Hydromorphone: Personal and social consequences

Last modified: Sunday, 31. May 2009 - 4:23 pm

The opiates and their semi-synthetic and synthetic relatives have long been among the most important drugs in the world because of their ability to alleviate the most severe forms of pain. Often, this pain is derived from invasive surgical procedures or from advanced cancer pain that is virtually unbeatable without this family of drugs. A clear majority of persons who use opiates and their relatives never develop an addiction problem. However, addiction can develop quickly in those with a propensity for these drugs. This can occur in those who are using them for medical reasons as well as in those who use them recreationally.
A drawback to physicians’ increased caution for prescription drug abuse has been the reluctance by some medical providers to prescribe opioids for persons having a legitimate medical need for the drugs. This has led to the under-prescribing of opioids and the under-treat-ment of patients with significant pain. Many in the medical community have held the view that increased opioid prescription rates would necessarily increase the rate of opioid abuse. This is not the case, according to a study published in the April 2000 issue of the Journal of the American Medical Association. This study showed that even though the rate of oxycodone use had increased by 23% in a recent period of time, the reported rate of abuse did not significantly change.
The increased vigilance of legal authorities to crack down on prescription drug abuse has led to situations where patients are afraid to ask for sufficient pain medication for fear of being seen as an “addict” or someone with a low pain threshold. Many physicians are afraid to prescribe opioids because they are required by law to record and justify all narcotic analgesic prescriptions. This fear of prescribing opioids even when the patient is obviously suffering has been labeled opiophobia. They face potential criminal prosecution if these records do not conform to federal law. Many physicians are also wary of getting their patients “hooked” on these narcotics.
Those patients who do become addicted to opioids as well as those who become addicted for nonmedical reasons typically have a difficult time getting off the drugs. These individuals usually face a variety of problems along the way. They often have a difficult time holding a job, and their family life tends to be unstable. If untreated for addiction, many of these individuals eventually resort to living off welfare programs.
Opiate addiction has also helped spread diseases, such as the human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and tuberculosis among addicts who inject the opiate drugs and share dirty needles. The rate of opiate-associated emergency hospital visits in recent years has significantly increased. Furthermore, the number of deaths related to those opiate overdoses has almost doubled in this period. All of these trends point to the significant social costs associated with opiate abuse in the United States.

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