With the rise of drug
addiction that has been attributed to prescribed pain medication,
there has also been an increase in the number of children born to
addicted parents. Beyond the immediate impacts of drug withdrawal among
newborns who come into the world already addicted to drugs, these children
often continue to suffer throughout infancy and into their school years (Nygaard
2015). Since it is becoming apparent that the consequences of drug addiction
extend far beyond the person who is doing the drugs, should physicians have a
responsibility to regulate the process by which they issue drug prescriptions?
Opioids work by
interacting with opioid receptors which can be found on certain neurons. Opioids
produce a feeling of euphoria by activating the mesolimbic reward system which
triggers the release of dopamine in the nucleus accumbens. It is this release
that causes the feelings of pleasure. However, over time, users of opioids
become tolerant which leads to them having to take higher concentrations of the
opioids in order stimulate the mesolimbic reward pathway and they find
themselves in a very dangerous spiral (Kosten 2002).
Doctors are expected to
help and do no harm. However, there is a drug epidemic underway that is
attributed to medications that are prescribed by physicians. While prescribing
these medications can offer a temporary help, it can be argued that their
prescription is doing more harm than good. While providing pain medication can
offer an immediate fix to a patient’s ailment, should physicians be responsible
with following up with patients and trying to transition them off of the pain
medication (or offering alternatives to pain medication to begin with)? If this
becomes an additional responsibility for physicians, will resources (both of the
financial and scheduling nature) have to be allocated to ensure that physicians
have the time to administer this level of care?
On the other hand, there
are many individuals who live with chronic pain. Without the help of the narcotics
they are prescribed, they would live their lives in excruciating pain and would
perhaps be reduced to a non-functional state. Should these people be penalized
because of individuals who have become addicted to prescribed opioids? It could
be argued that by withholding pain medication from these individuals, the
physicians are doing harm to the well-being of these people.
Moving towards stricter
guidelines for pain medication prescription is probably in the best interest of
societal justice. However, alternative methods of pain management such as chiropractry,
therapy, and massage may need to move outside of the realm of “alternative” and
into the mainstream as accepted treatments in order to provide patients with
more options for their pain management (Griffin 2011).
Reference:
Griffin, R. M. (2011). Alternative Treatments for Chronic
Pain. Retrieved December 04, 2017, from https://www.webmd.com/pain-management/features/alternative-treatments#1
Kosten, T., & George, T. (2002). The Neurobiology of
Opioid Dependence: Implications for Treatment. Science & Practice
Perspectives, 1(1), 13–20.
http://doi.org/10.1151/spp021113
Nygaard, E., Moe, V., Slinning, K., & Walhovd, K. B.
(2015). Longitudinal cognitive development of children born to mothers with
opioid and polysubstance use. Pediatric Research, 78, 330.
Retrieved from http://dx.doi.org/10.1038/pr.2015.95
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ReplyDeleteHello Halimah,
ReplyDeleteThis is a really good post for discussion. I was once asked an ER physician, "what do you do when you suspect a patient is faking pain in order to get pain medications?" She simply answered that pain is subjective and you can never really know whether a patient is in pain by only observing. She further explained that as providers, we cannot bring in our own biases despite some cases being very obvious that drug use is the primary goal. Later she explained that narcotic medication is not always the answer for patient's complaining of pain. She stated that when she is uncomfortable prescribing opiate medications she prescribes NSAID or other non opiate pain relief. She does this as to treat the patient yet stay true to the biomedical ethics of non-maleficence and justice. Since having this conversation with this ER doc I reevaluated the way I treated my patient's pain in the pre-hospital setting. I became more cautious of my administration of Morphine in Fentanyl and hope to continue to do so when I become a physician. I believe that if more providers evaluated their use of opiate medication prior to prescribing these left and right, our opiate epidemic would not have escalated to the level we see today.