Temporomandibular Joint Disorder Research Paper

Tina Webb, a forty year old wife and mother, suffered from chronic migraines and was diagnosed with temporomandibular joint disorder, which is a condition where pain radiates from the jaw. She was prescribed opioids for pain relief and quickly became addicted. Her husband noticed a change in her behavior and started to count her pills to make sure she was taking the prescribed amount. He found that she was taking up to 26 pills a day, she took 296 pills in an 8 day period. Together they tried to get help and Tina Webb quit cold turkey. She experienced the same symptoms that heroin users go through once they quit. She claimed that she couldn’t take it anymore and went back to get another prescription. On September 24, 2007, her husband found her dead at their home. She died from an overdose of prescription opioids (Hyde).
Opioids have been a huge problem in Utah and numerous people are affected by it everyday. Angela Stander, who is a Certified Health Education Specialist, CHES said, “in the mid 1990s is when [opioids] became FDA approved and it was under the impression that [they were] non-addictive and there were no dangers with them” (Bringhurst).

This is when opioid prescriptions skyrocketed because they were known to be a treatment for chronic pain. The problem with pain is that it’s something that cannot be seen or tested for, so essentially doctors make educated guesses whether or not they are qualified for an opioid prescription. Too often people are being prescribed these drugs without even knowing of the risk of addiction because their doctor did not inform them about the risk (McRae). Although people argue that opioids are key in the treatment of chronic pain and they are already regulated enough, they are still too accessible, addictive, and deadly.
Some people in Utah will say that opioids are needed for chronic and acute pain. Originally that was their main purpose. Doctor Lynn Webster said, “opioids were not without significant risk but it was important to remember that they were used to control pain and improve fuction far more frequently than they serve as agents of destruction” (Hyde). Webster explains that while opioids do have risks, that the benefits outweigh the risks. Opioids attach to the brain receptors and they slow the sending of pain messages to the body and reduce the feeling of pain. Not only do they block physical pain but they also block emotional pain (“What are”). People use opioids because of the relief it gives. Patients with mental illnesses are more susceptible to abuse because of the way that it blocks emotional pain as well (Bringhurst). They keep taking the drugs in order to not feel, or forget about their thoughts.
While they are effective in treating pain, they are highly addictive.

Health Specialist Angela Stander said, “ studies have shown that in as little as seven days you can become physically dependent on them” (Bringhurst). Pain is difficult to measure and patients need to understand and verbalize their symptoms and needs. Doctors also need to be more thorough about the effects and dangers of opioids. They need to spend more time educating patients and they should have more natural and healthy alternatives. Physicians are usually more inclined to increase patients dosage as time goes on and they become more tolerant to what they have (Lockhart, “Utah Opioid Bills”). Patients are taught to trust their doctors so a lot of the times they won’t question things that their doctors say, even if it doesn’t seem right to

them.
There already are regulations on opioids and people think that those regulations are enough. Bills have been passed and they are in place. HB286 allows family to make decisions for them through court-ordered intervention and treatment. HB375 required doctors and pharmacists to use a database to determine whether a patient may be abusing. HB50 changes prescribing habits of doctors and it limits the number of days an opioid can be prescribed (McRae). These regulations were put in place to bring awareness to the epidemic in Utah. While these regulations are helpful in cutting back on the accessibility of opioids, more can be done.
Utah representatives and the LDS church are pushing for even more regulation. Professionals support the current regulations but many agree that there should be more specific regulations put in place to avoid overdose. Gordon Lindsay, a BYU Science professor says “We the patients are at fault, the pharmaceutical companies are at fault, the doctors are at fault, as we pass these pieces of legislation, I do think it creates awareness” (McRae). Legislators are still trying to get bills passed in Utah to make it a safer environment for everyone involved. Opioids already have regulations but they need more specific and strict. Intermountain Healthcare announced that they wanted to decrease the use of opioids for acute pain in their hospital by 40% by the end of 2018 (Lockhart, “Utah opioid”). Von Korff and Deyo, who are doctors of science said that, “long term opioid therapy should be conducted in practice setting where careful evaluation, regular follow-up, and close supervision are ensured” (Sundwall and Rolfs). The way to stop the spread and make people aware of what is going on, is to talk about it and make it known. Everyone just wants to know what is going on and to understand the things that are happening in their own body. So if doctors made more of an effort to explain the risks to patients then they would be more concerned about their treatment plan.
Opioids are very accessible, not only just through legal sources but illegal ones as well. A lot of them are fairly inexpensive and they are readily available to someone with limited funds (Martinez). In 2015, 2.6 million opioid prescriptions were dispensed in Utah (Bringhurst). Opioids are already being prescribed too much in Utah which aids in the addiction. The distribution of opioids to Utah increased 6-fold from 1997-2002 (Sundwall and Rolfs). The more accessible opioids are, the more people become addicted and the more deaths there are. Opioids are well known for their benefits of pain relief and so often times they are the “go-to” drug to help the majority of patients manage their pain.
Once prescription drugs become too expensive most people turn to other illegal drugs, like heroin. John Clark Jr. can trace his heroin addiction back to when he was 23. He covered one of his coworkers shifts and in return the coworker paid Clark $30 and gave him oxycodone. His abuse of this opioid continued until they became too expensive and he transitioned into heroin. While he was sober he would hate himself and every single decision he had made since he took his first pill. On multiple occasions he found himself shooting up heroin and hoping to die (Bringhurst). 80% of heroin users in the United States were prescribed opioids previously. Opioid use leads directly into heroin for multiple people. In 2016, 166 Utahns died from heroin overdose compared to the 127 in 2015 (Lockhart, “Report”). The dangers of heroin don’t just include overdose but they can cause liver disease, HIV, hepatitis, depression, kidney disease, and heart infections (“Physical Effects”). Once someone starts taking any kind of drug they become tolerant to it, so they have to increase their dosage or add another drug to supplement benefits or alleviate side effects. It becomes a vicious cycle of drug experimentation for each individual. This can cause the dependence upon a drug to supposed wellness. The Utah Health Department Spokeswoman, Jenny Johnson said, “When they get to a point where they can’t get prescribed opioids, where they can’t afford them, that they’re turning to heroin because it is cheaper to get” (Lockhart, Report). By adding more regulation, doctors could potentially stop the spread of these addictive substances.
Opioids are highly addictive and a lot of the time they lead to overdose. In the past ten years, Utah has seen a 700% increase in opioid-related overdoses. Last year about 64,000 people in America died from an opioid/heroin overdose. This outpaces every other cause of death. Utah is currently 7th for having the most drug overdose deaths in the United States (Hyde). More people die in Utah from opioid overdoses than people die from gun and car accidents combined. In 2015, there were 410 opioid-related overdoses in Utah. DEA agent, Brian Besser, says “We are losing 26-30 folks a month from this and I feel those numbers are fairly conservative” (Bringhurst). Not only do these medications affect the person but they also take a toll on the abusers family. Michelle Martinez, a former pharmacist said, “the family picks up the pieces of that harmful behavior, and that they will often go without necessities because the addict has used resources set aside for food, rent, utilities, etc.” The people who are most common to abuse opioids are young adults who are between the ages of 18-25. Males are more likely to abuse even though females usually experience more chronic pain (Martinez). An addict will do whatever they have to do to get another fix, whether they get more from their doctor, go to a different doctor, or turn to cheap and illegal drugs. Representative Raymond Ward said, “If you look at the overdose deaths… about half of them overdose from the prescription pills, and about half overdose from heroin or other illegal street narcotics” (McRae). There is a problem with how addictive opioids are and how many people have overdosed and died in Utah because of them.
Opioids do have health benefits but the negative effects outweighs the good. There is more risk to opioids than there are benefits. What is the point in prescribing something to keep someone alive and out of pain if they are just going to end up dying because of the drug? Opioids are too accessible and essentially anyone can get them if they try hard enough. They can quickly ruin someone's life when they or someone they know becomes dependant on these substances. There are multiple places that people can get opioids from if they are in need of them. They have some regulations but not enough to stop the vicious cycle of opioid abuse. Opioids are also frequently used for chronic and acute pain and they do help. While there are good things about opioids there are more harmful affects than helpful ones. Tina Webb fell into this vicious cycle of opioid addiction. She is a perfect example of how difficult it is to recover from opioid abuse. She did not expect to become dependent on them, but because of the addictive nature of these drugs she couldn’t help it and it ended up taking her life. Maybe if she was never prescribed opioids in the first place she would still be alive today.