​Individuals with disabilities and the opioid epidemic

Posted by Reeve Staff in Daily Dose on March 15, 2019 # Health

Individuals with disabilities are prescribed medications more frequently and take such substances in larger quantities as a result of mobility impairment, pain, and complications with mental health. Requiring these prescriptions for daily function often complicates differentiating between necessary use and excess use/abuse. Studies vary in reporting prevalence of opioid abuse among individuals with disabilities. However, the United States Department of Health and Human Services Office on Disability reports that over 4.7 million individuals in the United States have both a disability and substance abuse disorder. Opioids are among the most commonly abused substances.

What are opioids?
When considering the prevention of opioid addiction, it is important to know what opioids are. Opioids are a class of drugs including both illegal and legal substances. Prescription pain relievers include oxycodone (brand name OxyContin®), codeine, morphine, hydrocodone (brand name Vicodin®), and several others. Healthcare providers prescribe opioids to manage chronic and acute pain. The United States Department of Health and Human Services reports that prescription pain medications are helpful when used correctly under a healthcare provider’s direction, however misusing prescription opioids greatly increases the risk for addiction and dependence. Illegal drugs such as heroin and synthetic opioids such as fentanyl are also included in this drug class.

What is addiction?
It is also important to understand what drug addiction is. Addiction is a chronic disease that can lead to changes in one’s brain that make self-control in addicted individuals incredibly difficult, and these alterations in brain function greatly interfere with one’s ability to combat the intense impulse to consume the substance of use. The compulsive urge for drug use can be persistent, as people in drug recovery often relapse after a great deal of time has passed since last consuming the drug. While relapse is common, this does not mean that drug addiction treatments and therapies do not work. Much like other chronic health diseases and illnesses, ongoing and carefully monitored treatment can aid in an individual’s successful recovery.

Drugs that affect the brain’s “reward system,” such as opioids, can disrupt the healthy functioning of this circuit. In a proper reward system, an individual is motivated to repeat patterns of behavior that allow a person to survive and thrive. Activities such as eating, leisure reading or watching television/movies, sexual activity, and spending time with loved ones activate the brain’s reward circuit in healthy function, as dopamine is released as a result of engaging in these activities. However, surges of dopamine are also released when an individual consumes a drug that affects this area of the brain. As a person continues drug use, he or she builds up a tolerance to the substance. The brain adapts by reducing the ability of reward circuit cells to respond to the drug. This means that more frequent use and/or higher doses must be used for the individual to feel the “high” that comes from dopamine release. Over time, these brain adaptations inhibit a person’s ability to derive pleasure from other activities that would activate a healthy individual’s reward circuit.

Other chemical changes in the brain due to substance use may affect other systems as well, impacting a person’s ability to learn, use judgement, make decisions, memorize, and manage stress and behavior. According to research, the risk of addition is 50% genetic and 50% environmental and developmental. Thus, it is hard to determine why some people become addicted and others do not. The greater number of risk factors an individual has, the more likely he or she is to be addicted to a substance.

Who can help prevent opioid addiction?
Prescription drug manufacturers research and develop abuse-deterrent formulations (ADFs) that aim to avert consumers from misusing medications via injection or snorting. Research illustrates that ADFs decrease drugs’ illicit value. Other research areas involved in the prevention of opioid addiction include the development of safer pain medications and treatments and identifying factors that increase the risk of substance abuse.

Providers, pharmacists, and patients must be involved in the prevention of opioid addiction. Healthcare systems should practice caution when prescribing opioids and monitor a patient’s consumption and his or her adherence to dosage guidelines. Prescription drug monitoring programs (PDMPs) have been employed in multiple states across the United States to track prescribing and dispensing of substances to patients. The use of PDMPs in some states has been associated with lower rates of opioid prescribing and overdose. The National Institutes of Health reports that physicians should balance the risk of misuse and addiction with the legitimate medical needs of patients and the benefits pain medications may bring.

Pharmacists can ensure patients understand dosage instructions and how the medication works, as well as remain watchful for problematic prescription patterns. Some pharmacies have implemented systems to alert surrounding pharmacies in the area when fraudulent prescriptions have been identified. In addition, pharmacists can also utilize PDMPs.

Patients can be mindful in preventing opioid addiction by following dosage directions, consulting a provider before changing a dosing regimen, never giving their prescribed medications to others and never using another person’s prescribed medications, discarding expired or unused medication properly or participating in drug take-back programs, and storing prescription opioids safely.

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By Brittany Branard, Policy and Advocacy Coordinator, Christopher & Dana Reeve Foundation