With the ever-increasing number of opioid abuse cases in the United States, we have to look at where so much of this family of drugs are coming from. While heroin does account for a large percentage of the problem, a growing concern is what is often referred to as “chronic pain opioid diversion.”
What is Opioid Diversion?
Simply put, chronic pain opioid diversion often occurs when a person who has been prescribed an opioid-based drug to control their chronic pain begins to abuse it, give it to friends, or exchange it on the black market. The problem with opioids is that the human body becomes used to their effects,. Soon it takes more of the drug to achieve the original desired results, whether that be pain management or the “high” associated with using opioids.
What Does Opioid Diversion Have to Do With Chronic Pain?
The most common form of chronic pain opioid diversion occurs when those who have been prescribed these medications give them to family or friends who are often trying to self-medicate a common pain.
On the other hand, someone who is so addicted to opioids can seek out illicit sources to obtain more drugs than they are prescribed at one time. Since ethical doctors won’t prescribe too many, as opioid addiction is well-known today, sometimes a person with chronic pain will grow a tolerance. This means they no longer feel the relief they desire from the doctor advised dosage. Therefore they might seek drug dealers, illegal online opioid vendors, or acquaintances in order to obtain more and more opioids.
More often than not, chronic pain opioid diversion occurs when these medications are taken more for their rewarding effects. They are frequently injected (heroin) or in the case of pills swallowed or crushed and inhaled (snorted). More importantly, most opioid abusers tend to take far more of these drugs than were originally prescribed by the doctor. Food for thought– while opioids are often prescribed for acute pain, there is still some question as to whether they are effective in the treatment of chronic pain.
Mitigation of Chronic Pain and Opioid Diversion
The best way to avoid diversion and addiction is through a variety of mitigation strategies designed to identify the problem before it becomes one.
There are several screening tools available that can be used to identify patients who have a substance-abuse disorder. The most common of these are the Opioid Risk Tool, the Brief Risk Tool, and the Screener and Opioid Assessment for Patients with Pain (SOAPP). Of course, asking a patient a simple question such as “Have you used illegal drugs or abused prescription medications in the past 12 months and if so how many times?” This information can then be used to determine the person’s risk of opioid abuse.
Prescription Drug Monitoring Program
The government has implemented the Prescription Drug Monitoring Program that records each time a person is prescribed specific medications such as opioids. This data can be used to determine if a patient is “doctor shopping.” This occurs when a person makes the rounds of several doctors making the same request for opioid painkillers. Each time they do this, they receive a new prescription that can be taken to different pharmacies to be filled. This information can be useful in identifying drug abuse and chronic pain opioid diversion.
The use of urine drug screening is another option. The test can be completed before the opioids are prescribed and at regular intervals. The results of these tests can be used to see if the patient is using more drugs than prescribed or are not taking them at all. This might be an excellent indication of potential chronic pain opioid diversion. A change in their prescription or switching them to a non-narcotic pain reliever may help prevent diversion from occurring.
Doctor-Patient Agreement and Accountability
A contract can be drawn up between the doctor and patient, allowing the doctor to monitor their patient’s adherence to the use of the pads as prescribed.
Preventing Inappropriate Medical and Prescription Errors
One of the best ways to prevent the abuse of prescription opioid pain medications is to stop it at the source. This means situations such as prescribing opioids to a patient who has no idea how addictive they can be, labeling the prescription as to be taken on an “As-needed” basis, incorrect dosages, and off-label use (using them for recreation purposes instead of pain relief).
Starting in June of 2010, the US DEA signed an order allowing the use of electronic prescribing of controlled substances. This may help to promote the safe prescribing of these medications and significantly reducing the risk of diversion.
Pharmacists need to be far more vigilant in checking the ID of anyone trying to pick up a prescription of opioid-based painkillers. Authorities have noticed an increase in the number of prescription opioid abuse cases resulting from identity theft. The best way to avoid this is to require a government-issued photo ID before filling the prescription being presented.
Switching to the use of Abuse-Deterrent Opioid Formulations
With so much of the blame for the current opioid crisis being laid at the feet of Big Pharma, these “megacorps” are trying to address the problem with chronic pain opioid diversion from within. They are looking at ways to create opioids with built-in abuse deterrents, including:
- Formulas that keep their extended-release characteristics even if they are crushed or dissolve the pills.
- Making the formulation easy to alter, but any attempts to tamper with the pills will result in a neutralizing antagonist being released.
- Creating a formula that has an aversion agent built-in that causes unpleasant side effects if a person attempts to take too much of the medication. Some of these medications have already made their way onto the market, including OxyContin (oxycodone), Embeda (morphine), and Suboxone (bumper morphine).
In order to prevent chronic pain opioid diversion, a multipronged approach will be needed. Doctors, employers, insurance companies, law enforcement, and others will all need to work together. Until this happens, the crisis is likely to continue becoming bigger and more expensive.
If You Have an Opioid Addiction Related to Chronic Pain
Many people who experience chronic pain suffer from opioid abuse. This doesn’t mean they’re addicted for life, or that they’re “bad people”. It means they are in a lot of pain daily and so far the only solution they’ve found to relieve their pain is through prescription pain relievers.
There are other options for pain relief, and more scientific research is happening on this every day. America and the world are seeing a huge rise in opioid addiction. Unfortunately, this type of addiction can lead to an accidental overdose. This is another crucial reason it’s so important to find alternative ways of pain relief. Nobody wants to be addicted to opioids. Likewise, nobody wants to be in chronic pain.
If opioid addiction is already developed, there are treatment options that also focus on the treatment of chronic pain through the recovery process.
If you or a loved one need help to overcome addiction or opioid diversion, call us at 949-625-4019