Opioid Safety, Respiratory Compromise

3 Things to Remember in the Fight Against Opioid Misuse, Abuse, and Overdose

According to the Centers for Disease Control and Prevention (CDC), the misuse, abuse, and overdose of opioids has reached epidemic proportions:

More people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid. And since 1999, the rate of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. From 2000 to 2014 nearly half a million people died from drug overdoses. 78 Americans die every day from an opioid overdose.

To address this epidemic, recent regulatory and legislative efforts have targeted misuse, abuse, or overdose of opioids:

  • The Centers for Disease Control and Prevention (CDC) issued guidelines for prescribing opioids for chronic pain to “ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”
  • In issuing an Opioids Action Plan, the Food and Drug Administration (FDA) stated that it is “deeply concerned about the growing epidemic of opioid abuse, dependence and overdose in the United States. In response to this crisis, the agency has developed a comprehensive action plan to take concrete steps toward reducing the impact of opioid abuse on American families and communities. As part of this plan, the agency is committing to work more closely with its advisory committees before making critical product and labeling decisions; enhancing safety labeling; requiring new data; and seeking to improve treatment of both addiction and pain.”
  • The Senate approved a bipartisan bill to bolster efforts “reinforcing government efforts against heroin and the abuse of opioid painkillers.”

3 key points must be remembered in these efforts to curb the misuse, abuse, and overdose of opioids:

1. Maintain Access for Patients Who Need Opioids

Access to opioids must be maintained for patients who require them to manage their pain. For example, the American College of Obstetricians and Gynecologists (ACOG) issued this statement in response to CDC’s guidelines that opioid treatments are still warranted and safe at times during pregnancy and the postpartum period:

ACOG agrees with the CDC that opioids should only be used for treatment of pain when alternatives are not appropriate or effective, but we also know that there are times, including during pregnancy and the postpartum period, when such use is both appropriate and safer than the alternative … we are concerned that some of the CDC’s patient education communications regarding use of opioids during pregnancy could discourage women from needed, appropriate care by overstating the risk of rare complications associated with opioid use during pregnancy and by understating the potential risk associated with opioid discontinuation.

2. Opioids Should Be Prescribed Sensibly, Not Automatically

Research published in JAMA (The Journal of the American Medical Association) found that there has been an increase in the use of opioids prescribed after low-risk surgical procedures in the US. The lead study author, Dr. Hannah Wunsch, MD (Sunnybrook Health Sciences Center, Toronto) said:

We were also surprised to discover that the amount of opioid prescribed per day has increased over time—and that this increase is not just for one procedure but seemed to be consistent across all of the procedures,” she said. “Particularly in the context of an epidemic of opioid abuse, we had expected either no change or a decrease in prescribing.

3. Continuously Electronically Monitor Patients Receiving Opioids

Opioid Safety, for patients receiving opioids in hospital and healthcare facilities, is the management and minimization of the risks of respiratory compromise, adverse events, and death through continuous respiratory monitoring with pulse oximetry for oxygenation and with capnography for adequacy of ventilation.

 

 

 

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