Magazine article The Exceptional Parent

My Child Has a Disability ... Do I Have to Worry about an Opioid Addiction Too?

Magazine article The Exceptional Parent

My Child Has a Disability ... Do I Have to Worry about an Opioid Addiction Too?

Article excerpt

"(In the United States), more people than ever are dying from opioid overdose; in 2016, over 42,000 people were killed by opioids. Across 52 areas in 45 states opioid overdoses increased by 30 percent from July 2016 through September 2017 ... Some opioids such as heroin, are illegal. However, many opioids are legal and are prescribed by health care providers to treat pain; these include oxycodone, hydrocodone, codeine and morphine ... Use of these prescription drugs for short durations, as prescribed by a doctor I, is generally safe ..." (1)

"In 2016, 3.6 percent of adolescents age 12 to 17 reported misusing opioids over the past year ... the CDC estimates that for every young adult overdose death, there are 119 emergency room visits and 22 treatment admissions ... Signs of opioid misuse include: drowsiness, constipation, nausea, dizziness, vomiting, dry mouth, headaches, sweating and mood changes ..." (1)

"The estimated cost of the epidemic nationwide in 2016 alone was $95.8 billion, and its estimated cost between 2001 and 2017 exceeded $1 trillion from lost productivity and increased spending on health care, social services, education, and criminal justice." (2)

Living with a disability can have a serious impact on a person's well-being, especially when that disability is associated with chronic pain. The challenges of living with daily pain contributes to substance abuse rates that are two to four times higher among individuals with disabilities than in the general population. (3) Every 25 minutes, an infant is born suffering from opioid withdrawal (a pre-birth consequence from mom), and an estimated 21,732 infants were born in 2012 with neonatal abstinence syndrome, a drug withdrawal syndrome. (4)

The risk factors for adolescent substance abuse are similar to the behavioral effects of learning disabilities: reduced self-esteem, academic difficulty, loneliness, depression and the desire for social acceptance. Thus, researchers theorize, learning disabilities may indirectly lead to substance abuse by generating the types of behavior that typically lead to substance abuse. (5)

Nevertheless, in the last decade there has been significant controversy about the appropriateness, efficacy, safety, and wisdom of treating chronic pain patients with opioids. Arguments against their use have included concerns about tolerance, dependence, addiction, persistent side effects, and interference with physical or psychosocial functioning. However, considerable experience and research suggests that in appropriately selected patients, opioids have a low morbidity, and a low addiction potential, and in addition to the primary analgesic action, can facilitate reduction in suffering, enhance functional activity level, and improve quality of life without significant risk of addictive behaviors. (6)

Although evidence is limited, the expert panel of the American Pain Society and the American Academy of Pain Medicine concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. (7)

Some patients are at risk. (6,7)

SOME LESSONS IN ANATOMY AND PHYSIOLOGY

The brain is wired to encourage life-sustaining and healthy activities through the release of dopamine. Everyday rewards during adolescence--such as hanging out with friends, listening to music, playing sports, and all the other highly motivating experiences for teenagers--cause the release of this chemical in moderate amounts. This reinforces behaviors that contribute to learning, health, well-being, and the strengthening of social bonds. (8)

The "high" produced by drugs represents a flooding of the brain's reward circuits with much more dopamine than natural rewards generate. …

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