A Variation In The Quality Of Care Through Opioid Medication Literature Review

Type of paper: Literature Review

Topic: Medicine, Nursing, Pharmacy, Medication, Substance, Treatment, Abuse, Bullying

Pages: 8

Words: 2200

Published: 2020/12/17

[Institution Title]


This study entitled A Variation in the Quality of Care through Opioid Medication sought to establishing the need to determine if there is any difference in the quality of care that patients receive in reference to the opioid medication based on their history of substance abuse during their hospital stay through the use of quasi experimental research. In this study 56 participants who were selected using stratified random sampling were asked to respond to the 10-item self-contructed questionnaire following the intervention of opioid medication for as treatment for patients with chronic nonmalignant pain. In the study it revealed that 93% of the participants have showed manifestation of opioid dependence. This answers the question that there is the variation in the quality of care for patients under opioid medication in reference to patient’s history of susbtance abuse and substance dependence considering that the patient with such history are twice at risk as patients without history of substance abuse and substance dependence.
Keywords: quality of care, opioid medication, susbtance abuse, substance dependence.


While the growing debate on the legalization of use of medical marijuana is making noise in the medical profession, opioid has long been utilized as an effective treatment of choice tracing to the ancient medical history . In fact in ancient Mesopotamia, opium, a raw form of opioid, was largely considered for its medicinal properties thereby falling under the classification of botanical medicine (Teall, 2013, p.4). In addition, there had also been several civilizations which recognizes the analgesic effect of opium leading to its massive use and popularity until 1729. During this year Emperor Yongzheng of the Qing Dynasty of China began the ardent campaign to prohibit the use of opium as medication of treatment of choice for many medical conditions despite its proven potency . However, the decision to prohibit the use of opium has nothing to do with it effects but rather on the impression that smoking has as being opposed to upholding the Confucian virtue. Gradually, opium was banned in different parts of the globe. In the US, the country began to restrict the importation of opium in 1883 with a policy that passes high tarrifs for bring opium into the country . In 1909, through the Opium Exclusion Act the importation of opium and its use in the country has been prohibited . Nevertheless, while many medical scholars has established the addictive property of opium the use of this particular type of medication has not been completely banned. Hence, opium is currently just among the medications classified under the Controlled Substance Act that is being regulated by the Drug Enforcement Administration. Considering the restrictions and the potential risk of using opioid as treatment of choice, this paper would like to determine whether there is, if any, variation in the quality of care relating to opioid medication in reference to patients with history of substance abuse versus patients who are classified otherwise.
Statement of the Problem: Do patients who have a history of past or current substance abuse problems get the same quality of care using opioid medications compared with someone who is a non-abuser during hospital stay?

Reviews of Related Literature

In a primer released by the Australian Prescriber, an Australian-based local medical health magazine, Director Michael McDonough of the Department of Addiction Medicine and Toxicology at the Western Hospital in Melbourne, expresses the benefit of opioid substitution . McDonough did, however, said that opioid treatment is not always for everyone. This is despite the promising and the successful results documented using this type of treatment among patients of different medical condition. In addition, certain protocols and measures had to be undertaken before this treatment is recommended to patient. Among the procedural requirement of using this treatment includes the identification of patient’s type and severity of addiction through applying diagnostic criteria based on history, examination and urine drug testing (McDonough, 2013, p. 83).
Similarly, in a study initiated in 2005, authors Bernard Le Foll and Steven R. Goldberg also poses that opioid medication and treatment can actually be benefitial for patients who were suffering from substance abuse like coccaine dependence (Le Foll & Goldberg, 2005, p. 876). According to the authors, while the said treatment does not exactly cure the dependency of the patient to coccaine what it does is to doused the cocaine-seeking behavior which initiates and triggers the urge to use coccaine (2005, p. 880).
Significantly, in an article published in 2007, a qualitative review of the opioid treatment for chronic back pain reveal that while efficienncy may be high the risk for addiction is also very likely . The authors offered to explain why amidst the effeciency and success of opioid medication, physicians still deny most patients with this treatment. According to a systematic review done by the authors they found out that opioid medication is not entirely effective to all patient’s reporting chronic back pain. Instead, the authors found that opioids are more effective than placebo or the active comparator drug (Martell, et al., 2007, p. 123-124). In addition, Martell and associates believed that a large number of patients who have been under this treatment has reported addiction to opioid. Hence, the chronic back pain is not entirely resolved by the opioid medication but is only being used as an excuse by patients to take the treatment.
However, a contrary findings has been identified which did not support of using opioid medication across all users, especially substance abusers. This findings was documented in a study that was facilitated by health practictioners and author of research Dr. David A. Fishbain, Brandly Cole, Dr. John Lewis, Dr. Hubert L. Rosomoff and RN R. Steele Rosomoff. According to Dr. Fishbain and associates, imposing the use of opioid medication among patients who were suffering from Chronic Nonmalignant Pain will only develop manifestations indicating aberrant drug-related behaviors (Fishbain, Cole, John Lewis, Rosomoff, & Rosomoff, 2008, p. 457). Fishbain, et, al. (2008) shares McDonough’s insight that opioid medication and treatment is not for everyone especially patients who have already have a history of substance abuse and substance dependence as compared to patient’s who have none. Similarly, Fishbain, et, al.’s study also suggest that opioid treatment and medication among should not be recommended because of the high incidence that they will put patients under the rish of developing aberrant drug-related behaviors especially those suffering from chronic nonmalignant pain.
Two quantitative studies documents personal opinions nd analysis made by patients themselve who were under opioid medication . According to Adams, et al, (2004), subjecting patients to take opioid medication unsupervised is most likely to lead to addiction or abuse. In fact, in the study they’ve conducted only 4% of the participants who were initially part of the 330 patients who were requested to undergo a contract for the lower back pain treatment using opioid medication has been able to satisfactorily complete the treatment because they have met all the specifications in the contract. The specification would ensure patients will not abuse the medication given to them (Adams, et al., 2004, p. 487). On the other hand, Wasan and associates (2009) have subjected patients under opioid medication to document their path under the medication. In the study, each of the participants will conduct a self-report on their craving for the prescription. Towards the end of the study, the author’s said that it helped identify the people who are most likely to develop addiction for the medication. Among those were patients who already have records and history of substance abuse because their tolerance is not very high (Wasan, et al., 2009, p. 197).


This study entitled A Variation in the Quality of Care through Opioid Medication was initiated with the goal of establishing the need to determine if there is any difference in the quality of care that patients receive in reference to the opioid medication based on their history of substance abuse during their hospital stay. In lieu with this, the proponent of this paper wishes to conduct a quasi experimental resarch.

Research Design

A quasi experimental research was initiated to test whetehr there is basis for saying that opioid medication should not be used for patients with present or previous history of substance abuse. Therefore, agreeing with the statement that there is a variation in the quality of care that nurses and other members of the healthcare team renders during hospital stay in reference to subjecting patients to opioid medication.


For this particular study, the propoent requested the participation of 56 patients who were all under opioid medication in three participating hospitals. The said participants were selected using stratified random sampling. The condition being that participants should be undergoing opioid medication for the treatment of chronic nonmalignant pain.


Prior to the experiment, the proponent requested that each of the participants who agreed to participate in the study should sign a consent form. The consent form bears the letter of intent as well as the detailed presentation of how the resarch will be conducted and what the objectives of the studies were intented to be delivered after the experiment has been concluded. Ina addition, the consent form also explains to the participants the responsibility and accountability of the proponent largely resulting from the study.


Results and Findings
Demographically, the 56 participants were composed of 27 females and 29 males. During interview it was found that 39 of the participants did not have a history of substance abuse or dependence. 17, on the other hand, admitted to have an issue with substance abuse and substance dependency. 12 of the 17 self-confessed substance abuser or substance dependent, they have already conquered their addiction, while the remaining 5 participants were presently abusing different kinds of regulated and prohibited substances.
Coccaine was among the most abused substance as revealed during the survey with 66%. This is followed by marijuana with 27% and opium with 7%. According to patients the effect of the opioid medication significantly varies. When asked if the medication aids in reliving their pain, 84% replied yes, while 16% said that they do not feel any significant improvement in their condition, more so, these 16% of the population said the they are still in excruciating pain even after the treatment. Numbness was reported following opioid treatment. This was according to 41% of the particpants. Drowsiness or sleepiness was reported by 36% while thre remaining 23% said they feel floaty or airy or aggitated.
Towards the end, when asked if they would instantly request for opioid medication at the slight onsent of, 93% said that at the onset of pain even before it progresses to an intolerable level they would always request for medication. This signals that 52 out of the 56 participants have already developed dependence of opioid medication.


Considering the limited time to conduct the study, the propoent has been limited to a very small sample population. In addition, the absence of a standardized matrix and questionnaire may compromise the results of the study.


After a thorough evaluation of the responses entered by the participants of this study, it revealed that patients are at risk of developing dependence over opioid. This findings is made regardless of their previous experience or history of substance abuse or substance dependence. However, it proves that patients who have already the history of substance dependence and abuse and twice more likely than those who have none to develop addiction or dependence over opioid medication. Hence, it is the conclusion of this study that the variation of the quality of care for opioid medication in reference to patient’s history of substance abuse is high. This conclusion is made after discovering that history of substance abuse does not significantly affect or impact the intensity of the potential risk of patient’s to develop addiction or dependence. All patient’s are most like to develop this addiction or dependence. However, special attention for relapse are more likely to occur for patients who already have history of substance abuse and substance dependence.


Adams, L., Gatchel, R., Robinson, R., Polatin, P., Gajraj, N., Deschner, M., & Noe, C. (2004). Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. Journal of Pain and Symptoms Management, 440–459.
Beckera, W., Sullivana, L., Tetraultc, J., Desaib, R., & Fiellina, D. (2008). Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates. Drug and Alcohol Dependence, 38-47.
Fishbain, D., Cole, B., John Lewis, J., Rosomoff, H., & Rosomoff, R. S. (2008). What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review. Pain Medicine, 444–459.
Gieringer, D. (2009, February 8). The Opium Exclusion Act of 1909. Retrieved from Counterpunch Organization Website: http://www.counterpunch.org/2009/02/06/the-opium-exclusion-act-of-1909/
Le Foll, B., & Goldberg, S. (2005). Cannabinoid CB1 Receptor Antagonists as Promising New Medications for Drug Dependence. The Journal of Pharmacology and Experimental Therapeutics, 875-883.
Martell, B., O’Connor, P., Kerns, R., Becker, W., Morales, K., Kosten, T., & Fiellin, D. (2007). Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine, 116-127.
McDonough, M. (2013, June). Article: Opioid treatment of opioid addiction. Retrieved from The Australian Prescriber Website: http://www.australianprescriber.com/magazine/36/3/article/1408.pdf
Rounsaville, B., & Kleber, H. (1985). Untreated Opiate Addicts How Do They Differ From Those Seeking Treatment? Archives of General Psychology, 1072-1077.
Teall, E. (2013). Medicine and Doctoring in Ancient Mesopotamia. Grand Valley Journal of History, 1-10.
Trocki, C. (2002). Opium as a commodity and the Chinese drug plague. Retrieved from Queensland University of Technology Website: http://www.humanities.qut.edu.au/research/socialchange/docs/conf_papers2002/TrockiCarl.pdf
Wasan, A., Butler, S., Budman, S., Fernandez, K., Weiss, R., Greenfield, S., & Jamison, R. (2009). Does Report of Craving Opioid Medication Predict Aberrant Drug Behavior Among Chronic Pain Patients? Clinical Journal of Pain, 193–198.

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