Research indicates that by lowering the number of pills given in an opioid prescription could reduce use of opioid painkillers. Prescription medications are a major part of the opioid epidemic that has spread throughout the US.
Two hospitals in California tested this theory and changed the default settings on computers to a lower number of pills given out in opioid prescriptions. Researchers believe this small change will help prevent opioid use disorder.
What is Opioid Use Disorder?
While not categorized as an addiction, opioid use disorder occurs when a person has a strong desire to take the pills and has developed tolerance to the medication. They may have difficulty reducing use and even suffer from withdrawal. Addiction and the likelihood of addiction to opioids can be classified under opioid use disorder.
This condition usually requires treatment for addiction. It can lead to withdrawal symptoms and further addiction. Both dependence and addiction are part of the disorder.
The Study on Opioid Use in Hospitals
The researchers reviewed how opioids were prescribed in two hospitals for the period between November 2016 and July 2017. They changed the default settings on medications commonly prescribed that contain opioids. This included Percocet, oxycodone and Norco. At one hospital, the default was at 12 pills while the other hospital sent out 20 pills per prescription. The numbers were changed to five, ten and fifteen along with a setting that remained blank for the prescribing doctor to input the number.
When analyzing the results, researchers found that the lower settings reduced the amount prescribed and the number that went above the recommendations from the CDC. Researchers admit this one change won’t stop the epidemic with opioid use, but it’s one small step that can help. It doesn’t cost anything to make these changes to default settings, and the study indicates it has a positive impact.
The Dangers with Prescription Opioid Use
Prescription opioids are meant only for short-term use in most cases. Long-term use has been shown to lead to addiction. While the medications are best used to treat acute pain, they have been prescribed for chronic conditions. The longer a person takes a prescription opioid, the higher the chance they have of developing a dependence on the drug.
When a patient is taking more of the drug than what is allowed, they may resort to visiting multiple doctors to get more than one prescription. The body continues to develop a tolerance which means it takes more of the drug to achieve the desired effect.
One concern with prescription opioid use is that it will lead to illicit drug use, specifically with heroin – another opioid. Research has shown that many people resort to street drugs when they can’t get more of their prescription drugs. A full-blown addiction often develops, which can be difficult to treat.
While prescription opioids aren’t the only cause of addiction, they do play a key role. Researchers are trying to find effective ways to reduce the risk in medications handed out by doctors.
Increased Risk for Opioid Addiction and Relapse with Pandemic
Along with the illness, the coronavirus outbreak has many potential secondary concerns. One of these is the likelihood of increased numbers of opioid addicts and relapses.
Most addicts attend some kind of meeting to help them maintain their recovery, whether it be Alcoholics Anonymous, Narcotics Anonymous or another 12-step program. Now that the majority of those meetings and groups have been suspended, the only option is online recovery for a lot of the recovering addicts.
For many of the addicts, online works well. For others, it just isn’t the same. They may not have access to online resources. They often say there is a disconnect online compared to being in the same room with people.
Recovering addicts may feel isolated and suffer from depression along with anxiety because of COVID-19 and the restrictions of social distancing. Even though they understand the need for it, many will be faced with mental health issues. It is these same mental health issues that often lead to addiction in the first place.
Addiction is an isolating situation with people hiding their drug use from others around them. This situation makes it easier for them to continue the behaviors.
A common part of addiction treatment for opioids is methadone and other opioid prescriptions. These medications are given to help prevent the cravings that go along with withdrawal from opioids like heroin. The government has relieved the restrictions of taking the medication daily at a treatment clinic with doctors being able to give prescriptions for 14 or 28 days to take at home.
The problem with this solution is that active addicts may take more than they should and overdose or relapse. They have the entire 28-day supply at their disposal, and they may not be able to withstand the temptation to take extra, especially if they are experiencing anxiety or depression from being alone.
The Risk of Addiction
Those who are prescribed opioid painkillers may face a greater risk as well. While they are monitored for medication use, the anxiety they feel at this pandemic may lead them to experience more physical pain as well. They may self-medicate by increasing the dosage over what was prescribed.
When this happens, people are at a higher risk for developing a dependency on the drugs, which can lead to addiction. With the stay-at-home orders throughout the country, friends and family may not even be aware of changes in mood and behaviors to recognize the indications of addiction.
Risks with COVID-19
Drug users are often a higher risk for developing complications from the virus because of compromised immunity systems and lung damage due to drug abuse. Their withdrawal symptoms can also mask the symptoms of COVID-19, which would lessen the likelihood that they would seek medical attention as quickly as they should.
Medical professionals could also misdiagnose those with COVID-19 as drug withdrawal symptoms. It may take longer for an accurate diagnosis, which could increase the risk of serious health issues or even death.
Could Johnson & Johnson Start Testing a Vaccine by Fall?
Johnson & Johnson, a major pharmaceutical company, has made plans to begin clinical trials on people of a vaccine for Covid-19 that it has developed. The company suggests it could be ready by September with the first batches of the vaccine ready for public use in an emergency early in 2021.
Hope for a Successful Vaccine
The company stated it had started work on a vaccine for the coronavirus early in January. It is working with BARDA, Biomedical Advance Research and Development Authority, which is a part of the Department of Health and Human Services. The two partners are committing $1 billion for research and development of the vaccine, along with testing.
The chairman of Johnson & Johnson, Alex Gorsky, says his company wants to do what they can to bring a vaccine to the public as quickly as possible. Manufacturing capacity around the world will be expanded if its approved to begin producing the vaccine immediately.
Early tests show the vaccine to be both safe and effective. The hope is that the partnership with BARDA will allow the vaccine to move through testing and approval faster. If approved, the vaccine would be distributed as not-for-profit.
Other Treatments and Vaccines
Another company has also been working on a vaccine. Moderna, a biotech firm based in the US, shipped a test vaccine to the government in February. The first dose has already been administered in a clinical trial in March. It uses material from DNA, which is injected into the body. Immune cells begin to make proteins that mark the virus cells for destruction.
Testing has also begun on a drug which could be used to treat patients with Covid-19. This drug, known as remdesivir, has been used in treatment of Ebola. It was given in a test to a patient who has Covid-19 and is the first drug to be tested for treatment. Other people who have tested positive for the virus will be part of the study.
The study will include volunteers who will either be given the drug or a placebo and monitored. The drug will be given intravenously over a ten-day period. Tests will be taken every other day to determine the amount of the virus in the system. If the drug shows some ability to prevent the growth of the virus, it could reduce the spread of Covid-19.
Experts warn the public not to rely on these early tests to make vaccines available right away. Even if they are viable, it’s expected that it could take at least a year before they would be readily available to the general public. Before this, specific people, such as medical care workers, may have access. Other methods will be necessary to control the spread of the disease in the meantime. However, a treatment for the disease may reduce the death rate. Researchers are working diligently to develop solutions to the coronavirus, but it’s not expected to see dramatic results overnight.
Opioid Addiction Patients May Take Medications Home
The United States Substance Abuse and Mental Health Services Administration, otherwise known as SMAHSA, has made some significant policy changes for patients who are currently in an opioid treatment program. They are now allowed to take home medication due to the impact of the COVID-19 pandemic.
Treatment Drugs Being Made Available to Recovering Addicts
Patients who are in a treatment program for opioid addiction may have the ability to take home medications, including buprenorphine and methadone. These medications are given to patients as part of the treatment plan. Treatment centers may send home a 28-day supply of the drugs. For those who aren’t quite as stable, they may request up to 14 days of medications.
These medications are given to patients to help wean them off opioid drugs. While the medications contain some opioid ingredients, it is at a lower rate than with heroin and other opioids. It can help the patient stop using drugs without the severe withdrawal symptoms often seen if they stop without the aid of medication. These medicines also help reduce cravings, which can mean the difference in relapse for the patient.
Doctors say it’s critical that patients have access to these medicines with the reality of fewer in-person visits while the pandemic continues. Without the medications, the patients are more likely to regress and return to their former drug use. They also have an increased risk for overdose.
While doctors say there is still some risk for overdose or even abuse of the drugs, the benefits outweigh the disadvantages. They believe it will be a great help to those who are stable in their treatment, but even those who are less stable will benefit, according to many experts.
Another change for drug treatment was announced recently from the Drug Enforcement Administration. Dispensing restrictions are being relaxed while the public health emergency lasts. Instead of just licensed doctors being able to administer or even dispense OUD medications, other professionals will also have that ability. This includes law enforcement and other treatment program staff members as well as members of the national guard.
How Buprenorphine and Methadone Work
Buprenorphine is given to people who are in treatment for opioid use disorder or OUD. It is generally given at the first signs of withdrawal symptoms. If given too soon, it can cause an acute withdrawal. The dosage is adjusted until the person has fewer or no symptoms. A maintenance dose is often continued through treatment.
Methadone is often given during detoxification to lessen withdrawal symptoms. It may also be used as part of maintenance because it helps people stay in treatment. It’s standard practice for the person to go to a treatment center daily to receive the methadone dose to risk them diverting the drug. The medication may be given for months or even years. In fact, some patients continue it throughout their lives to reduce the risk of relapse on heroin or other opioids.
The risk with these medications is in overdose or misuse because they are also opioids. In the time of a pandemic, it causes professionals to change the way they handle the drugs to provide the best care for those who are in treatment for opioid addiction.
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