Smart I Pill Dispenser-Juniper Publishers
Juniper Publishers-Journal of Anesthesia
News
The economic burden of the opioid epidemic cost the
US $78.5 billion a year. A person dies from an opioid overdose every 20
minutes which totaled 30,091 people last year. It is an epidemic that
difficult to treat. Opioid overdoses now outnumber the number of deaths
from gun violence and motor vehicle accidents per year. Over 90% of
patients who overdose on prescription painkillers are prescribed opioids
again. Currently in the US there are 100 million people in chronic pain
who are dependent on prescription opioids, 1 million veterans from war
who are dependent on prescription opioids, 20 million who abuse
prescription opioids and there is 30,000 who die from prescription
overdoses.
Opioids are necessary to treat pain but the
prescription opioid overdose has become a significant national problem.
Life expectancy in the US has dropped to 73 years and 8 months largely
because of it. The opioid epidemic was rooted by a US government agency
JCAHO (Joint Commission on Accreditation of Healthcare Organizations now
referred to as the Joint Commission) policy in 2001 that declared pain
as the 5th vital sign which has now lead to make prescription opioid
abuse/ addiction and the respiratory depression leading to death a
complex problem primarily in US. 90% of the opioids consumed in the
world are consumed in the United States. JCAHO began an education of the
public and of the medical community that patients deserved to be pain
free. Opioids were deemed safe to prescribe and deemed to have a low
addiction potential. Hydrocodone was prescribed rather freely and the
introduction of OxyContin compounded the growing problem. Treatment of
Opioid abuse/ addiction and the respiratory depression leading to death
is a complex problem to solve. 90% of those who overdose on prescription
opioid pain medications are returned back on opioids by their
physicians. 80% of the prescription opioids responsible for an overdose
come from friends or family. Naloxone and Suboxone, two drugs touted as
the solution to the opioid epidemic, unfortunately represents an
afterthought. Naloxone an opioid antidote is designed to treat patients
already actually overdosed on opioids and Suboxone is designed to treat
patients already addicted on opioids. It is a little too late to be
effective. In fact, studies report that 90% of patients who overdose on
opioids do not get Naloxone or Suboxone. When realization by government
agencies that chronic opioids could cause addiction and abuse it was too
late. The whole country was basically taking opioids. In 2014 there
were 261 million opioids prescribed for a US population of 319 million
people. Every single adult in the US could have received a prescription
for a bottle of opioids. The governmental policy to the opioid overdose
crises was to limit access to opioids with REMS (Risk Evaluation and
Mitigation Strategies) and CURES (Controlled Substance Utilization
Review Evaluation System). Unfortunately, the policy to limit opioid
access it has significantly worsened the problem and has created another
problem. The opioid overdose death rate in the US quadrupled in the
last 10 years and addicts desperate to recycle their euphoria with
access to prescription opioids limited were forced to resort to the
cheaper and easily accessible alternatives namely Heroin. The Heroin
addiction in the US has quadruple in the last 10 years. Heroin is has
become even more deadly because it is now being «cut» with fentanyl and
the even more deadly counterpart, car-fentanyl which are at least 100
times more potent than Morphine.
There is no solution to prevent overdoses and allow
safe treatment of pain. There are tamper proof opioids, extended release
opioids, and abuse deterrent formulations of opioids on the market now
to prevent overdoses. There is unfortunately no pivotal evidence to
support their to use. All these tamper proof, extended release, and
abuse deterrent formulation manipulations of opioids have one weakness -
ingestion. The oral route is most common method of administration of
opioids and it is the simplest method in which to abuse opioids. It is
easy to ingest more drug than prescribed. Doctors prescribe opioid
pills. Pharmacists fill opioid prescriptions. But when these patient
obtain a bottle of pills from the pharmacy, there is nothing to prevent
the patient from taking one pill or ten pills or the whole bottle of
pills. To treat a opioid addict with more opioids is intuitively
illogical because the opioid addiction is not treated. It is tantamount
to treating an alcoholic with more alcohol without treating the
alcoholism. It is a disease that requires more than just a special type
of pill. Rather than focusing just on the treatment of pain perhaps the
focus should be on the treatment of the patient as whole.
The solution to the opioid epidemic could possibly
involve ensuring compliance of of patient to the opioid prescription
directions. Patients who are dependent, abuse, and addicted to opioids
are different from other patients in terms of their level of compliance.
These want to take their opioids, and they will never forget to take
them. If they run out supply, they frequently attempt to get more
prescription opioids from family members or friends who have an extra or
an unused amount before going to illicit sources. Tamperproof, extended
release and abuse deterrent formulation used as preventive measures may
be employed but it must be understood that patients still overdose and
die with these manipulations because of the simple method in which they
can be abused. We know this information is likely correct because the
death rate from prescription opioids has quadrupled since 2004 and still
continues to climb even in their presence. Severely limiting or
curtailing opioids amounts to ineffective treatment of pain and
encourages patients to progress to Heroin to seek relief. This
information suggest that perhaps the treatment paradigm needs to be
altered by controlling the physical oral procedure of ingesting these
drugs. This can be done with a smart pill dispenser that is biometric
fingerprint controlled. The smart pill dispenser would enhance
compliance to the prescription by dispensing of pills only as
prescribed. The number of pills and the time interval between pills
would be controlled preventing an overdose. The biometric fingerprint
controller would ensure that only the patient would be able operate the
device to dispense the opioid and would also serve to prevent sharing.
The patients would receive their prescription opioid for treatment for
their pain and forced into compliance by the smart pill dispenser that
would prevent over ingestion of the opioid leading to an overdose. The
patient would be alive to seek proper treatment of their addiction
whether it would be a comorbid medical issue, psychosocial issue or a
socioeconomic issue.
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