Effectual postoperative pain management is a crucial procedure constituting to quality care for surgical patients. This is because insufficient pain control, aside from proving inhumane, can result to significant increase in mortality and morbidity. Effective management of pain resulting from a surgery is also important in preventing negative impacts that include hypertension, reduced alveolar ventilation, improper wound healing, tachycardia, and myocardial ischemia (Sorger 891). Postoperative pain, which has sensory as well as emotional components, can as well perpetuate negative patient experience thereby interfering with their normal daily functioning. Pain can for example interfere with patients’ ability to sleep or overall physical wellbeing. This may in return prevent timely discharge from the hospital, extend rehabilitation period and delay functional recovery. Proper postoperative pain management is thus important in reducing patient suffering as well as perpetuating timely mobilization, shorter hospital stay, reduced hospitalization bills and enhanced patient satisfaction (Tracy 56). This paper evaluates how pain-relieving substances, which have significant consequences on addiction, are being used in United States’ southeastern region to manage postoperative pain. The paper will take a historical overview to analyze how this product was used across the country to shape political, economic, and social aspects of the nation. It will then narrow down to the southeastern region particularly in Alabama to evaluate how the product is successfully being used to manage postoperative pain despite the significant addiction consequences.
The use of opioids in postoperative pain management in United States; with specific view of Alabama
Undergoing surgery is usually a scary experience among many individuals that fear the possibility of undergoing excruciating pain after the exercise and the potential lack of adequate pain treatment. Although a certain degree of discomfort is expected after a surgery, it should be bearable and enhance smooth and if possible, uneventful recovery. Some surgeries however perpetuate more pain compared to others and this calls for effective postoperative pain management. Opioids constitute to the first line of drugs used to relief painful conditions following a surgical experience. According to Mayo Clinic (2), opioids describe psychoactive chemicals that come from a popular plant known as Opium Poppy, which is scientifically known as Papaver Somniferum. Opium Poppy was first cultivated in Ancient Greek but today, it is common in most regions in United States, Asia and Europe.
According to Clayton (123), opium has for decades been used as an important drug that shaped the US political, social and economic aspects and it is only in recent years that implications associated with this product have become apparent. Historical evidence indicates that opium was used in United States to accomplish various social, political, and economic objectives since the country’s inception. As reported by Tracy (61), earliest references indicate that opium was legally grown in most parts of the country to generate huge economic benefits. This can for example by evidenced from a letter that was dated 1781, which was sent to farmers commending them for producing high quality opium that would be sold in the market.
Another important development confirming historical usage of opium in United States was the discovery of Morphine by a German pharmacist, which was found to be a powerful remedial substance that could be used to cure various ailments. A British pharmacist who mixed a sample of morphine and anhydride to create diacetylmorphine that was later used to treat certain ailments that included common cold, pneumonia, and tuberculosis (Volkow 11) made another similar discovery in 1974.
At the verge of these developments, a significant boom in opioids particularly in southeastern region of the country was taking place. Most states in this region started importing large quantities of opium, which led to United States’ Customs Service to establish the initial opium tax. Importation of this product thus gained significance as it helped to generate a huge economic benefit in form of tax revenue (Clayton 126). Domestic opium production was also carried out but the domestic crops produced very little juice that could not render any significant economic benefits. This indicates that most of the opium that was used in United States’ southeastern region particularly in Alaska, Alabama, and Kentucky was imported. Commentators argue that opiates gained popularity during the civil war during the colonial era when soldiers started to use some of the opium products to relief pain incurred in the battle fields. Dependence on these products as a pain remedy was particularly perpetuated by the introduction of hypodermic needles (Tracy 71). This enabled most civil war soldiers to intravenously administer morphine to relief pain. Throughout the colonial era, opium was used as a powerful medical remedy that could be employed to treat a variety of health implications that ranged from mild headaches to severe toothaches and insanities. A sharp rise in morphine and opium use in the United States’ southeastern region was reported five years after the civil war ended. Most users of these products during this period were women who reportedly used these products to treat diarrhea and dysentery among other common ailments. Historical evidence thus indicates that opiates during the nineteenth century were used for medical purpose (Sorger 893).
As explained by Tracy (98), opiates were also used for recreational purpose to help shape social statuses among men and women in United States’ high-class society. While it was widely thought unseemly for women to consume alcohol, there was a significant temptation for these women to use opium in place of alcohol to restore their euphoric sense. This saw a significant rise in recreational opium use among women belonging to middle and high-class societies. As a result, this translated into a significant rise in the number of women that abused this product. A survey that was carried out in the state of Alabama in 1885 for example showed that 75% of opium and morphine users were women. Increased use of opium for recreational purpose by women saw the rate of opiate addiction escalating to 4.5%. A growing increase in the number of Chinese immigrants in this region perpetuated rapid increase in opium usage for recreational purpose, which would eventually translate into addiction (Sorger 894). A rapid rush by Chinese immigrants in United States was contributed by discovery of gold in 1848. While a similar period was characterized by economic turmoil in China, most Chinese workers were hoping to make enough money in United States to be able to support their poor families. The Chinese immigrants however experienced a severe level of discrimination and oppression in the mining industry. They were for example exposed to hard and extremely dangerous tasks that included blasting mines using dangerous tools. This exposed them to an extreme level of physical and psychological torture and they thus resolved to smoke opium to relieve the pressure. Increased wage and labor discrimination against Chinese communities diversified racist attention to opium smoking particularly because the product was associated with low class Chinese laborers. Existing anti-Chinese laws were modified to condemn opium smoking among Chinese immigrants (Clayton 129). They were particularly condemned for tricking unsuspecting white women into becoming slaves to this drug. The need to condemn opium smoking particularly attracted the federal attention when press stories provided solid evidence that the practice had become rampant among gamblers, commercial sex workers, and criminals. This as a result perpetuated formulation of prohibitory laws to curb opium smoking and eventually promote social order. One such decree was passed in Virginia City where opium smokers were categorized into a criminal class (Daly 36).
From this analysis, it cannot be denied that prohibitory laws against opium smoking were perpetuated by a racist ideology that was further triggered by significant disturbances that Chinese immigrants posed on United States’ economic structure. Legal authorities thus intended to curb distribution and usage of this drug so s to curb the economic crises linked to its usage. The eventual prohibition of opium following significant perception about its role in perpetuating crime, prostitution, and economic crisis occurred in 1909. This occurred through the establishment of The Smoking Opium Exclusion Act, which outlawed importation of opium intended for smoking (Volkow 23). This became the first outright legal prohibition of opiate use, which perpetuated subsequent efforts for complete prohibition. These efforts led to establishment of the 1914 Harrison Act, which intended to terminate circulation of this product among the commercial traders. This gave opium use a medical establishment where any recreational use of the product was prohibited and only doctors were allowed to prescribe opioids to treat various health implications as part of legitimate medical activity. Despite the fact that heroin constituted to one of the major opiates that was used for medical purpose, the realization of its addictive attributes saw most medical practitioners avoiding to prescribe it to patients. This development has perpetuated the modern day rejection of heroin as a medical substance (Clayton 137).
Despite the significant legal restrictions as well as rejection by medical practitioners to prescribe certain opium substances, the state of Alabama has widely employed a huge variety of opioids to treat various implications. According to Sorger (895), the Alabama State Board of Medical Experts maintains that medical prescription is not equivalent to addiction. It thus leads other states in southeastern region as well as the country at large in allowing its people to access opioids to particularly relief pain. Proper application of modern day knowledge as well as treatment moderation has increasingly enhanced promotion of quality life among patients as well as reduced mortality and medical costs associated with untreated or ineffectively treated pain. On this note, the Alabama State Board of Medical Examiners has continually encouraged medical experts to view pain management as a viable medical practice for caring for patients experiencing severe pain (Tracy 109). The board thus encourages all medical experts in Alabama to gain conversance with effective pain management procedures and statutory requirements related to the prescription of controlled pain relieving substances. As a result of this advocacy by the Alabama State Board of Medical Examiners, most opioid analgesics have widely been used in this region to manage acute and chronic pain. Although pain among surgery patients does not vary from one state to another, Alabama leads in prescribing opioid analgesics to treat postoperative pain. According to Sorger (899), healthcare providers in this region give almost thrice the number of opioid analgesic prescriptions given in other states.
Medical practitioners in Alabama prescribe opioid analgesics during and after a surgical operation to perpetuate effective postoperative pain management and subsequently improve overall patient wellbeing. According to Hong-Wei (79), medical practitioners in this region prescribe opioids to prevent physiological implications that can result from path physiology of surgical pain. Evidence proves that pain plays a protective role by warning of any potential damage of an operated area thereby enhancing careful treatment and protection of the affected area. Postoperative pain can however be destructive in that it heightens cellular stress reaction as well as significant impulse decline in somatic, visceral, and endocrine systems. This attributes to increased protein breakdown, incompatibility in platelets, nausea, and weakened immune system. This in return perpetuates low oxygen supply and poor perfusion, which may eventually reduce collagen deposition in wounded body tissues. This may be as a result of direct pain impact or poor breathing due to pain thereby causing low-level hypoxia, which ultimately interferes with proper wound healing. An inquiry by Sorger (990) further showed that unrelieved postoperative pain could lead to significant decline in respiratory movement particularly following laparotomy as well as thoractomy. This reduces the overall capacity for lungs to function properly by inhibiting a patient from taking deep breaths or coughing, which ultimately results to hypoxia. Sorger (992) further found that unrelieved postoperative pain reduces mobility as a result of severe on movement. Challenges on early mobility due to unrelieved postoperative pain increases risk of developing deep venous thrombosis (Volkow 31). Poor postoperative pain management can as well contribute to extensive sympathetic activity, which attributes to increased discharge of catecholamine. This can lead to severe health-related implications that include hypertension and the subsequent myocardial ischemia as well as reduced blood circulation to certain body tissues. To avoid these implications, medical practitioners in Alabama prescribe opioids to reduce the overall postoperative pain that patients experience (Hong-Wei 85). This enables the patients to take deep breaths without being restricted by pain as well as mobilize their body to relieve pressure, which in return improves blood circulation into the recovering tissues. Some opioids that reduce pain when a patient is resting may not prevent pain when a patient coughs or changes position. Doctors in Alabama however prescribe high quality opioids that are used in epidural analgesia to help reduce physiological stress that can result from surgery. Evidence of this achievement can be drawn from a study that was carried in major hospitals in Alabama. During this study, a group of elderly patients who had undergone a colon surgery was injected with opioids through an epidural analgesia. The procedure was effective in managing implications linked to surgery as patients did not experience any pain after the surgery nor did they experience fatigue or nausea and they managed to leave the hospital within two days.
Doctors in Alabama also prescribe opioids to perpetuate preemptive analgesia in order to minimize the overall degree of postoperative pain. According to Sorger (997) doctors in Alabama, inject patients with opioids before a surgical procedure to minimize the degree of pain that patients would experience after undergoing the surgery. Through these injections using opioids, doctors in Alabama ensure that central consciousness to pain signals is suppressed. Morphine and ketamine constitute to the major opioids that doctors in this region use to suppress central sensation while conducting major gastric surgeries. This results in significantly reduced postoperative pain particularly when a patient is moving or at rest, which in return reduces the amount of postoperative analgesic drugs that the patient consumes (Pediani 2).
Doctors in Alabama further prescribe opioids to prevent development of postoperative chronic pain on the operated area. According to Hong-Wei (96), acute pain, which is usually linked to a distinct injury, usually lasts for about two weeks after a surgical procedure while chronic pain can last for about six months. While experiencing postoperative pain for a long time can lead to disability, doctors in Alabama prescribe opioids to patients to help suppress acute pain, which, if unrelieved, can translate into chronic pain. Evidence for this development can be drawn from a study inquiry that was carried out in Alabama. The study involved 400 patients that had undergone groin surgery but did not receive any postoperative pain management drugs. Findings of this study showed that 19% of these patients still experienced between moderate and severe pain on the operated area after one year. The doctors in the region thus suggested that opioids should readily be available for any patient undergoing surgery to help prevent acute postoperative pain, which, if unrelieved, translated into chronic pain (Hong-Wei 98).
Despite the significant level of success in postoperative pain management, opioid analgesics are widely being misused thereby attributing to increasing cases of opioid misuse and addiction in Alabama. According to Alabama Medicaid Pharmacist (2), Alabama is reported to have the highest rates of prescription drug overuse, which has attributed to a rapid increase in the number of drug-related deaths by five fold. Legal prescription of opioids has enhanced increased availability of this drug among members of the public, who end up using it for nonmedical unsafe purposes (Fingerhut 3). OxyContin, for example, is designed to relieve pain through slow release but it is widely being crushed and intravenously being injected to increase its euphoric impact. Opioids are also being used in Alabama to create new formulations in effort to stay ahead in illegal drug trade (Daly 72). A new formulation is for example being established using OxyContin and morphine to increase its euphoric significance by 12% to 48% compared to the normal version. Prescription medication overdose in Alabama is also on the rise as the overall cost of opioids increase compared to other drugs. Physicians in this region are reported to prescribe the highest number of narcotic opioids, which leads to drug overdose and subsequently perpetuating lethal consequences (Pediani 6).
Opium, a plant from which opioids are derived, has legally been used throughout United States’ history to accomplish a wide range of purposes thereby shaping the country’s social, political and economic history. The product, mainly during the 19th century was used to accomplish various medical purposes that included relieving pain as well as treating diarrhea and dysentery. It was also used for recreational purpose mainly by distinguishing members of high-class society. Political aspects, that included discriminating against a huge number of Chinese immigrants, attributed to increased prohibition and subsequent illegalization of this product in the public domain. Opium was only legalized in the medical domain, which paved way for the .widespread usage of opioids, which are derived from opium, to manage postoperative pain in United States Alabama region. Opioids have widely been used in Alabama to enhance preemptive analgesia, prevent development of chronic pain, and prevent psychological implications that result from postoperative pain. Despite this success, opioids have widely been misused, which attributes to increased cases of addiction and subsequent lethal consequences.
Alabama Medicaid Pharmacist. Prescription Drug Abuse and Overdose.
Clayton, Foster. “The Rocky Road to a “Drug Free Tennessee”: A History of the Early Regulation of Cocaine and the Opiates, 1897-1913.”Journal of Social History 29.3(2011):123-145.
Daly, Marie. Generation Rx: A Story of Dope, Death, and American Opiate Crisis. New York: Counterpoint, 2014.
Fingerhut, Lois. Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005.
Hong-Wei, Min. “Management of Multijoint Stiffness of Bilateral Upper Limbs Secondary to Heterotopic Ossification: Case Report and Literature Review.” Journal of Rehabilitation Research & Development 51.3(2014):78-98.
Mayo Clinic. Pain Medication after Surgery.
Pediani, Ramon. World Wide Wounds: What has Pain Relief to do with Acute Surgical Wound Healing?
Sorger, Chang. “Pain and Palliative Medicine.” Journal of Rehabilitation Research & Development 44.2(2010):891-998.
Tracy, Sarah. Alterting American Consciousness: The History of Alcohol and Drug use in the United States. New York: University of Massachusetts Press, 2012.
Volkow, Nora. America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
Witmer. Kathy. What Should you know about Pain Killers after Surgery.