Benefits and Harms of Opioid Therapy

Question :

On that, the 3rd one ASSESSING BENEFITS AND HARMS OF OPIOID THERAPY. I prefer that topic. In the introduction part, you can write about what is opioids and what is COCA stands for all those. When you click #3 you will see call materials and additional resources. Make sure you read, transcript, listen to the audio and watch the webcast. Then summarize it. You can use any other materials from any books or website, but it should be a high-level reference and should be anything after within 5 yrs. Make sure to write it properly. It is my major grade paper. I don't want to lose any marks. It needs to have a proper Running head-(BENEFITS AND HARMS OF OPIOID THERAPY), Title in the middle of the first page-(Advantages and Disadvantages of Opioids), Just write INSTITUTION NAME on the next line and STUDENT name on the following line. I'll fill up those things. I attached an APA format,if you have any doubt.

Answer :

Introduction

Opioids are class of drugs that works on the opioid receptors and it produces effects like morphine. They are utilized for relieving pain among patients. Illegal drug such as heroin also fall in this category and there are various synthetic opioids and pain relievers that can be taken on prescription such as morphine, hydrocodone, and others. Cases of misuse and overdose have been witnessed in the case of opioids and, thus the question arises that whether opioid is beneficial or harmful. The focus of this paper is to understand and summarize an opioid module published by Centre of Disease Control through COCA (Clinician Outreach and Community Activity) Call (Brown et al, 2016). There were three presenters in the webinar: Dowell (Senior Medical Advisor), Sullivan (Professor, University of Washington), and Ballantyne (Professor, University of Washington). The topic of the study was “Assessing Benefits and Harms of Opioid Therapy for Chronic Pain”. The sections ahead provides the summary along with a plan for opioid prescription based on the study.

Summary

It has been found that there is no proper clarity over the long term benefits of opioid therapy in resolving chronic pain. There are some short term benefits, but they are between the ranges of small to moderate. A challenge with opioid therapy is of overdose and disorder. Moreover, risk assessment instruments often fail to predict whether opioid is being misused. As per CDC recommendation, opioid therapy should be considered by clinicians only when benefits to the patients in their function pain is likely to outweigh the associated risks. The COCA Call primarily focused around ways to identify whether expected benefits of opioids with outweigh risks for the patients, and also to determine the risk and benefits after the opioids consumption started. 

There are various initial aspects that have been recommended to be considered before engaging in opioid therapy. Some of them are: establishing treatment goals; considering diagnosis of the patient; consideration of goals of patients; and focusing on life goals achievement of patients instead of only reducing pain score. Four steps have been suggested to consider prior to initiating opioid therapy for chronic pain. First is to determine the expected benefits in comparison to risks. Second is to identify treatment goals. Third is to predetermine criteria to indicate if opioids will be continued (Brown et al, 2016). Fourth is to have strategy to exit therapy if no help is evident from the process.

It has been stated that opioids have not been useful enough when it comes to reduction of pain over a longer period of time. There are substantial lack of evidence that can prove otherwise. Risk factor determination is quite important which can be sleep disorder, breathing problem during sleep, non-fatal overdoses, anxiety in patient, post-traumatic stress, history of substance use in the patient, and/or cases of depression. All these will help determine if opioid should be brought into picture (Nelson et al, 2015). There are tools such as GAD7, PHQ4, and PHQ9 that can help in identifying most of these risk factors. Further, screening tools such as Alcohol Use Disorders Identification Test or Drug Abuse Screening Test can be used as well. 

It has been recommended that realistic goals for the patients should be established. Moreover, it should be the responsibility of clinicians to determine if continued therapy will be harmful for the patients on a regular basis, at least every three months or less. Here, if clinicians find out that the patient is not benefitting as per the expectation, and harm seems to outweigh benefit, then therapy should be terminated. If possible, adjustments in doses can be done to reduce harm. 

Though opioids are being used in pain handling, but they cannot be considered as routine therapy or the first line to resolve chronic pain. Interestingly, there are not good enough evidence to prove that opioid is beneficial in long term, but there is enough evidence that it creates major problems. Moreover, application of opioid on some of the common conditions such as headaches and back pain have also found no evidence of longer benefit. 

The presenters in this COCA Call has continuously iterated that only short-term benefits have been found to be beneficial, but not the long term. A case of Ms Christie was presented in which her dose was doubled for a short period of time that made her feel good. However, the study recommends that the focus should be on achieving the life goals and not just on driving down the pain score. And this is the reason that identifying goals is very important (Becker & Fiellin, 2017). Resistance from patients are likely to be faced by the clinicians at this juncture, however, clinicians have to make the patients understand that significant pain reduction can be subjective and despite opioid usage, they have to live with it their whole life. So instead of focusing on temporary goals and ending up harming themselves, the focus should be on the long term impact (Brown et al, 2016). It has also been found that when opioid is used, the mood and sleep of the patients improve even before is any impact on the pain levels, which shows signs of improvement later. 

Plan for Opioid prescription

As far as plan for opioid prescription is concerned, then based on the above study it can be recommended that the clinician should begin first with the determination of the goals for the patients and also with the goals of therapy. Further, once the goals are determined, the next aspect is to understand that whether the expected relief to pain will be higher than the risks. After it is determined that the opioid has to be administered, then the next step is periodic measurement. It will help the clinicians and their patients understand that whether they are reaching the intended goal. If they are reaching the intended goal, then the opioid should be continued else it should be terminated. However, here it has to be ensured that patients and clinicians are not blindly following the pain score because life goals are important as well. 

Conclusion

Overall it can be said that it is yet to be determined through any existing studies in an effective manner that use of opioid has any long term benefits for the patients. However, it has been certainly determined by various studies that long term use of opioids lead to negative impact on the patients. Therefore, it has been recommended that the opioid usage should be goal based and its effective and expected outcome should be periodically measured to ensure that the patients are reaching where they want and not preparing themselves for disastrous consequences in the long run. There is no doubt that the short term benefit of opioid does exist, but it is best for short term only. However, there are patients who inadvertently ends up getting addicted to it and either do not want to get out of it or are unable to do so. Here, clinicians have to make effort to keep the patients on track towards goal achievement.

References

Brown, L., Sullivan, M., & Ballantyne. (2016). Call Transcript: August 3, 2016|Clinicians Outreach and Outreach Communication (COCA). Retrieved 16 April 2020, from https://emergency.cdc.gov/coca/transcripts/2016/call-transcript-080316.asp

Becker, W. C., & Fiellin, D. A. (2017). Abuse-deterrent opioid formulations—putting the potential benefits into perspective. New England Journal of Medicine, 376(22), 2103-2105.

Nelson, L. S., Juurlink, D. N., & Perrone, J. (2015). Addressing the opioid epidemic. Jama, 314(14), 1453-1454.