Camille Cassard is a senior and a University Scholar at the University of Pennsylvania, majoring in Political Science and French. Her research focuses on the impact of emerging technologies on health and immigration policies.
In 2016, approximately 11.5 million Americans misused prescription opioids, including 1.8 million people who had a substance use disorder related to a prescription pain reliever. We are currently living through a devastating opioid crisis in the US with the number of overdose related deaths failing to subside. While not all opioid addictions result from prescriptions, a large number of people become addicted to opioids after being prescribed them by a doctor.
It is clearly very important to appropriately and adequately address acute pain in patients. We must reassess how these pain medications are provided to patients and consider how Medical Cyber-Physical Systems (MCPS) could be used to manage users’ access to these opioids. These networked systems could provide closed loop systems of controlling patient’s dosage of opioids to prevent long term addiction and/or illegally selling of excess pills.
The current issue with medicated opioids is that in an acute setting, doctors have the duty to treat pain appropriately. For a patient undergoing surgery (sports injury, dental surgery, cancer, etc.) or suffering from trauma, opioids often present the most suitable option. However, opioids are highly addictive because they activate powerful reward centers in your brain. Taking opioids for over three days consecutively can develop into an addiction. Around six per cent of people who had never used opioids prior to surgery take them for longer than necessary and of those that receive curative-intent cancer surgery, 10 per cent use opioids for three to six months. Hysterectomy recipients get twice as many opioids as necessary. Given that 600 000 hysterectomies are performed in the United States every year, it is necessary to identify specific patient factors to manage how much pain medication is prescribed and controlled. The leftover extra pills might be either consumed by the patient if they develop addictive behavior or illegally sold to others.
MCPS can provide a solution to the problem of extended usage and over-prescription of opioid medications. MCPS are capable of treating a patient within a specific clinical scenario, ensuring their treatment options are personalized and adjustable. The devices used in MCPS are categorized either as monitoring devices (oxygen-level monitors; heart-rate sensors) or as delivery devices (infusion pumps). In the case of opioid medication, MCPS used as an infusion pump could help control patients’ access to opioids, preventing the development of addictions or the reselling of excess pills. Patient Controlled Analgesic (PCA) infusion pumps are currently used in some cases to deliver pain relievers upon the patient’s demand. This type of infusion pump is widely used for pain control of post-operative patients.
Existing safety mechanism built into PCA pumps include limits — programmed by a doctor before the start of the infusion — on the dosage delivered, as well as minimum time intervals between doses. Nonetheless, this system still leaves primary control in the hands of the patient; the safety mechanism is not sufficient in protecting all patients, and there is the risk of overdoses if the pump is mis-programmed or if the pump overestimates the maximum dose a patient can receive, leading to respiratory failure.
There is, therefore, an opportunity for delivery systems to be not controlled by the patient, but based on a smart controller that analyzes the data received from the monitoring devices in real time to estimate the quantity of pain medication needed to treat the patient, and to automatically initiate drug infusion. An interconnected delivery system could control treatment by monitoring patients chemical and physical signals in the body and by tracking patient’s somatostatin receptors and their body’s sensory nervous system’s nociceptor to detect the threat signals of painful stimuli.
This tracking of the body’s pain receptors is not currently being practiced in regards to delivering pain medication, but a French startup called Remedee Labs is researching and developing ways to facilitate this type of system in the US. This system based on physiological closed loop control in distributed medical device systems is a relatively new idea and clearly needs more practice in application and more safety assurance — yet it could provide an effective way for treating patients, based on their individual needs and circumstances. The use of physiological closed loop systems for tracking a patient’s pain receptors could enable individualized patient modeling to account for the internal state of the patient, represented by drug concentration in the blood. It presents an opportunity to see the level of pain medication that the individual body needs and can support, and prevent an overextended usage or an overdose of opioid medication.
Using an infusion pump to supply opioids to post-surgery or post-trauma patients certainly does not minimize all risks for drug dependence, nor does it solve the opioid epidemic at large in the US. However, it does reduce the risk of patients getting oversupplied with pills and having too much autonomy over their dosage. This could, therefore, render it harder for patients to stay on opioid medication beyond a certain period, and to have an excess of pills to use or sell, since the medication would be independently regulated and controlled with a PCA system.
CREDIT: UPENN
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