Sunday, September 26, 2010

Responsibility is Key to Curbing Opioid Crisis

Opioids911Opioid analgesics are essential for relieving many types of cancer and noncancer pain, so it is not surprising that the prescribing of opioids has dramatically risen during the past two decades. Along with that, however, prescription opioid misuse, abuse, addiction, diversion, and overdose have become what some have described as a public health crisis of epidemic proportions [Stetka 2010]. Unless those safety problems can be stemmed the availability of opioid analgesics for patients in need may become severely restricted.

All authorities have stressed the need for better patient education to help curb the crisis and this is the mission of Opioids911-Safety []. This new, Web-based program for patients and their caregivers provides an understanding of opioid analgesics, their risks, and safe practices to prevent opioid-related problems. Research evidence confirms that a lack of such patient education in the past has resulted in unsafe practices that are driving alarming trends — for example:
  • According to recent government data, 7 out of 10 persons who misuse or abuse opioids get them from relatives or friends who, in many cases, do not understand the urgency of keeping their prescribed opioids in a safe place [SAMHSA 2010].

  • In one study, 72% of patients reported having leftover opioid medication but only a quarter said they properly disposed of it and the rest kept the excess opioids on hand for later use or to share (illegally) with others [Porucznik et al. 2008].

  • Another study found that nearly half of patients prescribed opioid analgesics did not follow directions, with 34% of them admitting underuse and 14% overuse of their pain relievers [Broekmans et al. 2010].

  • An extensive investigation found that less than a quarter (23%) of patients read and/or understand the information and instructions that come with their opioid prescriptions [Wolf et al. 2006].

  • The U.S. CDC indicates that accidental prescription-opioid overdose deaths increased 5-fold, reaching 12,000 fatalities in 2007 and greatly exceeding deaths due to cocaine and heroin combined [CDC 2010].

  • In an investigation of prescription-opioid-related deaths, the majority of fatalities (65%) occurred within one week of a change in medication dose; most were discovered in the morning in bed and nobody had watched over them during the night [Webster et al. 2010].
Many of the reported problems with prescription opioids could be avoided if patients follow safe practices and know how to handle opioid emergencies if they do occur. In short, patients should and can assume greater responsibility for opioid safety but they need education in order to do that.

It seems reasonable to expect that most persons will use their prescribed opioid pain relievers responsibly and safeguard them from doing others harm IF they know what to do. Necessary information has been widely scattered over the Internet and available from other sources; however, is a first-of-its-kind resource bringing all the essentials together in one convenient place for patients, their caregivers (relatives or friends who help look after them), and their healthcare providers.

The website has four sections providing an understanding of the various types of opioid pain relievers and their risks, along with specific safety-action steps for preventing opioid misuse, abuse, addiction, diversion, overmedication, and life threatening overdose. Plus, there are life-saving instructions for what to do in an opioid-emergency situation as well as links to other helpful resources.

There also are special tools and resources for healthcare providers, since patient education on opioid safety should begin at the point-of-care whenever an opioid prescription is written. These include a slide/flip-chart presentation, instructional handout materials for patients and their caregivers, and other tools for effectively using the Opioids911-Safety program. This is essential because research has shown that two-thirds of the time busy healthcare providers do not adequately instruct patients on critical drug-safety practices [Tarn et al. 2006]. So, this new program makes it easy to start the opioid education process before patients leave the clinic or office.

All contents can be accessed free of charge and without required registration at:

Opioids911-Safety is an independently developed, noncommercial, Internet-based educational program from Pain Treatment Topics ( Construction of the program website was made possible by educational-funding support from King Pharmaceuticals and Purdue Pharma, L.P.

> Stetka B. Unintentional Drug Poisoning Deaths: A National Epidemic. Medscape[online]. 2010 [
article here].
> SAMHSA (Substance Abuse and Mental Health Services Administration). Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. 2010 (Sep 16). Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586Findings, Rockville, MD.
> Porucznik CA, Sauer BC, Johnson EM. Adult use of prescription opioid pain medications — Utah, 2008. MMWR. 2010;59(6);153-157.
> Broekmans S, Dobbels F, Milisen K, et al. Pharmacologic pain treatment in a multidisciplinary pain center: Do patients adhere to the prescription of the physician? Clin J Pain. 2010;26:81-86.
> Wolf MS, Davis TC, Shrank WH, Neuberger M, Parker RM. A critical review of FDA-approved Medication Guides. Patient Educ Couns. 2006;62(3):316-322.
> CDC (Centers for Disease Control and Prevention). Unintentional Drug Poisoning in the United States. 2010(Jul) [
article here].
> Webster LR, Dove B, Murphy A. Select Medical-Legal Reviews of Unintentional Overdose Deaths. Presented at: 2010 AAPM Annual Meeting; February 3-6, 2010; San Antonio, TX [
article here].
> Tarn DM, Heritage J, Paterniti DA, et al. Physician communication when prescribing new medications. Arch Intern Med. 2006;166(17):1855-1862.