Chronic Pain and Aberrant Drug-Related Behavior in the Emergency Department
Introduction
Most patients admitted to the emergency department are driven by either acute pain or chronic pain that threaten their wellbeing. Due to its prevalence, patients presenting with pain are usually prioritized by physicians operating in emergency treatment. Physician responds to patients in pain with more apt than patients presenting with little or no apparent pain. What non-health practitioners do not understand is that pain is invisible to any physician in action. Several pieces of research have documented that pain among patients has remained under managed. Such a report indicates the level of suffering among patients, whether the pain is acute or chronic. Cases of under-managed or poorly managed pain are associated with dissatisfaction with health care. Early identification and proper management of pain are associated with optimal health outcomes. Patients can direct feelings of pain to physicians; this can manifest in the form of aggression and uncooperativeness. Poor pain management can contribute to frequent visits to the emergency department hence causing congestion in the waiting list (Salsitz, 2016). Also, poorly managed pain can be a major contributor to slow recovery among patients. Early recognition and treatment of pain are necessary to prevent pain-related anxiety, sleep disturbances, and depression. Pieces of research have documented that pain increases oxygen demand in the body. Increased demand for oxygen can cause limited oxygen to vital organs such as the kidney and brain. Such cases are associated with organ ischemia, leading to their eventual failure.
Based on the number of problems associated with pain, health departments must identify barriers to pain identifications. Early recognition, followed by appropriate treatment of pain, can improve the overall health outcomes of patients; but most importantly in the emergency department. One common barrier that has barred physicians from managing pain is the fear of being tricked by patients. Chronic pain is effectively managed by controlled substances such as diazepam. Physicians may not be in a position to ascertain if a patient is actually on controlled medication such as diazepam. Some patients are driven by their addictive behaviors and may use a trick to obtain the medication. Such patients fabricate pain-like symptoms to deceive physicians to make prescriptions. What physician can suspect when a patient presents to the emergency department requesting for pain medication is medication addiction. Among the signs of addiction to watch out include aggressive complaints or requests for opioid mediation. Also, such patients may show signs such as hoarding the drug when symptoms subside. Unethical practices have surrounded the prescription of schedule IV and V substances. While the effort may be seen in patients, but physicians are sometimes involved in malpractices regarding medication prescription. Practices like selling of the drug to a patient while aware they are not in pain or giving patients prescription drugs even if they had acquired similar medication from other health facilities (Park et al., 2016).
Problem statement
Cases of aberrant drug behaviors are identifiable in our community. Patients under chronic opioid therapy are reported to have an elevated risk of showing aberrant behaviors. Commonly observed behaviors include borrowing opioids medications, stealing from confined places, or diversion. All the behaviors involve both physicians and patients; sometimes, patients and physicians work collaboratively against the law. The behaviors have impaired health care outcomes in health facilities. The inappropriate use of prescribed opioids affects hospital planning for patients who genuinely need medication. Patients seeking prescription opioids for recreational purposes should never have access to the medication. Patients undergoing opioid treatment should be closely monitored since they are at the highest risk of developing drug-related aberrant behaviors. Such behaviors are attributed to addiction. Opioid-related deaths are ever-increasing globally.
According to a report filed by the world health organization (WHO), deaths from prescribed and synthetic opioids rose from 3 persons per 100000 people in 2000 to about 21 persons per 100000 people in 2019 (Hawk et al., 2018). The first alarm was raised in mid-2006 in the US, a country that records the highest number of opioid-related deaths. Many patients report to the emergency department with deceitful behavior on feeling pain. Poisoning by prescriptive opioids has risen due to the increase in patient’s cunning behavior to extract controlled drugs. Some of those patients seeking pain medications from the emergency department are not any form of pain or, if any, have exaggerated pain.
Further research revealed increased use of tranquilizers, sedatives, and other prescribed opioids. Another analysis indicates an increased number of visits to the emergency department. According to the Agency for Healthcare Research and Quality (AHRQ), the number of patients with opioid-related diagnoses has risen sharply since 2012. Such visits impair patients’ health outcomes and cause congestion in the departments hence affecting patients with other forms of illnesses. The department of health and human service, US, made an emergency declaration of opioid abuse crises. The move focused on reducing the causes of opioid abuse among patients, whether prescribed or illicit. Five key strategies were laid to combat the presenting opioid crises, which included improved research on pain and drug-related addiction, access to treatment, and safer and better pain management.
References
Salsitz, E. A. (2016, March). Chronic pain, chronic opioid addiction: a complex nexus. In Journal of Medical Toxicology (Vol. 12, No. 1, pp. 54-57). Springer US.
Hawk, K., D’Onofrio, G., Fiellin, D. A., Chawarski, M. C., O’Connor, P. G., Owens, P. H., … & Bernstein, S. L. (2018). Past‐year prescription drug monitoring program opioid prescriptions and self‐reported opioid use in an emergency department population with opioid use disorder. Academic Emergency Medicine, 25(5), 508-516.
Park, T. W., Saitz, R., Nelson, K. P., Xuan, Z., Liebschutz, J. M., & Lasser, K. E. (2016). The association between benzodiazepine prescription and aberrant drug-related behaviors in primary care patients receiving opioids for chronic pain. Substance abuse, 37(4), 516-520.