases from pharmacies, script doctors, and dealers were made with cash. The Elderly is a consistent theme among the focus group participants was that many members of the elderly population in Wilmington were in the business of deceiving their physicians because they could complain of pain (whether they were in pain or not) and get prescriptions they wanted.

Some of these elderly individuals were reportedly abusing their drugs, but the overwhelming majorities were diverting their medications for economic reasons. Some sold their prescriptions on their own initiative, while others would work in conjunction with a dealer or pill broker. It was clear from the focus groups with prescription drug abusers that the elderly generally were not drug dealers, but filled their prescriptions and sold part or all to a few abusers known to them, as well as to dealers or pill brokers for much less than the street value of the drugs. For example, one female prescription drug abuser in her early 30’s explained: In my neighborhood we have a lot of old people who get these pills prescribed; they get methadone prescribed; they get needles and all that, and that’s how they make their money. I have 20 different old people that I can go to [to get prescription opioids. Similarly, a young male polydrug abuser echoed: The elderly have a lot of 80 milligram Oxys (ER oxycodone); everybody got the big green pills, and everybody had Xanax.

There were old people that were, especially this lady, that was doing like 5 or 6 doctors and getting all kinds of prescription pills. They were just giving them to her. She was just selling them. And yet another explained: I’ve seen a lot of older people who don’t have a lot of money get addicted to getting the money from the pills that they sell and they’ll go from doctor to doctor, shopping for pills to sell to people. Pain patients are another prominent theme among the focus group participants, dealers, and pill brokers was that many patients who were suffering from serious pain would use part of their medications and sell the rest because of a need for cash. Some were dependent on street drugs, and would sell/exchange prescription drugs for heroin or crack. Several patients would reportedly ask for additional prescriptions from their pain management specialists, which they would fill and sell to an abuser, a drug dealer, or a pill broker. Also common in this group was selling supplies of unused medications.

For example, one male dealer in his early 20s explained: The people that I knew that had fentanyl patches and fentanyl lollipops. They had them for like back pain, or they were in an accident or something, and a lot of them were addicts but they wouldn’t take their patches and stuff. They would trade them off for other drugs like crack or something. Also: I was buying my fentanyl patches from somebody who was getting them prescribed because of back problems. And sometimes they want their crack money so they’re going to get rid of their pain pills. Dealers, Brokers, and Drug Markets as noted earlier, prescription drug dealers are typically abusers who hustle prescription medications and other drugs whenever and however they can, to help support their own drug habits. Pill brokers, on the other hand, tend to specialize in only one or two drugs. A few, however, buy and sell any type of prescription medication. It was consistently reported in the focus groups with prescription drug abusers that pill brokers develop name, address, and medication lists of individuals who they know are willing to sell their medications.

They also maintain a roll of elderly individuals who are willing to deceive their physicians, have their prescriptions filled by certain local pharmacists, and then sell their pills back to brokers at only a small percentage of their street value. In the in-depth interviews pill brokers themselves confirmed the sophistication of their brokering operations, such as tracking when their contacts’ various prescriptions run out, maintaining a network for contacting these individuals, and arranging for doctor’s visits, refills and transportation as needed. As one prescription drug abuser in his early 20’s explained: Once people (pill brokers) know you take them prescription opioids, they’ll start calling you. “Oh, it’s this time of the month.” Then they wait for that person to get their script. They know exactly in their head what day the script’s getting ready to come so they got the patterns down.

Pill brokers and dealers reported congregating in open air drug markets typically strip mall and pharmacy parking lots, and outside methadone clinics to buy, sell, and trade prescription drugs. These markets were reported to involve a variety of transactions, including the purchase of prescription drugs for cash, as well as trades for crack and heroin. Pill brokers also reported the purchase of used fentanyl patches from nurses who have stolen them from pain patients or from disposal containers in hospitals. Some individuals frequenting the drug markets also barter their oxycodone for other opioids or benzodiazepines, typically alprazolam. Doctor Shopping focus group participants indicated that even in a small state like Delaware, doctor shopping appeared to be fairly easy.

The vast majority of abusers reported obtaining medications through doctor shopping, and most reported frequenting at least four physicians in order to obtain sufficient amounts of their desired medications. Occasionally clinics and hospital emergency rooms were reported as locations for doctor shopping as well. A heavy user stated: Another focus group member was saying about the doctors, it’s out of control. I had 8 doctors that would give me four or five different kinds of painkillers at one time” (Beard, Cicero, Inciardi, & Surratt, 537-545).

On the other hand, in 2008 W.C. Becker, R. A. Desai, D. A. Fiellin, L. E. Sullivan, & J. M. Tetrault stated, “{Data on licit and illicit substance use frequency and type were obtained via a self-report questionnaire. NMU was assessed by the following question, derived verbatim, from the NSDUH: “Have you ever, even once, used one of the medications listed below that was NOT prescribed for you or that you took only for the experience or feeling it caused?” For each medication listed, respondents checked whether or not they had “used in the past 12 months.” The list was comprised of the following prescription analgesics: Buprenorphine, Codeine, Darvocet, Demerol, Dilaudid, Fioricet, Fiorinal, Hydrocodone, Methadone, Morphine, Oxycontin, Percocet, Percodan, Propoxyphene, Talwin, Tylenol with Codeine, Tylox, Ultram, and Vicodin. As done previously, we excluded respondents whose only past-year non-medical analgesic use was Fiorcet and/or Fiorinal because these medications are not opioids.

Alcohol use was assessed by the Alcohol Use Disorders Identification Test (AUDIT). Drug abuse and dependence and opioid abuse and dependence were collapsed into drug use disorder and opioid use disorder, respectively. All participants were administered the AUDIT and were grouped into alcohol-related categories in a hierarchical fashion based upon their AUDIT responses}” (Becker, Desai, Fiellin, Sullivan, & Tetrault 1136-1137). The article Traci C. Green, Ryan Black, Jill M. Grimes Serrano, Simon H. Budman, and Stephen F. Butler wrote said, “The current study is the first latent class analysis of prescription opioid use in a population of individuals being assessed for substance use problems from a large and diverse sample of such respondents in the U.S. Due to the high degree of specificity of the ASI-MV database, we were able to explore patterns of prescription opioid use that incorporated route of administration, source of drug, and product-level indicators of non-medical use for short and long-acting opioid medications.

Our results show that four unique groups of prescription opioid users could be identified within this sample: use as prescribed class (class 1), prescribed misusers class (class 2), medically healthy abusers class (class 3) and illicit users (class 4). These groups differed in key ways relevant to public health and clinical intervention, including: age, race/ethnicity, concurrent drug use, onset and duration of their drug use, routes of administration, and co morbid psychiatric and medical problems, among others. Several of our findings converge with other studies of trends in prescription opioid abuse. Data comparing 1998 to 2008 substance abuse treatment admissions involving prescription opioid pain relievers from the Treatment Episode Data Set (TEDS) showed a four-fold increase in admissions, with notable increases in the proportion of people reporting pain reliever abuse with a co-occurring psychiatric disorder.

In general, the TEDS sample of prescription opioid abusers is demographically similar to the current study population (i.e., predominantly non-Hispanic White, aged 18-34 years sizeable and growing proportion of females). However, the NSDUH and NESARC are household-based samples and exclude incarcerated populations, those who are homeless, and other marginalized populations whose exclusion or non-participation may lead to an under-counting of the extent and nature of drug use in the community” (Black, Budman, Butler, Green, & Serrano 11). Marilyn Byrne, Laura Lander, and Martha Ferris expressed, “In recent years there has been a dramatic increase in the abuse of and dependency on prescription opioid pain medications (also known as narcotics). Viewed as safer than street drugs like heroin, prescription pain misuse is on the increase in age ranges. Frequently abused prescription pain medications include hydrocodone (Lorcet, Lortab, Vicodin), oxycodone (OxyContin, Percocet, Percudan), codeine (Tylenol 2s, 3s, and 4s), fentanyl (Duragesic), and morphine (MS Contin).

These drugs are commonly prescribed for acute pain (for example, tooth, post-injury, or surgery pain) or chronic pain (for example, back pain or pain associated with malignancy). For social workers addressing the problem of prescription pain pill dependence, there are four primary areas of intervention: treatment, education, advocacy, and research. Treatment should be provided through a multidisciplinary, abstinence based approach, with physicians and social workers collaborating by using evidence-based treatments such as those described earlier” (Byrne, Ferris, & Lander, 1). The Lorcet abuse help website indicated, “Lorcet is an opiate commonly prescribed for mild to moderate pain. Lorcet is comprised of hydrocodone and acetaminophen. Hydrocodone is an opiate that gives Lorcet its addictive qualities, and acetaminophen is added to enhance the effects of hydrocodone. Even when taken as directed, there is still a risk of becoming addicted to Lorcet.

Lorcet is being abused when it is taken more frequently or in larger doses than prescribed, or when it is taken with other drugs or substances such as alcohol. There exists a wide range of cultural factors that can influence Lorcet abuse, from the environment a person lives in, to the glorification of drug use in the media. No matter what influences a person to begin abusing Lorcet, rehab is the great solution that helps people regains normal healthy lives. The media spotlight on celebrities and drug use may have a direct impact on the abuse of painkillers such as Lorcet. Celebrities and their substance abuse problems make headlines on a regular basis. To some, abusing Lorcet may seem inconsequential if celebrities are seen carrying on a successful career while abusing drugs. However, addiction usually leads to the downfall or even death of high-profile celebrities who fail to get help. There also exists an abundance of movies, television shows, and music that glorify drug abuse, all of which are available with just the click of a mouse.

Young, impressionable minds could be easily influenced by such media to believe that experimenting with drugs such as Lorcet isn’t dangerous. At the age of 18, many young adults are beginning a college education or moving away from home, free from parental supervision. Young adults are often introduced to abusing Lorcet and other substances through pressure from friends. It is important that young adults be educated about the consequences of abusing prescription medications such as Lorcet so that they may resist giving in to peer pressure. These side effects may include the following: liver damage, severe mood swings, depressions, unusually high fatigue, hallucinations, paranoia, dizziness, and nausea. Lorcet abuse can lead to acetaminophen overdose. Acetaminophen has a recommended maximum dose of 1 gram (1000 mg) only 4 times (4 grams, 4000 mg) per day.

Some Lorcet prescriptions contain as much as 750 mg of acetaminophen per tablet. Large doses of acetaminophen can lead to liver damage and reduced kidney function. Drinking alcohol while taking Lorcet increases the negative effect acetaminophen has on the liver. Developing liver disease (cirrhosis) is common when taking Lortab and abusing alcohol or other drugs containing acetaminophen. Lorcet sedates users, and if used in combination with another sedative drug or alcohol muscle sedation can occur. Muscles become overly relaxed, resulting in loss of motor function or respiratory failure. Major organs such as your heart and lungs are muscles, and sedation of these essential organs can lead to death. Sedation and loss of inhibition also leads to serious lapses in physical, mental and emotion self-control. The financial consequences of Lorcet abuse can be devastating. Users may lose their job or be passed over for promotion.

They may have trouble paying bills or even putting food on the table, as Lorcet becomes the priority. Desperate measures may be taken to acquire the drug. Inner cities are where a large portion of illicit drug use is found. Such areas provide greater accessibility to these substances, and the people who inhabit inner cities are often poorer, less educated about the risks of drug use and overall less healthy. Prescription drugs are some of the most sought-after illicit substances. There is a reason these drugs are not available over the counter, and medications like Lorcet are not safe to use without the strict supervision of a medical professional. In some cities opiates like Lorcet are abused as much as their illegal counterparts. Lorcet creates a strong high, especially when combined with other drugs and alcohol. Combining Lorcet with other drugs is extremely unsafe, and dangerous side effects increase in likelihood. Lorcet is often easier to obtain than heroin or cocaine, and users often believe drugs labeled as medicine are safer than illegal drugs.

However Lorcet abuse comes with the same risks as any drug misuse and can lead to addiction and serious life consequences” (www.lorcetabusehelp.com). The article from the lorcet dependency mentioned, “People who are in severe pain will often do almost anything to make the pain stop. Pain can affect a person’s ability to think and function normally. Medication, like Lorcet, that is used for pain management is often based on opiates. Opiates change brain chemistry and affect the central nervous system, blocking pain receptors. Instead of pain, the person feels a sense of euphoria, known as a “high,” that heightens awareness and makes reality seem distant. Lorcet is the trade name of a drug that combines an opioid called hydrocodone with acetaminophen, the principal over-the-counter drug in Tylenol and other painkillers. It is available in the United States by prescription only and is used to relieve moderate to severe pain or suppress coughing. More popularly known versions of this same drug combination are Vicodin and Percocet.

This pain medication is available in tablets, capsules, and in liquid form. The ease in which Lorcet can be ingested and the tolerance that some people develop for the drug means that Lorcet use can slip into abuse with and without conscious intention. It is important to be able to recognize the signs of Lorcet abuse in yourself and your loved ones, because misuse of the drug can lead to serious health complications, dependency and addiction. The hydrocodone component of Lorcet is a narcotic that is comparable to morphine and heroin. Like those two drugs, hydrocodone affects the chemistry of the brain and can be habit-forming if usage directions are not strictly followed. How addictive is Lorcet? It can be highly addictive, if the drug is misused or used for an extended period of time. Addiction is a function of interrelated factors. The level of use that qualifies as an addiction is different for each individual.

A person can misuse Lorcet and develop physical and psychological dependencies without necessarily developing an addiction to the drug. Conversely, a person who is not in pain but uses Lorcet for its euphoric properties is more likely to be in the grip of a traditional addiction that requires structured intervention. Pain management is a critical part of health care. It is doubly important to people who experience chronic pain. The hydrocodone in Lorcet is the most frequently prescribed pain management narcotic in the United States. It is also abused more often than any other narcotic. It is a doctor’s responsibility to put a patient on a safe dosage schedule that will prevent Lorcet dependence; however, the debilitating nature of pain and the possibility that a person can develop a tolerance for the drug mean that a person can start misusing Lorcet without fully understanding the consequences. The issue of tolerance, in particular, is a tricky slope. Some people naturally adjust to opiates, so it takes a constantly increasing dosage to achieve the same level of pain relief. Dependency can start with a simple need to make the pain stop, when the last dose has worn off too soon.

It is important to be able to recognize the signs of physical and psychological dependence in yourself and others. If a person experiences a strong desire to deviate from the prescribed dosage schedule and regularly takes Lorcet in greater amounts or more frequently than directed by a doctor, he or she may be dependent. The dependency may be physical if failure to take the drug results in restlessness or insomnia. It may be psychological if the person seems to be experiencing pain while not under the influence of the drug, when no pain should be present” (www.dependency.net). Manchikanti, Sehgal, & Smith in 2012 wrote, “Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids.

Opioid abuse and misuse occurs for a variety of reasons, including self medication, use for reward, compulsive use because of addiction, and diversion for profit. Treatment approaches that balance treating chronic pain while minimizing risks for opioid abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic noncancerous pain has increased dramatically in the past 2 decades in conjunction with a marked increase in the abuse of prescribed opioids and accidental opioid overdoses” (ES67-ES92). A. Thomas McLellan and Barbara Turner believes, “The study of overdose deaths in West Virginia by Hall and colleagues in this issue of JAMA1 revealed that opioid analgesics contributed to 93% of those deaths and most of these potentially avoidable deaths occurred in younger persons (aged 18-44 years). These disturbing findings are certain to raise questions about physician prescribing practices, the safety and adverse effect profiles of opioid medications, and the appropriate management of pain.

These findings also raise several important questions for physicians who are trying to balance their duty to relieve pain in individual patients and their obligation to prevent the broader public health problems of addiction and overdose death. First, do these overdose deaths suggest excessive opioid prescribing practices? The 2006 death rate from unintentional overdose by prescription drugs in West Virginia was 16.2/100 000 population, more than 2 times higher than the US average of 5.6/100 000 population during the same period. Also, from 2000 to 2005, the number of opioid prescriptions in West Virginia increased at a higher rate than in most other states, although rates of opioid prescribing increased significantly in all states. Second, what does the study by Hall et al suggest about the role of addiction in overdose deaths and about physician responsibility for addiction? In this study1 79% of the cases of overdose deaths also tested positive for alcohol and other drugs, suggesting that many to most of these individuals were addicted.

But 56% of decedents had no registered prescription for an opioid and another 20% had misrepresented themselves to 5 or more physicians to receive opioid prescriptions (“doctor shopping”). Third, what do the data from the study by Hall et al suggest about the role of prescription diversion and overdose deaths and, in turn, about physician responsibility for prescription diversion? Among the most concerning findings from this study was that 56% of those whose overdose was attributed in part to “prescribed opioids” were never actually prescribed these medications. Some patients with legitimate need for pain medication may have sold part of their prescription, either to supplement their income or to pay for that prescription. Some opioid prescriptions may have been obtained from physicians through frank deception, perhaps by individuals who convincingly portrayed false pain symptoms repeatedly and to multiple physicians” (MeLellan & Turner, 2672-73). Janice Phillips discovered, “Prescription drug abuse has emerged as the nation’s fastest growing drug problem, stimulating renewed concern and activity nationwide.

During the 112th Congressional session, lawmakers introduced several legislative bills in response to this growing epidemic. Each legislative bill addresses prescription drug abuse from a different perspective. The National Institute of Drug Abuse definition is the definition used by many of the national data surveys or data collections systems and will be used to define prescription drug abuse in this paper. Experts in the field are careful to distinguish between the misuse of prescription drugs and the abuse of prescription drugs. The misuse of prescription drugs may occur when one takes a prescribed medication at an improper dose or in a manner not recommend by the legitimate prescriber. In contrast, prescription drug abuse relates to one’s intention or motivation to seek a pleasant or euphoric feeling by taking a drug” (Phillips 78-80).

Paul Webster noted, “Fischer and Jürgen Rehm, director of the Social and Epidemiological Research Department at the Centre for Addiction and Mental Health in Toronto, Ontario, warned the federal government in a recent report to the Department of Justice that Canada isn’t doing enough to track opioid abuse or treat medically induced addiction. Canadians are among the highest users of prescription opioid in the world, Fischer and Rehm say, adding that their report informed the government that overall usage of prescription opioids has more than doubled over the past decade. While widespread use of illicit opioid use has been widely reported, the researchers say they are increasingly concerned that vast numbers of “medically dependent” addicts are being created simply by following doctors’ orders.

“I think it’s fair to say that the number of patients who develop an addiction in Canada is sufficiently high that prescribers and public health authorities should be concerned,” says Dhalla” (Webster, 1). In conclusion opioid prescription pills are used for pain but people misuse the drugs to get high. The usage of the opioids can cause several harmful problems to the body. It can also cause death. I feel like the abusers are not aware that are addicted so they continue until they depend on it. I hope everyone who is on opioids carefully watching the usage of it.

References
Barry, D. T., Becker, W. C., Fiellin, D. A., Gordon, A. J., Goulet, J. L., Justice, A. C., & Kerns, R. K. (2011). Non-medical use of prescription opioids and pain in Veterans with and without HIV. Current Research in National Institute of Health, 152(5), 1133–1138. Beard, R. A., Cicero, T. J., Inciardi, J. A., & Surratt, H. L. (2009). Prescription Opioid Abuse and Diversion in an Urban Community: The Results of an Ultra rapid Assessment.
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Inner City Lorcet Use. 2010-2013
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Webster, Paul. (2012). Medically-induced opioid addition reaching alarming levels. Current Research in CMAJ, 109(1).