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OPIOID CRISIS

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mulation being released,
abuse of other prescrip-
tion drugs, such as fen-
tanyl and
hydromorphone, in-
creased from 20.1 per-
cent to 32.3 percent.
Heroin use also doubled
during that time, and was
cited as being “easier to
use, much cheaper, and
easily available” (16).

Battling the stances. Modern urine drug screens can determine which metabolites
Epidemic: and/or parent compound is present in the urine, so other opioids,
be them illicit or prescribed, can be discovered if taken in conjunc-
To battle addiction tion with the prescribed medication. Lack of the prescribed opioid
and the opioid epidemic, in the urine, especially when taken regularly, can be a strong indicator
the Centers for Disease that diversion has occurred. Given that evidence shows most people
Control and Prevention abusing prescription opioids received them for free from a relative
(CDC) has released (6), regular use of these tools can hopefully limit diversion and recre-
guidelines for the pre- ational opioid use.
scription of opioids in
2016 (17). These include Treatment of Addiction:
such ideas that acute pain Treating addiction can prove challenging to say the least, especially
typically requires three
days or less or less of when many of these patients have legitimate reasons for pain. In
opioids, with rarely more general, treatment with opioid agonist therapy is more effective than
than seven days needed, abstinence, detoxification, or non-pharmacologic approaches alone
and that nonpharmaco- (19). Opioids such as methadone and buprenorphine can reduce re-
logic and nonopioid pharmacologic therapy are preferred for chronic lapse rates by providing patients with reduced cravings, prevention
pain. A study published this year in 2017 noted that, in patients who of withdrawal symptoms, and maintenance of opioid tolerance, thus
are opioid naïve and cancer-free who received a prescription for opi- decreasing the euphoric effect from more commonly abused opioids
oids, the highest probabilities of continued opioid use at one and
three years were those who were initiated on long acting opioids, fol-
lowed by those who started on tramadol (18). This same study noted
that the risk of chronic opioid use increased with each additional
day of medication supplied starting with the third day, with a risk of
chronic use that doubled after a second prescription is given to a pa-
tient; these data support the recommendations noted above from
the CDC about limiting prescriptions for acute pain.

Also, the CDC recommends that prescription drug monitoring
programs, which give clinicians information on how often, from
whom, and what controlled substances are being filled by patients,
and urine drug testing should be used routinely on patients whom
are undergoing long-term opioid therapy (17). Not only does this
allow for evaluation of other medications that may have interaction
with opioids, such as benzodiazepines, but also gives a helpful
screening tool to combat divergence of opioids and use of illicit sub-

16 San Antonio Medicine • October 2017