INTRODUCTIONThe around 400 B.C.. Later on, near 330

INTRODUCTIONThe use of opioids dates back to 8000 B.C. when the opium poppy, called Papaver somniferum, but he first known cultivation of opium poppy plants was in Mesopotamia, around 3000 B.C., by Sumerians (Gerrits, Lesscher, & Ree, 2003). in ancient Mesopotamia. The “father of medicine”, Hippocrates, recognized the usefulness of opioids as narcotics and treatment for pain around 400 B.C.. Later on, near 330 B.C. Alexander the Great brought opium to India where different cultures used it as sedatives.  Around 220-264 A.D., a well-known Chinese surgeon used opium preparations along with other drugs for his patients to take before undergoing major surgery in order to minimize the pain (A brief history of opioids 2014).  Fast forward to the early 1800s, Britain became extremely dependent on opiates. In response to China attempting to reduce the amount of opiates being sold, the British sent warships to China, hence that was deemed as the impetus of the “First Opium War” of 1839 (A brief history of opioids 2014). Around 600 A.D. the territory became Persia, where the opium poppy was cultivated then exported by Arab traders from the Middle East to India, China, and later to Europe (Gerrits, et al., 2003). The Muslim prohibition of alcohol and Chinese ban against tobacco smoking may have favored the spread of opium. The Muslims and Chinese were known to mainly smoke opium, but as it moved west the manner in which it was consumed changed. The ancient Greeks and Romans were aware of opium and at the end of the middle ages the physician Paracelsus invented the opium tincture, laudanum, which was a liquid preparation of alcohol and opium (Gerrits, et al., 2003). It was commonly used as an ailment for pain relief, diarrhea, and cough suppression. The problem with laudanum was its addicting nature due to the opium, which contains the alkaloids morphine, codeine, and thebaine. These are natural opiates found in opium that induce analgesia (pain relief) and euphoria, enhancing their risk of addictiveness (Miller & Lyon, 2003). In 1806 German pharmacist Friedrich Serturner was able to isolate an active component of opium, the alkaloid morphine (Reisine & Bell, 1993). Morphine was a very effective painkiller, but it appeared as addictive as opium. This sparked an interest in researchers to find a painkiller that did not have addictive properties.Researchers spent nearly a century trying to separate the pain relieving and addictive properties, resulting in chemist Heinrich Dreser’s discovery of heroin (Gerrits, et al., 2003). Heroin was introduced as the ideal nonaddictive substitute for morphine, but around 10 years later it became clear that heroin has a higher addictive potential than morphine, and was banned in the United States in 1905 (Gerrits, et al., 2003). During the 20th century, a number of semi-synthetic and completely synthetic opiates were synthesized from morphine, codeine, and thebaine. Examples include semi-synthetic opiates like hydromorphone, oxycodone, heroin, and completely synthetic opiates like meperidine, fentanyl, methadone, buprenorphine, and many others. These are all regulated by the Federal Drug Administration (FDA) and controlled by doctors and pharmacists under the Controlled Substances Act.  The people of America are facing a problem regarding the over dependence on opioids which had led to the increase of opioid abuse and overdoses. Despite attempts at regulating the distribution of opioids, the amount of deaths due to opioid overdoses has risen and will continue to rise if something isn’t done to prevent it from doing so. This rapid increase in opioid usage and deaths due to overdoses has made the opioid issue an epidemic nationwide. This opioid epidemic has negatively impacted all genders, various age groups, and stretches across a multitude of ethnic groups. Possible causes of this problem could be the lack of knowledge and education that pharmacists have in prescribing opioids as medication or the stigma that surrounds the idea of people that have addictions to drugs. To efficiently fight this crisis, experts say that “governments must fully embrace every solution out there” (Quinn 2017).  Naloxone hydrochloride, also known as narcan, is an effective antidote to combat an opioid overdose; when given intravenously or by nasal spray, it works within minutes to reverse the effects of an overdose due to opioids, saving the lives of many users of these particular drugs. It has been used in hospitals for many years to reverse the effects of opioid overdoses (Singer 2017). Since 2013, the U.S. Centers for Disease Control and Prevention (CDC) has encouraged jurisdictions to equip first responders with naloxone hydrochloride and make it more available to other third parties — friends and relatives — who are likely to come across an overdose victim. Access to narcan can be expanded through various attempts: standing orders at pharmacies, distribution through local, community-based organizations, access and use by law enforcement officials, and training for basic emergency medical service staff on how to administer the drug (CDC 2017). Access to this antidote should be universal as it could solve the issue of overdoses. On the other hand, if this were to be the case, people might take advantage of the fact that they have this safety net to rely on if they do so happen to overdose by abusing opioids (2017). Improving the way opioids are prescribed through clinical practice guidelines can ensure that patients have access to safer, more effective pain treatment while lessening the number of people who potentially misuse or even overdose from opioids. Reducing the amount of exposure to prescription opioids, for situations where the negative outcomes of opioids outweigh the benefits, is a pivotal part of prevention (CDC 2017). Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. The urgency of patients’ needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited therapeutic alternatives for chronic pain have combined to produce an over reliance on opioid medications in the United States, with associated alarming increases in diversion, overdose, and addiction. Given the lack of clinical consensus and research-supported guidance, physicians understandably have questions about whether, when, and how to prescribe opioid analgesics for chronic pain without increasing public health risks.There have been numerous solutions that have been proposed. However, some are controversial and others have just proven to be ineffective. One thing that can be attempted is having drug labels clearly pointing to the known harms and limited evidence of effectiveness for long-term opioid use, especially in high doses. There are a number of agencies that are working to combat this epidemic. Is it enough? The Center for Disease Control and Prevention (CDC) is working to raise awareness to the public about this epidemic and provides health care professionals with the information and materials they need to ensure patient safety. Controversial approaches include needle exchange programs, safe injection sites. This is where addicts can shoot up heroin under the supervision of a health-care professional without having the fear of being arrested. Allowing people that are addicted to use in a controlled setting is a method of treatment because “detox isn’t a treatment” and in allowing them to do so they’ll learn how to control the dosage amount, leading to less deaths due to overdoses.  Efforts to ameliorate the issue should focus on four main objectives: providing prescribers with the knowledge to improve their prescribing decisions and the ability to identify patients’ problems related to opioid abuse, reducing inappropriate access to opioids, increasing access to effective overdose treatment, and providing substance-abuse treatment to persons addicted to opioids. Pharmacists have to be educated on the prevention of prescribing medications that can be misused and abused. Substance-use disorder is a disease. It is important to understand that, treat it as that, and erase the stigma surrounding drug abuse, misuse, and overdose.

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