Successful pain management is essential to improving and maintaining patients’ quality of life. Many patients today suffer from chronic health conditions that are associated with painful symptoms that prevent them from engaging in their regular activities, such as socialization or sports. Additionally, acute diseases may also require effective pain management, particularly after various treatments and procedures. Opioids are among the most effective methods for managing both chronic and acute pain, which is why doctors prescribe them. However, opioids are addictive and dangerous, and in recent years, there has been an increase in the number of opioid prescriptions, people with addiction to opioids, and even deaths from overdosing. This is a critical bioethical issue because there is a conflict between the ethical values of beneficence and nonmaleficence. The present paper will summarize and review the problem of opioid overprescribing and suggest ways in which healthcare administrators can handle it in their facilities.
To understand the full scope and impact of the problem, it is essential to consider the statistics. There have been many research studies comparing the rates of opioid prescribing over the years. A report by Guy et al. (2017) considered changes that occurred between 1999 and 2015. The scholars noted that the number of opioids prescribed in the United States peaked at 782 morphine milligram equivalents (MME) per capita in 2010 and slowly decreased to 640 MME in 2015 (Guy et al., 2017). Nevertheless, the 2015 figure was still three times higher than in 1999 (Guy et al., 2017). This shows that there was a significant increase in opioid prescribing over the years, despite measures to address the issue.
While opioids can be beneficial to patients, they can also induce addiction and pose a threat of overdosing. According to Kolodny et al. (2015), overprescribing opioids has led to an increase in the prevalence of opioid addiction and related overdose deaths. Scholars note that “from 1997 to 2011, there was a 900% increase in individuals seeking treatment for addiction to OPRs,” and “the OPR-related overdose death rate nearly quadrupled” in this time period (Kolodny et al., 2015). This proves a correlation between opioid prescribing, addiction to opioid pain relievers, and overdose deaths.
From the perspective of bioethics, it is essential to balance the principles of beneficence and nonmaleficence while providing care to patients. In other words, care providers should seek to address the patient’s concerns while minimizing the risk of harm. Prescription of opioids is justified by their effectiveness, but many patients could benefit from less addictive alternatives, and these should be explored first. In order to address the problem of opioid overprescribing in healthcare facilities, administrators should seek to implement and support the application of the so-called analgesic ladder for patients with chronic pain. In this guideline, medications used for pain management increase in strength until adequate pain management is achieved (Yang et al., 2020). The four-step analgesic ladder helps to prevent unnecessary long-term use of opioids in patients with chronic pain while offering sufficient pain relief to improve their quality of life (Yang et al., 2014). Administrators should also ensure care providers’ access to the latest pain management guidelines and recommendations and develop internal policies for reducing opioid overprescribing. These measures would help to address the problem while providing high-quality care to patients.
On the whole, opioid overprescribing is a significant issue in the United States. The statistical data show that over the past two decades, the volume of opioids prescribed per capita increased along with the number of people addicted to prescription opioids and related overdose deaths. To balance the principles of beneficence and nonmaleficence, healthcare administrators should encourage the application of appropriate pain management guidelines through provider education, access to information, and internal policies.
References
Guy, G. P. Jr, Zhang, K., Bohm, M. K., Losby, J., Lewis, B., Young, R., Murphy, L. B., & Dowell, D. (2017). Vital signs: changes in opioid prescribing in the United States, 2006–2015. MMWR. Morbidity and Mortality Weekly Report, 66(26), 697-704.
Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559-574.
Yang, J., Bauer, B. A., Wahner-Roedler, D. L., Chon, T. Y., & Xiao, L. (2020). The modified WHO analgesic ladder: Is it appropriate for chronic non-cancer pain? Journal of Pain Research, 13(1), 411-417.