The opioid
epidemic in the United States is one that continues to progress and cause
concern for physicians and their patients that they prescribe these medications
to. Opioid analgesics are prescribed for multiple reasons in hopes of providing
relief to pain and given on an as-needed basis. This allows for the consumption
of these medications to be taken freely and typically not as they are
prescribed once the patient is discharged from a healthcare facility. People
take the opioid analgesics based on their perception of pain making it
difficult to measure adherence of those taking the medications and them being
honest about their consumption routine.
With the
nonadherence of patients’ opioid prescriptions, especially in the emergency
department, Dr. Chai and his team decided to test the use of a digital pill to
measure the as-needed opioid ingestions of patients discharged from the
emergency department after an acute bony fracture. A digital pill is one that
is ingested and consists of a digital radiofrequency emitter within a similar
capsule of an oxycodone tablet. The participants in the study were prescribed
oxycodone for pain for one week and also the digital pill that was signaled
each time the patient ingested the medication. The signals are directly sent to
a cloud-based server that documents how much pain medication was consumed and
was compared to the patient’s answers at their follow up appointments. The
results showed that from 10 participants in the study, there were multiple
simultaneous ingestion events at one time and that four participants continued
to with pain medication after the study. 90% of the patients also agreed that
with the digital pill was one they would be willing to use a digital pill to
improve medication adherence and monitoring.
With how
fast the opioid epidemic is growing, I find the use of a digital pill and prescribing
opioids to people a way of treating the person as a whole and protecting them
from further harm. When considering the four-biomedical ethics I see the beneficence
towards the patient would be that they would receive pain relief from the
opioids they are prescribed and being treated for their complaint of pain. The
non-malfeasance would be by preventing the patients from over-consumption of
the medications, causing potential harm to themselves, and helping prevent
opioid abuse. The autonomy of the patient will be conserved with them being
able to consume the amount of medication they think is needed for their pain
and refusal of the opioids if they do not want to ingest the digital pill as
well. The justice ultimately is for the prevention of the continued opioid
abuse and by being able to educate the dangers of opioid analgesics and not
adhering to their correct use.
Reference:
Chai, P., Carreiro, S., Innes, B., Rosen, Ro., O’Cleirigh,
C., Mayer, K., Boyer, E. (January
19, 2017) Digital Pills to Measure Opioid Ingestion Patterns in Emergency
Department
Patients with Acute Fracture Pain: A Pilot Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5273398/
Thank you for the post, this is a great topic of discussion! Opioid abuse is a large and uncontrolled problem especially among those discharged from an ED. I work in the emergency department at Denver Health, a huge level 1 trauma center in Denver, and see this misuse and frequent drug-seeking behavior in patients all the time. I like the idea that this digital pill might at the very least hold people accountable for their ingestion. I came across an article (linked below) that further describes the opioid abuse epidemic and the mechanisms by which addiction as well as other side-effects such as tolerance and hyperalgesia occur. This specific article talks about different ideas to develop drugs that are less addictive, specifically by making the drugs more specific to exact pain receptors in the nervosa system to avoid these side-effects. I think that a more specific pain-relief pathway used in conjunction with an accountability method such as this digit pill you mentioned could be an extremely effective strategy to combating this abuse epidemic while still providing patents with needed analgesia.
ReplyDeletehttps://www.ncbi.nlm.nih.gov/pubmed/26468188