TPC Journal V8, Issue 3- FULL ISSUE

The Professional Counselor | Volume 8, Issue 3 227 and acute ailments, including diarrhea and injuries sustained in battle. Smoking opium recreationally became popular in some circles, and physicians also inadvertently addicted their patients by prescribing opioid treatments. As medicine and public health advanced, more diseases could be avoided, cured, or treated without the use of highly addictive opioids, and their use fell out of favor by 1919 (Kolodny et al., 2015). In the second half of the 20th century, heroin addiction intermittently rose to epidemic levels among disadvantaged urban populations, especially in the large cities of the northeast and west coast of the United States (Kolodny et al., 2015; McCoy, McGuire, Curtis, & Spunt, 2005). More recently, the introduction of synthetic prescription opiates (e.g., Vicodin, Percocet) in the 1980s and the approval of sustained-release oxycodone (brand name OxyContin) in 1996 brought pain relief to millions of users, but has contributed to high levels of abuse and dependence nationwide (Van Zee, 2009). Opioid Effects To understand the addictive nature of opioids, counselors must account for the acute effects of their use (e.g., relief from physical and psychological pain), unique side effects (e.g., opioid-induced pain sensitivity, painful withdrawal symptoms), ease and speed with which tolerance is established, and potential resulting impairments in daily functioning (Kosten & George, 2002). When opiates bind with neural opioid receptors in the brain, spinal cord, gastrointestinal tract, and other organs, they inhibit the release of pain signals, blocking the user from experiencing both physical and emotional suffering. Some people are naturally more vulnerable to developing opioid tolerance (taking more drug for the same effect) and dependence (drug required to avoid withdrawal; Kosten & George, 2002). Susceptibility is influenced by a variety of biopsychosocial factors (e.g., brain structures, cellular differences, context of use, stress). In a study examining opioid prescribing patterns, 25% of patients who had a new opioid prescription progressed to receiving additional prescriptions episodically or chronically (Hooten, St. Sauver, McGree, Jacobson, & Warner, 2015). Nicotine addiction, overall poor health, psychiatric diagnosis, and history of substance abuse were found to increase the likelihood of ongoing opioid use. Withdrawal symptoms lasting three to five days—including nausea, muscle cramping, body aches, anxiety, and inability to sleep—can compel users to obtain immediate symptom relief via the use of additional opioids (Kosten & George, 2002). In an attempt to avoid debilitating withdrawal symptoms, users become reliant on the drug to function at a normative, baseline state. Current Opioid Epidemic Although the pathway to opioid abuse and addiction is not new, a culmination of ecological factors over the last 20 years has led to what is now commonly referred to as a national epidemic (Kolodny et al., 2015; Skolnick, 2018). These factors include changes in prescribing patterns, increased supply, rampant growth of illicit use, the progression to intravenous heroin use among chronic users, and the lethal contamination of heroin and fake prescription pills with highly potent synthetic opioids like fentanyl, as well as broader systemic variables such as poverty and access to health care (Dasgupta et al., 2018). The dramatic increase in the availability of prescription opioids in the early 21st century stemmed, in part, from changes in medical attitudes and policies (Kolodny et al., 2015; Skolnick, 2018). Spearheaded by the American Pain Society’s advocacy efforts to have pain recognized as a fifth vital sign (along with temperature, pulse, respiration rate, and blood pressure) in the mid-1990s, the Joint Commission and the Veterans Health Administration formally endorsed patients’ rights to pain assessment management in 2000 (Kolodny et al., 2015; Skolnick, 2018). Helping patients avoid physical pain thus became a primary focus of medical care. During the same time period, Purdue Pharma provided financial contributions to multiple medical and patient organizations (e.g., the American Pain Society, the Joint Commission, the Federation of State Medical Boards) and lobbied to allay concerns regarding long-