In an age when the speed of information can often outstrip the speed of verification, the COVID-19 pandemic has taught us that it is crucial to cut through the noise and focus on facts, a lesson that we must heed in order to protect societies from the impact of drugs.
Drug use killed almost half a million people in 2019, while drug disorders resulted in 18 million years of healthy life lost, most due to opioids . Serious and often lethal illnesses are more common among drug users, particularly those who inject drugs, many of whom are living with HIV and Hepatitis C.
Despite the proven dangers, drug use persists and, in some contexts, proliferates. Over the past year, around 275 million people have used drugs, up by 22 per cent from 2010.By 2030, demographic factors project the number of people using drugs to rise by 11 per cent around the world, and as much as 40 per cent in Africa alone.
Meanwhile, the COVID-19 crisis has pushed more than 100 million people into extreme poverty, and has greatly exacerbated unemployment and inequalities, as the world lost 114 million jobs in 2020.In doing, so it has created conditions that leave more people susceptible to drug use.
Furthermore, disparities in access to essential controlled medicines around the world continue to deny relief to patients in severe pain. In 2019, four standard doses of controlled pain medication especially tramadol,codein,morphine and pethidine were available every day for every million inhabitants in West, East and Central Africa, in comparison to 32,000 doses in North America.
Tramadol This centrally acting analgesic is an atypical opioid which relieves pain by opioid as well as additional mechanisms.Tramadol causes less respiratory depression, sedation, constipation, urinary retention and rise in intrabiliary pressure than morphine. It is well tolerated;side effects are dizziness, nausea, sleepiness, dry mouth, sweating and lowering of seizure threshold. Haemo-dynamic effects are minimal. Tramadol should not be given to patients taking SSRI therapy like, fluxetine, citalopram, paroxetine because of risk of ‘serotonin syndrome’
Tramadol is indicated for mild-moderate, short-lasting pain due to diagnostic procedures, injury, surgery. etc, as well as for chronic pain including cancer pain, but is not effective in severe pain. Little tendency to dose escalation by chronic users is seen and abuse potential is low.
Medicinal uses of Opioids;
- As analgesic Opioid analgesics are indicated in severe pain of any type. However, they only provide symptomatic relief without affecting the cause. Pain may be valuable for diagnosis; should not be relieved by a potent analgesic unless proper assessment of the patients has been done. Indiscriminate use of opioid can be hazardous. On the other hand, inadequate dose or reluctance to use an opioid for a patients in distress is equally deplorable.
For milder pain, e.g. toothache, headache, arthralgia, etc, aspirin like analgesics are preferred. When they are not effective- codein/dextropropoxyphene may be used orally, either alone or in combination with aspirin like drug. For majority of painful conditions, especially more severe and longer-lasting pain, a NSAIDs like , diclofenic or ibuprofen may be combined with the opioid. This helps to enhance analgesia while keeping the opioid dose low.
- Relief of anxiety and apprehension Especially in myocardial infarction,internal bleeding(haematemesis, threatened abortion, etc.) morphine or pethidine have been employed. They may prevent worsening of the condition by suppressing reflex over-activity. However, they should not be used as anxiolytic or to induce sleep.
- Cardiac asthma Cuts down sympathetic stimulation by calming the patient, thereby reduces cardiac work.
Morphine is also indicated to relieve pulmonary edema due to infarction of lung,but not due to irritant gases.It is contraindicated in bronchial asthma.
- Cough Codein or its substituents are widely used for suppressing dry,irritating cough.
- Diarrhoea The constipating action of codein has been used to check diarrhea and increase the consistency of stools in colostomy.Loperamide and diphenoxylate are synthetic opioids used exclusively as anti-diarrhoeals.