Misuse Of Opiates Health And Social Care Essay

Mis uptake Of Opiates Health And Social parcel out EssayThe mis recitation and demoralize of illicit and prescription opiates is a growing difficulty in the united States. Even though Ameri ignores make up less than 5 percent of the worlds cosmos, we consume close to cytosine% of the worlds supply of hydrocodone and nearly 80% of the worlds supply of legal and illegal opiates .Be father of the vast availability of do dosess and its impact on many facets of wellnesscare and the economy, it is imperative that health care providers and policy makers understand what medicates are being abused, who uses these drugs, where the drugs pass off from, and the health and economic burden on the United States. It is becoming exceedingly important for those directly gnarled with substance abusers to understand the physicalal consequences, psychosocial consequences and insularity consequences of drugs. Opiates and opiate derivatives in particular, whether illicit (such(prenominal) as h eroin) or prescription (such as Oxycontin) are being heavily abused across the country. These drugs mess accept serious health implications during use and during abrupt cessation (detoxification or withdrawal).This paper will present a review of the literature on the epidemic of heroin and prescription opiate abuse. Through a critical review, concepts such as the prevalence of the problem, the physical consequences of abuse, the current trends in management of the problem and implications for nursing and healthcare will be explored.Background originally proceeding, it is important to briefly discuss the basic pharmacology of opiate drugs. Opiates, otherwise know as narcotics, include the drugs heroin, morphine, codeine, oxycontin, hydrocodone, methadon and other chemically- link up derivatives. All opiates are considered dispensable only by prescription in the United States with the exclusion of heroin, which is illegal in all circumstances. Opiates wield their effects by act ivating pleasure centers in the brain. The neurobiochemical pose of addiction suggests that over time, the brains chemistry changes so that it yearns for the substance when it is not there and can produce physiologic effects of withdrawal when stopped. Heroin for example, which is chemically-related to morphine (the chemical name for heroin is diamorphine) readily crosses the blood-brain barrier to event a rapid spilling of dopamine into the dopaminergic receptors of the brains neurons. For this reason, the drug is easily addictive and absence of the drug causes a sensation of craving and can cause feelings of illness, such as nausea and diarrhea, when stopped abruptly. .Prevalence of the Problem some(prenominal) researchers in the nursing, allied health and economics disciplines lay down explored and discussed the prevalence of prescription opiate abuse and hypotheses of the origin of the problem. However, there is a large gap in the literature related to the prevalence of i llicit drug abuse (heroin) among different universes. The prevalence data for heroin abuse in the US is largely reported by national flock trends, such as the National Institute of Drug Abuse (part of the National Institutes of Health) adopt on Drug Use and Health (NSDUH). Even so, the massive survey document pays little guardianship to the problem of heroin abuse and reports only two percent of the 67, d survey respondents using heroin in the month preceding the survey (National Survey on Drug Use and Health, 2009).The etiology of prescription drug misuse and abuse is discussed more heavily in the literature than is heroin abuse. According to the NSDUH, in 2009 4.8% of the survey respondents aged 12 and older reported using prescription opiates for non- medical examination reasons. Of those, over 55% reported obtaining the drug for free from a friend or relative, and 4.8% reported purchasing the drug from a dealer on the streets (National Survey on Drug Use and Health, 2009).Res earchers at Columbia University surveyed adolescents aged 12 to 17 in 2005 and found that 9.3% reported the misuse of prescription opiates over the past month. In exploring the adolescents motives for abuse, the researchers found that the close to usually reported motives were ease of attainment and affordability . Among youthfulness adult college students, prevalence of non-medical prescription opiate abuse has been reported surrounded by seven and nine percent in the past month to twelve to fourteen percent life history prevalence .One of the most at-risk groups for misuse of and addiction to prescription opiates is the chronic paroxysm population. When used appropriately, opiate disturb medications are a amber standard of care for serious pain-related conditions (such as post-operative pain, neuropathic pain and so on). In an effort to let on manage pain, the moment of prescriptions for opiate medications change magnitude 154% in the ten-year period from 1992 to 2002, e ven though the population of the United States increase by only 13% .Although prescription opiates fox been used to track pain and improve the quality of life among acute and chronic pain perseverings, the advent of the drugs misuse has led to a wide body of literature on prescriptive practices and monitoring of opiate drugs. thither delicate balance in the midst of managing pain adequately and the risk for misuse, addiction and warp has been discussed in the literature recently, largely among the adolescent/young adult and chronic pain populations.Although there is a general lack in the literature of the number of people prescribed opiates for chronic pain . There is a large body of literature which suggests that the increased number of prescription opiates for chronic pain patients has contri thated significantly to the drug abuse problem. In studies to investigate the use of prescription opiates for chronic pain, it has been found that pain treatment plans are sparse, good d ocumentation on the patients health history and history of substance abuse is rare, and opiates are sometimes improperly utilized or not indicated at all .Health Consequences of Opiate AbuseBoth prescription and illicit opiates have the electric potential to work a myriad of acute and chronic invalidating health effects for the user. Neurological decline, vision changes, cardiac abnormalities, vascular complications, pulmonary disorders and mortality have been studied and reported.In a study of over 500 opiate addicts, electrocardiographic changes were record in 61% of the sample. These ECG changes included ST-segment elevation, which may indicate ischemic sum damage (or lack of oxygen-rich blood to the myocardium) and QTc prolongation (seen mostly with methadone addicts). Prolonged QTc intervals may lead to unlike triggering of the ventricles and may lead to potentially lethal ventricular tachycardia .The use of heroin and other drugs by guessing with non-sterile or reused w ishles may produce powerful toxins in the bloodstream leading to endocarditis, left ventricular exhaust and death. Researchers in Ireland reviewed the autopsy findings from eight cases of heroin users and found rapid calamitous illness caused by the endotoxin clostridia novyi which caused fatal subendocardial hemorrhage, spleen enlargement and pulmonary edema in all of the subjects studied .Heroin can cause significant acute peripheral and central nervous system complications such as neuropathy and audience loss. In a study six of intravenous and intranasal heroin users admitted to the hospital for acute illness, five had documented rhabdomyolysis between three and 36 hours after administration of the drug. In each of the five cases, there was no documented trauma. Typically rhabdomyolysis occurs after a traumatic, compression-type disfigurement where enzymes spill into the musculature and cause rapid neurological decline, loss of muscle tone and coma. In each of the subjects st udied, no trauma or compression injury occurred . In a group of patients with a reported history of speedballing (or mixing heroin and cocaine), 2 of the 16 studied experienced sudden, bilateral sensorineural hearing loss four hours after speedballing which resolved inside three days. One additional participant experienced sudden hearing loss after speedballing plainly unilaterally. The mechanism by which the hearing loss occurred was described as a accomplishable cochlear perniciousness or autoimmune reaction related directly to the drugs .Injection of drugs of any type can cause vascular complications, skin and soft tissue infections and infectious diseases such as hepatitis and HIV . In the most severe cases, opiate abuse may lead to death, generally from overdose. Heroin has been related to 1.65 deaths per 100,000 people in the Florida population alone over the last decade and in Alabama between 1986 and 2003, a review of medical examiners reports revealed those whos cause of sudden death was undermined were 5.3 times more likely to have a history of drug abuse . Researchers in the United Kingdom have gain investigated heroin deaths and concluded that overdose related to heroin rarely occurs after the use of heroin alone- in 50% of the cases they reviewed, alcohol was also abstruse .Although studies have been published on the health effects of abuse itself, a review of nursing, medical and allied health literature shows a significant lack of studies on the health consequences of withdrawal (abrupt cessation) of opiate drugs. Several studies have been found relating to the use of pharmacotherapy to treat opiate addiction (such as methadone and similar programs) but no studies have explored the physiologic effects of withdrawal without medication assistance. Searching online databases for relevant articles on opiate withdrawal does not knuckle under any studies other than those using medication-assisted withdrawal therapies (such as methadone and bupren orphine). This is important to populations such as inmates in a correctional facility where pharmacotherapy is not generally used during detoxification and requires further attention .In sum, the potential health-related consequences of opiate abuse can negatively affect a myriad of body systems. The risk of potentially fatal infectious disease, neurological and cardiovascular complications and death by overdose creates a public health problem that demands attention. Health care providers in all arenas must be able to rapidly and appropriately tell apart those at risk.Implications for Advanced Nursing PracticeNurse practitioners are allowed prescriptive authority in close to any state across the country. Depending on the practice setting, they may prescribe opiates to treat pain. Opiates are the gold standard for treating moderate to severe pain in both acute and chronic pain syndromes . There has been some discourse in the literature on the dilemma to treat or not to treat pain w ith opiates. On the one hand, effective pain management is not only ethical but also opiates are effective for many patients for pain management and on the other hand there is a fear of misuse, dependence and addiction issues . The ability for advanced practice nurses to identify drug-seeking behavior, issues with addiction and possible diversion of opiates is crucial to the problem of opiate abuse. As it has been documented in the literature, diversion of prescription opiates generally occurs with the patient selling, trading or giving away the medication to another. According to Annie Gerhardt, emergency room nurse practitioner, drug seekers become victims of their own disease, becoming involved in a tangled web of addiction, drug-seeking, drug diversion and criminal behavior that escalates over time with increased drug use . Gerhardt (2004) suggests monitoring patients treated with opiates for alternate meds before their follow up appointments, patient reports of losing medicat ions, attempting to see different providers for pain medications (which can usually be identified by pharmacies), and scamming providers for more medications by complimenting the provider or the office staff or displaying increased levels of pain in order to procure more medication. When prescribing opiates to treat pain in patients already known to have addiction issues, using sustained-released formulations may reduce dependency while adequately treating pain. Sustained-release formulations usually have a reduced street value and are less likely to be sold and diverted, and the withdrawal from sustained-release opiates is typically not as severe .In terms of advanced practice nursing, prescribers have the erratic ability to screen for potential addiction issues, monitor those who are prescribed addictive medications and potentially insure diversion of those medications to others for whom they are not prescribed. Ultimately, the knowledge of drugs of abuse and health-related cons equences is important for nurses at all levels to possess.Implications for ResearchTo further add to the body of literature on the subject of opiate drug abuse, addiction and withdrawal, several areas still need to be explored.First, patterns of drug use in individual populations and communities should be investigated. The types of drugs most commonly used, the routes of administration of these drugs and their negative health-related consequences should be studied in a variety of communities, both urban and rural, to gain a better understanding of the patterns of use across the country. More research is needed beyond simple prevalence studies on the number of people who use to expand on the actual patterns of abuse. Similarly, the psychosocial consequence of drug use across different populations ineluctably further investigation in order to articulate the negative impact on individuals and communities.Because the abrupt cessation of opiate drugs without medication assistance occurs frequently in specific settings, more research needs to be done on the physiological effects of non-assisted detoxification. The patterns of symptoms of withdrawal and negative health effects among populations such as the incarcerated and the hospitalized need to be explored. The potential for the development of evidence-based protocols for the management of abuse and withdrawal in these settings can occur once the patterns of symptoms and health consequences are documented.ConclusionIn sum, the problem of drug abuse (which extends off the beaten track(predicate) beyond even opiate drugs) has been reported in multiple sources, and prevalence studies seem rampant in the literature. However, overmuch more work needs to be done on the consequences of drug abuse from a healthcare perspective across a variety of populations in different settings to begin to understand the impact of drugs on communities.