opioid dependence

Ways to Prevent Opioid Dependence

Endless measures are being put in place to help prevent opioid addiction before it even starts.

Every single day, over a 100 persons die in the United States from an opioid overdose. (1)As the Country continues to grapple with the adverse effects of the opioid crises, many in the scientific community are looking at ways to prevent addiction before it takes hold.

Doctors are being taught about more conservative prescribing practices and ways to identify patients who are abusing painkillers, states have integrated prescription drug monitoring programs, and the U.S. Drug Enforcement Agency (DEA) is holding events where people can learn about safe disposal of unused medication to avoid abuse. Researchers are also looking into nonaddictive alternatives to opioids for pain relief, such as vaccines.

“When you take a look at the numbers of overdoses and how many people are affected by these problems, in the United States and outside the United States, what we’re doing now is not enough,” says Marco Pravetoni, PhD, associate professor of medicine at the University of Minnesota Medical School in Minneapolis. “We either have to optimize existing treatments or develop new ways to address the problem.”

Safe Prescribing and Clinician Awareness

Many persons who become addicted to opioids firstly got hooked by taking pain medication prescribed by their doctor.

According to the National Survey on Drug Use and Health in 2015, nearly 92 million U.S. adults — or about 38 percent of the adult population — took a legitimately prescribed opioid. (1) Of these people, approximately 11.5 million misused the drugs, and 1.9 million qualified as having an opioid use disorder.

In a bid to reverse these numbers, several steps have been taken to help doctors practice more cautious and responsible prescribing of opioid medication.

In 2016, the Centers for Disease Control and Prevention (CDC) published its CDC Guideline for Prescribing Opioids for Chronic Pain. (2) These clinical standards are meant to help doctors balance the benefits and risks of chronic opioid treatment. The guidelines focus on determining when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing risk and addressing harms of opioid use.

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The American College of Physicians also offers the SAFE (Strategies. Assessment. Fundamentals. Education) Opioid Prescribing Course, available to doctors on its website. (3) The course features six segments focusing on best practices for how to start treatment therapy with opioids, how to monitor the therapy, how to end it, and everything in between.

Other continuing medical education (CME) courses funded by the U.S. Department of Health and Human Services on prescribing opioids for chronic pain are available through various universities and medical organizations across the United States. (4)

Prescription Drug Monitoring Programs

A prescription drug monitoring program, or PDMP, is an electronic database that tracks controlled substance prescriptions.

These databases can help identify patients who may be misusing prescription opioids. Doctors can use the PDMP to assess patients’ history of controlled substance use before prescribing medication.

The programs were first established as tools for law enforcement officials to oversee the prescribing and dispensing of opioids by medical professionals. The focus has since shifted to center more on the care of the patient and develop opioid abuse prevention and treatment strategies. (5)

According to the National Institute on Drug Abuse, research regarding the effectiveness of PDMPs is mixed, but in some states these programs have been associated with lower rates of prescribing and overdose. (6)

For example, a study published in August 2015 in the journal PLoS One found that a mandatory PDMP in New York State led to a significant reduction in the number of opioids prescribed by dentists over a three-month period. (7) Prescriptions for the nonopioid painkiller acetaminophen increased over this time.

Another study published in October 2015 in the journal JAMA Internal Medicine found that Florida’s implementation of a PDMP was “associated with modest decreases in opioid prescribing and use.” (8)

Currently, 49 states and the District of Columbia have a PDMP that is operational. A variety of state agencies administer these programs, including state health departments, boards of pharmacy, and law enforcement agencies. (9)

Prescription Drug Take-Back Programs

When patients no longer need their prescription medication, it should be disposed of promptly.

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This will help reduce the risk of others, including friends and family members, accidentally taking or intentionally misusing the unneeded medicine.

One way to properly dispose of unused opioid medication is to participate in a National Prescription Drug Take-Back Day, periodically hosted by the DEA.

During these events, temporary collection sites are set up in communities around the country where people can bring their unused or unwanted prescription drugs for safe disposal.

In October 2018, 4,770 law enforcement agencies participated across the country, collecting more than 450 tons of prescription drugs.

People who miss the date can still bring unneeded medicines to DEA-registered collectors. These permanent collection sites may be located in retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities in your community.

Some authorized collection sites may even offer mail-back programs or collection receptacles to make the process easier for consumers.

To get more information about National Prescription Drug Take-Back Day and to locate a DEA-registered collector, visit the DEA’s website. (10)

Steps Patients Can Take to Prevent Opioid Abuse

Patients can also take steps to reduce their risk of opioid dependence. These include:

  • Closely following the directions as explained on the label on prescription medication
  • Being aware of potential interactions with alcohol and other drugs
  • Never using medication from another person’s prescription and never sharing your prescription medication with others
  • Never stopping or changing a dosing regimen without consulting your physician
  • Safely storing prescription stimulants, sedatives, and opioids (6)

Ongoing Research to Help Prevent Opioid Addiction and Overdose

Scientists are currently looking into the development of effective, nonaddictive pain medication as an alternative to opioids. But Dr. Pravetoni notes that these studies are still in very early stages and have a way to go before being used in humans.

In the meantime, researchers are also working on novel strategies to prevent opioid abuse and overdose.

Researchers at the Viterbi School of Engineering at the University of Southern California in Los Angeles, for example, are using computer-learning models similar to those in self-driving cars or in certain smartphone’s facial recognition software to learn how to predict opioid dependency. (11)

These computer-learning models are programmed to sift through patients’ medical records to identify trends that may signal opioid misuse and opioid addiction. Factors the program looks for include patients’ history of prescriptions; whether they had been diagnosed with any other relevant disorders that could increase the risk of developing an opioid addiction; other forms of substance abuse; recreational drug use; alcohol disorders; or mental health disorders, like anxiety and depression.

Researchers tested the AI algorithm against the traditional method of a doctor diagnosing opioid use disorder in a study and presented their results at the 2017 American Medical Informatics Association conference.

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“Our evaluations show that the deep learning models provide better or comparable results in classifying long-term opioid users and opioid-dependent patients,” says lead researcher Yan Liu, associate professor in computer science at the Viterbi School of Engineering.

While more research is needed before implementing this type of technology in a real-world setting, having this data readily available could one day help physicians make better-informed treatment decisions, taking steps to combat addiction before it begins by prescribing alternative forms of pain medication and management, Liu says.

Another potential strategy looks at a new way treat opioid abuse and prevent overdose through the use of vaccines. Pravetoni, along with a team of scientists from the University of Minnesota Medical School and Minneapolis Medical Research Foundation are currently developing vaccines for prescription opioids, such as oxycodone and fentanyl, as well as heroin. (12)

These vaccines work by using the immune system to produce antibodies that target, bind, and prevent opioids from reaching the brain.

Pravetoni says preclinical trials done in rodents show promising results, and he is hoping to begin a clinical trial in humans in about a year.

Notably, in the animal studies, the vaccines appear to help in preventing opioid-induced respiratory depression, a hallmark of an opioid fatal overdose.

Pravetoni also points out that the vaccines could be used in conjunction with traditional opioid treatments, such as methadone.

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