Sophia Ranta   

Combing through the stories on the internet, I came across a shocking, testimonial of a woman who became addicted to OxyContin. Her name was Cheryl. She suffered from Fibromyalgia, which caused her to be in constant pain. When her pain became too unbearable, she went to see her family physician. Immediately, her physician prescribed her OxyContin, but stressed how important it was to follow the correct amount of dosage. At first, she was careful and cautious. Very quickly, Cheryl liked the feeling of not being in pain anymore. She craved the drug’s potency, so she began abusing the drug. Some of the side effects that Cheryl suffered from were: weight loss, black-outs, isolation, no personal hygiene care, and general chaos all around her. Even though she visited her doctor every month, he never spent more than 10 minutes with her. She was able to trick him into writing a new prescription every time. Eventually, the way she broke her addiction was when she overdosed and suffered from cardiac arrest. The doctors were able to save her life.  Then she began the long road of recovery and rehabilitation. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients.

First and foremost, in order to gain a new perspective, it would be helpful to obtain a greater understanding of prescription opiate abuse. O’Neil and Hannah describe prescription drug abuse as “the use of a legend drug in a way not intended by an authorized prescriber of the medication. The intent of prescription drug abuse is to obtain an altered state of mood or behavior. Prescription drug abuse frequently involves circumventing the intended route of drug administration.” This is a statement that gives a clear understanding of what drug abuse is as a whole. Opiates are prescribed by doctors to control pain. With the prescription of opiates there is a specific individualized care plan that doctors carefully go over with each patient. There are two sides to prescription opiate abuse: intentional and unintentional. Intentional abuse is having the mind set of misusing the prescription. Patients who intentionally manipulate their care plan do so because they desire the high that comes from using the drug. A second reason, people choose to self-medicate is to dull emotional pain. The other form of opiate abuse is unintentional. Patients taking opiates due to pain may take more than their prescribed amount because they think they can cure the cause of their pain. This inadvertently leads to addiction. Having a greater understanding of opiate abuse will provide knowledge in accessing whether an individual is addicted to their prescription or not.

Next, this new perspective requires an understanding of how the brain is negatively impacted by opioids. Narcotics and opiates can become extremely addictive. But how does that work within the brain and all the science behind it? Hagaman gives an excellent representation of how the brain is affected from opiate usage. “Opiates are considered extremely addictive and this addiction can affect the structure and function of the brain. Opiates can alter the brain and affect one’s motivation and emotions. The brain changes over time and hence a person’s behavior changes. Moreover, if one uses a high enough dose of drugs, frequently enough, and over a long period of time, the drugs can change the way the brain works. The way in which the nerve cells communicate is changed so a compulsive, out of control use develops despite experiencing some of the many side effects. More specific effects of opiates on the brain include changes in the synapses and shapes of brain cells. Chronic use is linked with structural changes in the size and shape of specific neurons. That is to say that there is a difference noticed in the brain between a chronic opiate user and an occasional user” (Hagaman). The human brain is a complex organ that when manipulated, can affect the entire body and throw it off balance. The science of the manipulation of the brain’s neurotransmitters when exposed to narcotics is explained. “Narcotic painkillers bind to opiate receptors which are typically bound by special hormones called neurotransmitters. When painkillers are used for a long period of time, the body slows down production of these natural chemicals and makes the body less effective in relieving pain naturally. That is because narcotic painkillers fool the body into thinking it has already produced enough chemicals as there becomes an overabundance of these neurotransmitters in the body. Existing neurotransmitters have nothing to bind with, as the drugs have taken their place on the opiate receptors” (Effects 2015). Thus, the brain produces less of its own neurotransmitters to relieve pain, and becomes dependent upon the opiates. The human brain is a delicate organ that when distorted, struggles to regain normal cognitive function and the ability to maintain homeostasis for survival.  Other organs can also be injured. “Painkiller use and abuse also can affect nerve cells. Additionally, based on the manner in which the drug is used, painkiller abuse can cause long-term heart damage and increase the likelihood of a heart attack” (Effects 2015). Medical care personnel need to fathom the perils narcotic painkillers can have on the human body. It is necessary for health care workers to understand how the brain is negatively impacted by narcotics.

Third, to continue building this new model, education is necessary to teach about true addiction and the need to create appropriate medical care solutions. Society today sees drug abuse only coming from illegal drugs and not from prescribed drugs. Opiates are one of the most often prescribed pain medications. “The abuse of opioid drugs is a public health epidemic that has been growing since the mid-1990s” (Maxwell 2015). To recognize and stop the opiate abuse, education is necessary for the public. Having the knowledge to identify prescription drug abuse can lower the risk of addictions. Even now schools are introducing programs to explain and warn the dangers of overuse of prescription drugs. RX for Understanding is one resource widely used. “This training program, resources, and tool kit empower principals, teachers, school nurses, and other specialized instructional support personnel to begin a dialogue in their schools about prescription drug abuse. Schools can use this program to inform parents, students, and educators about the growing problem of prescription drug abuse through school assemblies, lesson plans, and informational materials for teens and parents” (Embrey 2014). In time, the goal is that the general public will have a broader comprehension of the dangers of prescription drug abuse which will carry over into the medical setting. In the meantime, education must be provided to patients and family on the potency and hazards of long term use of opiates. Second, education of physicians could also greatly reduce the growth of this trend. “Understanding prescribing patterns, as well as the perceptions of adverse effects associated with these agents, is crucial because these physicians play a critical role in curtailing the prescription drug abuse epidemic, said Catherine S. Hwang of the center for drug safety and effectiveness and the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates” (Moon 2015). Physicians need to be informed of the adverse pattern of prescription drug misuse as much as students. Third, health care providers require an understanding of the psychological effects of long-term drug use in order to treat patients with compassion and wisdom. “If patients cannot trust their physicians, their pain may be compounded by feelings of isolation and fear” (Johnson 2007). Perception is a powerful lens by which decisions and responses are made. Johnson introduces a triad of factors in understanding the psychological aspect of addiction. “The first includes a patient’s biology (brain chemistry and genetics). The second involves ‘self-medicating,’ in which patients use medications in response to feeling helpless about emotions generated in interpersonal situations or to treat a psychiatric disorder. The third aspect notes that addictive drugs may serve as a ‘companion,’ substituting for meaningful relationships with other people. A physician may feel trapped by this combination of factors when the patient behaves in a subtly complex way and attempts to get his or her feeling of helplessness understood by the physician. As a result, the physician may feel compelled to issue a prescription as the only way to immediately disengage from an uncomfortable encounter. Unfortunately, this same process is likely to recur at the next visit” (Johnson 2007).  Grasping a greater knowledge and understanding of the psychological side is imperative in guiding those who suffer from addiction to safety. Effective care can be given when caregivers have proper understanding of the potency and danger involved in the use of narcotics.

Continuing on with education, another element in constructing this new medical perspective, is the need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief. Pain demands an answer. “Having pain is very common in older adults, but it is never normal. There is almost always a real problem behind pain” (Resources). Understanding what causes the pain is crucial in knowing how to treat it. Arthritis and Muscle pain are quite common in the elderly. When pain is severe enough, patients may lose the ability to move comfortably or be incapable of doing activities of daily living. Sleeping may become so painful that it would not be enjoyable anymore. “Pain can lead to other problems such as losing the ability to move around and do everyday activities. The sufferer may have trouble sleeping, experience “bad moods,” or develop a poor self-image. In addition, people with pain often become anxious or depressed. They may be at greater risk for falls, weight loss, poor concentration, and difficulties with relationships” (Resources). Once understanding the patient’s level of pain, health care workers can formulate a plan of treatment. Health care workers need to provide different methods for relieving pain before administering addictive narcotics. Resources suggests several methods to be used first, before embarking on a long road of recovery from addictive opiates. “Treatments such as physical therapy, massage, heat and/or cold packs, exercise, and relaxation therapy may be tried first” (Resources). These methods are all non-narcotic options. Non-narcotics pain medication, other options are offered “Acetaminophen is recommended as the safest type of pain reliever for long-term use” (Resources). Acetaminophen pain medication includes the following: Ibuprofen, Aspirin, Naproxen. These treatments may be beneficial and eliminate the need for narcotics. Having a broader base of treatment options, may help to reduce the risk of addiction to opiates as well as administer comfort to the patient.

A fifth point to consider with this new medical model must include detoxification as part of the plan of care. An example of this detoxification piece is the organization ISIS. “Nevertheless, there is a place in primary care for community detoxification in substance misuse, as demonstrated by the primary care service pioneered at the Integrated Substance-misuse Islington Service (ISIS) by NHS Islington. ISIS is a primary care open access drug service that assesses and processes drug users for treatment. If patients have complex needs, they are directed to the appropriate services” (Fernandez 2011). Patients may need to go from an acute hospital setting into a detox center before entering a skilled nursing facility for rehab. An acute hospital setting provides a quick detoxification of the body to remove the potency of the drugs by pumping the stomach for example. This gives the patient an immediate solution from the overdose of drugs. The detox center is the next step in the rehabilitation process. The detox center offers a specific plan for each individual’s needs. Patients suffering from drug abuse will go through a detoxification program provided by their local detox center. “There are two types of detoxification: community and inpatient. The inpatient detoxification regimen consists of a five- to ten-day admission to a specialist centre for patients who present with a profile that is clinically risky – for example, polydrug use with mental health problems. Community detoxification is for patients who have a minimal risk profile – however, this often excludes patients with alcohol and substance misuse” (Fernandez 2011). Fernandez gives an organized and complete layout of what a patient’s plan of care for detoxification should look like. Including detoxification into a patient’s plan of care will ensure that the process of detox is performed safely and effectively. Based on the patients individualized needs, each detox center will provide a plan of care for the rehabilitation to come. The importance of a detoxification center is to safely assist each patient with the cleansing of their body from the drug toxins.

Next, the new medical model will allow for doctors to be better informed of the patient’s history with opiates and narcotics. When interviewing a patient about their history with pain medications, doctors and medical care workers need to have discernment about asking the right kinds of questions. Examples of questions that need to be asked would include the following. “Do you have a history of seizures or epilepsy? Have you had previous treatment for alcohol dependence? What previous detoxification regimens have you completed? Do you have any mental health issues that could compromise the detoxification regimen? Have you had any recent liver function tests?” (Fernandez). Other examples of questions could include: How long have you been taking narcotics? How often? What was the original prescribed amount? Do you have a history of using narcotics? Do you have any relatives that have suffered from addiction? These are only a selected few questions that should be asked of a patient with a history of narcotics. In determining the right kind of care plan, doctors need to better comprehend what each patient has been through. Obtaining a greater understanding of a patient’s history can help to distinguish what the proper treatment should be.

Furthermore, this new medical model requires anger management training to better help equip those who are going through detox. Anger is known to be included in the side effects from drug abuse. “Anger is a big problem for many people and it’s often one of the complicating factors for those struggling with addiction” (Roes 2007). The anger can become compounded due to the process of detoxing that a patient must go through. Hazardous situations can occur when a patient is struggling with the detoxification. For example, the patient might try to harm themselves, lash out at the medical care workers that are trying to help them, or even family and friends who are trying to support them through the detox. Some examples of ways to help a patient decrease from anger or improve anger management are expounded upon by Roes. “First, count to 10. Or 110. This simple and time-tested practice really helps. The more time a client buys by postponing anger, the more likely he/she will act rationally rather than emotionally. Second, relaxation techniques are often helpful: deep breathing, listening to soothing music, taking a hot bath, etc. These calm the physical sensations associated with anger. Third, distraction (thinking about something else) also can help. As our thoughts turn to another topic, there are fewer thoughts to feed our anger. Finally, do something incompatible with anger. Kiss your spouse, or pet your dog. These types of activities can help displace anger with more agreeable emotions” (Roes 2007).  These are just a few examples to help a patient deal with the side effect of anger. Another example is given in guiding an aggravated patient to a calm level. “Keeping a log also can be helpful. If clients list what they think, how they feel, and how they choose to act in an angry situation, they can become more aware of their ‘triggers.’ They also can become more aware of what thoughts feed their anger, and what thoughts starve it. The more deeply ingrained the anger problem, the more likely it is that cognitive, rather than solely behavioral, interventions will promote lasting change” (Roes 2007). Focusing on cognitive interventions can help the patient slow down to think rationally. One of the ways to help patients think rationally is to have a list of questions to ask themselves. Examples of questions could include: What just happened to make me angry? Was it what was said? How it was said? Or who said it? How am I going to respond without hurting myself or someone else? These questions can be personalized by health care workers to address the type of anger the patient is experiencing.   It is essential for medical care providers to know how to assess each situation involving drug abuse and anger management.

Moreover, this new medical model can be useful in understanding how cognitive therapy can aid with anger management, a secondary by-product of addiction. Roes gives a great representation of how anger management can be facilitated with the use of cognitive therapy. “Cognitive therapy has proven successful for even the most severe problems of anger management. For perpetrators of domestic violence, for example, the belief that it’s OK to use anger, power, and control to get what you want might be a focus of therapy. Successful change to a more prosocial type of thinking would reduce both the anger and the likelihood of victimizing others” (Roes 2007).  The term prosocial means being able to interact with people in a person’s social setting.  Being prosocial means a person’s behavior is positive and helpful when interacting with others. Those who are becoming prosocial are learning to focus on integrating positively with others, so they will be more careful to control their anger. Redirecting neurological pathways can help in correcting the damage that has been done to the brain.  Cognitive therapy can help a patient retrain their brain so that anger is not their first response. This type of therapy, overall, can reduce the amount of anger a patient experiences, because they have become better prepared to deal with situations that create anger. Cognitive therapy has proven to aid with anger management, a secondary by-product of addiction.

In conclusion, a new perspective is needed to create appropriate care plans for patients suffering from prescription drug abuse. One must obtain a greater understanding of prescription opiate abuse. The brain is negatively impacted by opioids. Education is necessary to teach about true addiction and the need to create appropriate medical care solutions. The need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief is essential. The plan of care must include detoxification. Doctors must be better informed of the patient’s history with opiates and narcotics. Anger management training should be included to better help equip those who are going through detox. Cognitive therapy can aid with anger management. As previously mentioned, Cheryl was only trying to control the pain she was experiencing. However, she loved the feeling of being pain free and was able to manipulate her doctors into continuously prescribing her pain medication without closely monitoring her. The personal testimony of Cheryl demonstrates the flaws of prescription opiates and the addictions that are taking place. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients that will help save lives.

Work Cited

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