Aveneu Park, Starling, Australia

Opioids 2008.7,8 Opioid medications are related with need,

Opioids are a type of strong pain
relieving medication used for moderate to severe pain that may not respond well
to other pain medications.1 This medication is considered  a
class of powerful narcotic medicines.2 Opioids medications are under the classification of Scheduled I – V
type drugs.3 Prescription opioid medications commonly used in the VHA are the
following: codeine, fentanyl, hydrocodone, oxycodone, oxycodone and
acetaminophen, oxycodone and naloxone, oxymorphone, meperidine, methadone,
morphine, tramadol, and buprenorphine.1 The classification of opioids is: naturally occurring compounds (i.e.
morphine, codeine, thebaine papaverine); semi-synthetic compounds (i.e.
diamorphine heroin, dihydromorphone, buprenorphine, oxycodone); and synthetic
compounds (i.e. pethidine, fentanyl, methadone, alfentanil, remifentanil,

Prescribing opioid medications to
treat chronic pain has augmented dramatically in the last two decades,
subsequent in unparalleled numbers of people receiving opioids chronically.5 Prescriptions for opioid medications have increased intensely, with 174
million prescriptions dispensed from retail pharmacies nationally in 2000
increasing to 257 million prescriptions by 2009.6 Prescription opioid abuse has settled as the foremost public health
problem mostly in the United States, which embodies about 5% of the world’s
population, but consumes 80% of the global opioid stock and 99% of the global
hydrocodone stock.6 According to data from the Center for Disease Control (CDC), deaths due
to prescription opioids went from 1.3/100,000 in 1999 to 5.0/100,000 in 2008, resultant
in 14,800 prescription painkiller deaths in 2008.7,8

Opioid medications are related with
need, broad-mindedness, abuse, and peril of accidental overdose.9 Veterans are twice as probable to die from a unintentional overdose related
to the non?Veteran population.9 Veterans with posttraumatic stress disorder are more probable to: be
prescribed opioids at higher doses, obtain opioids and sedative hypnotics concurrently,
and combinations lead to increased risk of accidental overdose.9 More than 50% of male VHA patients in primary care report chronic pain;
the prevalence could be even higher in female Veterans.9 From fiscal years 2004 to 2012, the prevalence of opioid prescriptions between
Veterans increased from 18.9% to 33.4%, an upsurge of 76.7%.10 The groups with the highest prevalence of opioid usage were women and
young adults (i.e., 18-34 years old).10

A national cohort that documents
more than 21 million patient records and 97 million outpatient opioid pain
medication prescriptions was created and covering a 17-year period (2000-2016).11 Some of the results from this study were that the cohort included
21,735,486 patients, with an average age of 69 years, of whom 88% were male and
57% were Caucasian.11 The race/ethnicity percentage of Hispanics were 943,056 (4%).11 The mental health comorbidities percentage of posttraumatic stress
disorder were 1,138,796 (5%).11 The most commonly prescribed opioid pain medication were oxycodone,
hydrocodone and tramadol.11

It appears that the United States of
America is fronting a new epidemic of prescribed opioid misuse and abuse.12 The veteran population is more inclined to misuse and abuse prescribed
opioids due to their high risk for combat-inflicted traumatic injuries and
PTSD.12 Opioids may mollify the symptoms of PTSD and might be abused to
self-medicate for the symptoms, especially during periods of high stress.12  Moreover, drug overdose is now the foremost
cause of injury deaths amongst US adults, with those subsequent from opioid
overdose more than the death rates from all other illicit drugs combined.13

The Institute of Medicine (IOM) issued
a report on relieving pain in USA.14 The report recognized multiple evidences, counting that there are more
than 116 million Americans with pain persisting from weeks to years, with
financial costs ranging from $560 billion to $635 billion per year.14 The report referred to the stern problem of the deviation and misuse of
opioid drugs, questioning their long-term utility.14

The Drug Abuse Warning Network stated
that the number of emergency department visits linked to the nonmedical use of
prescribed opioid significantly increased (111%) between 2004 and 2008.12 The uppermost numbers of visits were documented for oxycodone,
hydrocodone and methadone.12 The National
Institute on Drug Abuse (NIDA) defines prescription opioid drug abuse as any “non-medical
use” or use different than the exact regimen in which it was prescribed for
reasons other than why it was prescribed.15

The epidemiology
and cost of prescription opioid abuse are conspicuous.16 According to the World Health Organization (WHO), the
annual global prevalence of opioid abuse was projected at between 28 and 38
million users.16 The strongly pleasant particular effects shaped by
opioids can hearten nonmedical use leading to addiction.16 In place of, the misuse liability of this drug class generates
a dilemma as chronic pain and opioid abuse are two foremost public health

clinicians are consequently tasked with balancing suitable pain management using
opioids with the peril of patients developing abusive patterns of usage.16 Augmented accessibility of opioid painkillers
combined with other issues such as greater social acceptability of consuming
these medications and belligerent marketing by pharmaceutical corporations are alleged
to have led to a significant increase in the incidence of prescription opioid misuse.16 More prescribing of opioids in clinical practice also
rise the probability that they will be sidetracked to the illegal market.16

The Veterans Health Administration
(VHA) is the largest integrated health care system in the USA and serves a
considerable number of Americans, with approximately 5 million patients treated
annually.17 VHA have documented that opioid dependence is the foremost problem for
many U.S. military veterans.18 Veterans Affairs Caribbean Healthcare System (VACHS) have a total of
eleven care sites including: Arecibo Community-Based Outpatient Clinic, Ceiba Community-Based
Outpatient Clinic, Comerío Rural Outpatient Clinic, Guayama Community-Based
Outpatient Clinic, Mayagüez Outpatient Clinic, St. Croix Community-Based
Outpatient Clinic, St. John Outreach Health Services, St. Thomas
Community-Based Outpatient Clinic, Utuado Rural Outpatient Clinic, VA Euripides
Rubio Clinic-Ponce Outpatient Clinic, and Vieques Rural Outpatient Clinic.19,20

The Department
of Defense (DoD) stated that Hispanics cover the third largest ethnic
population in the military: 10.7% of the Active Duty force and 9.2% of Selected
Reserve members.21 As of November 2009, approximately 13,865 military
service members have deployed from Puerto Rico.21 As the number of Puerto Rican service members is likely
to increase, devotion to this population is reasonable.21