Opioid use has increased substantially in the United States over the past few decades. The increased prescription can be attributed to the rising prevalence of chronic pain and increased efforts directed towards treating chronic pain. Opioids can be prescribed for acute cancer-related pain, self-limited pain, and chronic pain. These situations present different populations with unique circumstances that can advantages and disadvantages. One of the main concerns of the use of opioids to treat chronic pain is its misuse which leads to addiction. Overdosing opioids can have multiple side effects and can lead to death. This paper discusses the pros and cons of RX medication for managing chronic pain by considering the biological, psychological, behavioral, and physiological effects and consequences.
Biological Effects
The biological effects present a strong advantage for the use of opioids in managing chronic pain. Humans have opiate receptors in the brain that function as action sites for different types of opiates like morphine and heroin. The brain has these receptor sites because of the presence of internal neurotransmitters. Opioids help alleviate chronic pain by mimicking the effects of pain-relieving chemicals produced naturally. The drugs bind to opiate receptors in the spinal cord, brain, and other parts of the body. The result is that it blocks the perception of pain and causes a feeling of well-being.
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There are multiple biological disadvantages and side effects associated with the use of opioids. While the drug can create feelings of better well-being, it can also cause negative side effects like confusion, nausea, and drowsiness. Apart from relieving pain, the drug can also lead to feelings of euphoria. People that use the drug can also develop a tolerance to the drug and they may require higher doses to realize the same effects ( Muthulingam et al., 2019 ). As the body continues to tolerate the effects of the drug, people can take higher doses to experience the same pain-relieving symptoms and to reduce the symptoms of withdrawal. Some of the withdrawal symptoms that one can experience include irritability, muscle aches, anxiety, runny nose, vomiting, insomnia, and abdominal cramping.
One of the biological negative effects of using opioids is that it can lead to an alteration of the structure of the brain. Repeated exposures to higher doses of opioids can alter brain functioning such that it functions less or more normally when the drugs are present compared to when the drugs are not in the body. The results of such an alteration in the brain structure are that it can lead to opioid tolerance and opioid dependence. Opioid tolerance occurs when there is a need to take higher doses of the drug to realize a similar effect from the opioids and drug dependence occurs when one is highly susceptible to withdrawal symptoms ( Anderson, 2019 ). The withdrawal symptoms are most likely to occur among patients that have developed tolerance. Tolerance occurs when the brain cells with opioid receptors gradually become less responsive to opioid stimulation. Dependence occurs mostly from the pleasure derived from the use of opioids as it alters the natural reward system of the brain.
Psychological Effects
Opioids can be prescribed to patients that have mental health problems and issues with depression. Chronic pain can lead to an overall reduction in the quality of life and can cause depressive symptoms. One of the assumptions is that using opioids to treat pain will to a reduction in depressive symptoms. However, a reverse relationship exists with opioids being used to treat depression. 10 percent of people prescribed opioids were found to be more likely to develop issues with depression a month after taking the drug ( Nichols et al., 2020 ). The longer the use of the drug, the more likely that one had the risk of developing depression. The combination of chronic pain and mental distress can make one decide to take opioids. However, the increased symptoms of psychological distress can lead to a reduction in opioid responsiveness. Opioid use has also been found to be strongly associated with the presence of anxiety and panic disorders. People with panic disorders were found to be more likely to be prescribed opioids ( Novak et al., 2019 ). Using opioids can have negative consequences on someone’s mental health. Opioids should thus not be used to primarily treat mental health but other alternatives should be sought.
Cognitive Effects
Opioid use can also lead to cognitive impact as it impacts someone’s visuospatial memory. According to Tolomeo et al. (2019), opioids had a negative cognitive impact as opioid-dependent participants showed signs of visuospatial memory. The individuals were also found to report higher scores of depression and anxiety. Visuospatial short-term memory is a mechanism used to maintain and manipulate visuospatial information for a wide range of cognitive functions like orientation and navigation of the environment. Other negative effects associated with cognitive impairment were that it could lead to a reduction in problem-solving, information processing, verbal memory, and visual memory. Considering the negative impacts of opioids, there is a need to limit the use of opioids due to the cognitive effects.
Behavioral Effects
The behavioral consequences of opioid use are related to the drug dependence that alters a person’s perspectives and behaviors. When opioids are taken without following the proper dosage, it can lead to physical dependence and addiction. Addiction is a behavioral consequence as one would continue to take the drug even when it has harmful effects and dependence means that one would need to have the drug to function well. Opioid addiction will involve a daily drug intake to avert the unpleasant symptoms associated with drug withdrawal. Further prolonged use of the drug can lead to long-lasting changes of the brain that cause drug-seeking behavior and adverse behavioral consequences that are a key sign of addiction.
There are special concerns with the use of opioid-like fentanyl as it can lead to breathing problems and even death if not taken properly. Fentanyl should be taken along with other narcotic medications. It can especially cause serious harm or death if taken accidentally by a child or an adult that has not been prescribed the medication correctly. Taking certain medications along with fentanyl can also increase the risk that one will develop serious and life-threatening problems. One should inform their doctor in case they are taking other medications like amiodarone, and antibiotics like erythromycin, telithromycin, and clarithromycin (Laing et al., 2018). Taking fentanyl should be done under strict surveillance from a doctor. In case one develops certain symptoms like slowed breathing, extreme sleepiness, lightheadedness, and dizziness, one should seek medical care immediately.
Social-Interpersonal Effects
Opioid use can lead to addiction that leads to negative social-interpersonal effects. Immediate family members can suffer as the addicted person continues to engage in addictive behaviors. The addicted person can shrink from family responsibilities and it can lead to a straining of extramarital relations and a distortion of family relations. Family and friends can respond differently to the addicted individual by showing annoyance and anger. Other reactions can include blaming, denial, bargaining, and depression. People can also be ashamed of the addict’s behaviors and show hopelessness when there are no signs of change.
Risk Factors for Addiction
There are multiple risk factors that can lead to opioid addiction. The people that are most at risk for misuse are younger adults, individuals with mental disorders, and individuals with substance or alcohol abuse disorders ( Nichols et al., 2020 ). Genetic, psychological, and environmental factors also play a role in increasing the risk of addiction. One of the main risk factors for addiction involves taking it using methods different than that which it was initially prescribed. For instance, crushing the pill for injection or snorting can deliver large quantities of the drug to the body and could lead to an accidental overdose. Taking more of the prescribed dose and more often than the initial prescription can also increase the risk of addiction. The length of time taking the prescribed opioids can also present as a risk factor. Taking opioids for more than a few days can lead to a risk of long-term use and addiction.
Recommendations
Alternative Treatments
There are multiple non-opioid medications available over-the-counter or through prescription. Examples of such drugs include ibuprofen, acetaminophen, aspirin, and steroids. Most patients will find the drugs all that they need. Additionally, the treatment of chronic pain can be possible through the use of non-drug therapies. For instance, physical therapy can involve muscle massages that decrease pain and improve the ability to function under distress. Acupuncture involves thin needles inserted at different places on the skin to interrupt pain signals ( Lirk & Rathmell, 2019 ). When other treatment options are not effective, one can have nerve block injects to short-circuit the pain or surgery to correct abnormalities in the brain.
Dosage Adherence
Strict adherence to prescription rules like the dose and inter-dose interval can reduce the risks of becoming addicted. One of the main causes of opioid addiction is noncompliance and nonadherence to the prescription. Adhering to the prescription ensures that the drug will not have a long-term effect on the brain and lead to adverse consequences. Close monitoring and surveillance can help reduce the reluctance associated with the use of opioid therapy where the prescription states ( O'Brien et al., 2017 ). Poor adherence can occur in different forms like escalation or reduction in dosage, prescription forgery, hoarding, or diversion. Clinicians sometimes suspect that prescription opioids are being abused by patients that request escalation of the doses due to treatment failure. A proper assessment of the patient should be done before increasing the subscription.
One of the main lessons to be learned from the saga of oxycontin, oxy-neo, and Purdue chemicals was the need for pharmaceutical companies to represent data accurately. Purdue Chemicals was a maker of OxyContin and Oxy-neo painkillers. The company enabled the supply and use of the drug without having a legitimate purpose. Purdue also aggressively promoted the use of opioids for non-malignant pain treatment, leading to an overall increase in the use of opioids by the larger population. The company also observed that the medication was less addictive and the risk of addiction was at one percent (Podolsky et al., 2019). The company was fined for falsifying the information and it showed the need for pharmaceutical companies to present accurate information about their drugs.
Conclusion
The study explored the pros and cons of using opioids for treating chronic pain. Opioids were found to be effective in alleviating pain by binding to opioid receptors in the brain and relieving pain. However, the use of the drug had an increased likelihood of addiction, especially when one does not adhere to the dosage. The result is the presence of behavioral effects through addiction, cognitive effects through depression, and social-interpersonal problems. The recommendation for taking opioids was that there needs to be strict adherence to medication. Additionally, one should resort to alternative options to treat chronic pain.
References
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