Current perspectives on the opioid crisis in the US healthcare system

Abstract

Introduction: The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription. Several reviews attempted to summarize the epidemiology and management of opioid misuse, this integrative review seeks to summarize the current literature related with responsible parties of this opioid abuse crisis and discuss potential associations between demographics (ethnicity, culture, gender, religion) and opioid accessibility, abuse and overdose. Methods: We performed an extensive literature search in Google Scholar and Pub Med databases that were published between December 7, 1999 and January 9, 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines. Searches were referenced using medical subject headings (MeSH) that included “opioids”, “over-prescription”, “opioid consumption”, or “opioid epidemic”. The final review of all data bases was conducted on July 24, 2018. Results: A total of 7160 articles were originally identified. After 3340 duplicate articles were removed, 3820 manuscripts were removed after title and abstract screening. Following this, 120 manuscripts underwent eligibility selection with only 70 publications being selected as reliable full-texts addressing related factors surrounding the opioid crisis. Conclusion: With approximately 100 million people suffering from both chronic and acute pain in the United States (US) in 2016, opiates will continue to remain a prominent class of medication in healthcare facilities and homes across the US. Over 66% of total overdose episodes in 2016 were opioid-related, a figure that attests to the severity and wide-spread nature of this issue. A three-point approach accentuating the prevention, treatment, and rehabilitation of both those currently affected and at-risk in the future may be the comprehensive solution.

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

“…[24] These findings may be of use in developing targeted efforts to prevent fatal opioid overdoses. [25,26,27] Compared to Hispanics, Whites had the highest HRs for opioid overdose death. This disparity, affecting the largest U.S. racial group, [5] has been attributed to socioeconomic despair [4] and limited opportunity in distressed U.S. communities [28] Other explanations U.S. policy priorities for health care, healthy behaviors, and the physical and social environment.…”

“…If SES partially mediated the effect of race in the final model, then interventions that impact SES, such as improving education, may have among their many advantages, the ability of help decrease opioid overdoses and associated racial disparities. [25][26][27][28] Furthermore, although the opioid epidemic has been most acute in some areas with low percentage Black populations, [7] (e.g., Appalachia, New England, the Midwest, and Mountain states), the recent shift toward a more urban centered opioid overdose epidemic [8] and high opioid overdose fatality rates in other areas with sizeable Black populations (e.g., Southeastern U.S.) could place Blacks at risk moving forward. People who were disabled had almost three times higher risk of death from opioid overdose than those without a disability, likely reflecting use of opioid analgesics to treat chronic pain.…”

Nonfatal diseases and quality of life: perspectives in Brazil

“…It has been reported that in the United States, an epidemic of misuse of opioids is causing 33,000 deaths per year, through both prescribed and illegal use of opioids. 4,5 In a recent review, Stoicea et al concluded that with approximately 100 million people suffering from both chronic and acute pain in the United States in 2016, opioids would continue to remain highly prescribed medicines across the US. 5 More than two thirds of overdose episodes in 2016 were opioid-related.…”

“…4,5 In a recent review, Stoicea et al concluded that with approximately 100 million people suffering from both chronic and acute pain in the United States in 2016, opioids would continue to remain highly prescribed medicines across the US. 5 More than two thirds of overdose episodes in 2016 were opioid-related. 5 Nonetheless, this is not the first crisis relating to use of opioids over the course of the history of humanity.…”

“…5 More than two thirds of overdose episodes in 2016 were opioid-related. 5 Nonetheless, this is not the first crisis relating to use of opioids over the course of the history of humanity. However, it is now important to discuss combined strategies for dealing with chronic pain and psychiatric disorders in Brazil.…”