Addressing challenges of opioid use disorder treatment in women
May 11th, 2017 |
Problems related to opioid use have reached epidemic levels in the United States, prevalent in both men and women. The Centers for Disease Control and Prevention (CDC) suggests a higher prevalence of chronic pain and use of prescription opioid pain medications in women than men with nearly 48,000 deaths caused due to prescription painkiller overdose between 1999 and 2010.
There has been a drastic rise in the number of deaths from overdose of prescription painkillers of more than 400 percent among women since 1999 compared to 265 percent in men. Moreover, women are reported to develop drug dependence faster and they experience more cravings compared to their counterparts.
The risk factors contributing to higher vulnerability of women to opioid use disorders may include psychological and emotional distress, which is less among men. Moreover, responsibilities of childcare and looking after home and family may also act as significant barriers in seeking treatment for substance use disorders (SUDs), especially among caregivers.
Prescription opioid use among women is a concern in terms of both prevalence and effects. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2015 survey, 4 percent of females aged 12 and older misused prescription pain relievers in2014. Furthermore, misuse of prescription painkiller accounts for one-woman emergency room visit every three minutes, suggests the 2010 Vital Signs report from the CDC.
Steps to minimize risk of opioid use disorder
The CDC has recommended some safe guidelines for prescribing opioids to patients and clinicians to treat chronic pain. However, these guidelines are not applicable to patients with cancer, palliative, and end-of-life care. Key points in the guidelines are:
- Clinicians should prefer non-opioid pharmacologic therapy to treat chronic pain. Opioid therapy should be used only if “expected benefits for both pain and function are anticipated to outweigh risks to the patient”. If opioids are prescribed, they should be combined with non-opioid pharmacologic therapy and non-pharmacologic therapy, as appropriate.
- Opioid therapy for chronic pain should only be started after the patients are made aware of treatment expectations including realistic goals for pain and function, opioid selection, dosage, duration, follow-up and discontinuation (in case benefits do not outweigh risks to safety).
- As the opioid therapy for chronic pain begins, clinicians should start with prescribing immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.
- Clinicians should carefully assess evidence of individual benefits and risks before increasing the dosage.
- Using opioids for acute pain should begin with prescribing the lowest effective dose of immediate-release opioids and should not exceed the quantity required for the period of severe pain. While three days or less is often sufficient, more than seven days is a rarity.
- It is important to evaluate benefits and harms (for dose escalation or termination) within 1 to 4 weeks after the clinician has started with opioid therapy for chronic pain. It is advised to reduce the dose or discontinue opioids if benefits do not outweigh harms of continued opioid therapy.
- Before starting and while administering opioid therapy, clinicians should always keep an eye on the risk factors for opioid-related harms and take effective steps to mitigate the risk.
- Clinicians should review state prescription drug monitoring program (PDMP) before administering opioid therapy for chronic pain to evaluate patient’s history of opioid use that might increase the risk of overdose.
- Urine drug testing at least once in a year is essential before prescribing opioids for chronic pain to see if the patient is using controlled prescription drugs or illicit drugs.
- Clinicians should refrain from prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
Getting the right professional help
People who are looking for professional help to deal with opioid use disorder can contact the Arizona Substance Abuse Helpline to get expert advice pertaining to substance abuse treatment centers in Arizona. One can chat online or call the 24/7 helpline number 866-857-5777 for information regarding the best facilities to tackle substance abuse problems.