A major personal factor which has been a key motive to improve the quality of the report is my belief about the importance of this project. I have not taken this as an “academic obligation” which has to be done to get a degree or good grades but I treat this as a “very special project” which has a potential to help others to understand the basic functions of financial institutions and problems related to their function and their contribution to economy and our daily life.

As some work of the project has to be done in a group, so combination of like-minded people in a group is regarded as a big privilege for beneficial out come for all the members. I was extremely lucky to be able to find very enthusiastic group members within appropriate time. Later in the project, I realized the importance of this step as there were difficult times during the project where we were apparently caught in unfamiliar territory. However, sharing the same objective and enthusiasm about the topic helped us control our frustrations and overcome the difficulties with continuous effort and zeal.

Recollection of Experience

The process started on 8th February 2010 with comprehensive classes from some of the famous and competent teachers of the university who did a wonderful job in eliminating the doubts related to the project. We were given the topics on 9th of February followed by the three day tutor support sessions. These sessions were extremely beneficial for all group members because of the contributions made by the tutors were focused, reliable and acted as a basic guidance later in the purist of this project.

One incident that has contributed to boost my moral to follow the project in a proper professional way is related to one of my finance teacher Mr. Peter Patrick. On Wednesday 10th of February 2010 while he was discussing about the project with our group, he excuse us to go out and drop Mr. Rob Carman and said he will come back to continue. When everybody left after the session we did the same assuming that he will not come back but the very next day he came straight away to our group and said ” I came back to continue as I said but you were not here”. This has taken me to the particular day when the university has faced a power cut and Mr. Peter Patrick was teaching in the lawn of vicarage street campus in freezing winds. These actions not only show the commitment and passion of the individual but also encourage students to follow them in a same manner. For me, this was a major source of inspiration which has strengthen my belief that if you want to something positive, nothing can ever stop you from doing it. Obstacles are part of the game and passion can overcome this.

Once the topics and teams were finalized, our team met to discuss the roles and responsibilities of the group members and the methodology to carry out the project. As with most of the projects, the topic assigned to us had the potential to grow in scope, which motivated us to figure out a concrete plan to carry out the work required and, define boundaries to facilitate time and work management. With regards to roles and responsibilities of individual group members, each of us was assigned a particular task and being the most enthusiast and a class representative, I was also awarded the responsibilities of the team leader. In addition to other project related activities, my extra responsibilities as team leader were to overlook the project to maintain the focus of the project, conduct team meetings, and ensure the pace of the project to meet necessary deadlines. Furthermore, I was also responsible to help the team members maintain the original motivation and energy as it can become difficult to overcome frustration and disappointment over the course of a stressful project. I would also like to mention here that it has been an honor for me to work with such dedicated and enthusiastic team of people and also that they have been a very cooperative team to manage as well.

With regards to the methodology, it was decided to comprehensively explore the resources available related to the topic as the initial phase. This included both electronic resources such as; journals, reports, and other articles available on the Internet and, books and journals available in the university library. Because of the length of the project and number of people involved in the project, it was decided to make this a concurrent process whereby each of us was expected to carry out research for the project. The findings of this process were then thoroughly discussed in the team meetings to facilitate constructive debates leading to a collective opinion, which was then documented for formal analysis. This exercise proved to be very helpful in learning new concepts and exploring different opinions about them. Consequently, a lot of time was also consumed as part of this process putting us under some pressure to meet deadlines. However, we cannot deny the importance of this phase towards improving our understanding of the topic and facilitating a very healthy analysis in the later phase of the project. As a result of the first phase, we had a very firm foundation for analysis with very carefully selected knowledge base and a rich documentation of critical and thoughtful analyses of this knowledge base. In the second phase, further analysis of the data collected from initial phase was performed. This involved interpretative inquiry of secondary data facilitating conclusion of discrete results. These sessions were again very helpful and were followed by documentation of collective opinion, which was later used in the preparation of the project report.

Personal feelings and learning from the experience

As I try to rejuvenate my career with this degree, this project provided the much-required impetus to achieve my objectives. It has provided me with the all-important knowledge, confidence and the opportunity to improve my project management skills. Although I always realized the importance of stock markets for globalization and economic growth for any country, I was not absolutely certain about the role of stock markets as compared to other financial institutions of an economy. Therefore, I was curious and excited about the findings we were meant to do over the course of the project. At the start of this project, I was selected as the team leader, which was a pleasant surprise for me and provided me with the valuable opportunity to get some experience of managing project and team.

During the initial stages of the project, we agreed that each of us would conduct the literature survey, exploring all the available resources. In order to ensure that no stone is left unturned, I started with online articles to get started with the concepts, terminologies and the operating mechanisms of global stock markets. This was because I felt the need to understand the basics of stock markets before delving into detailed arguments. Later experiences from the project approved my decision and helped me understand and make sense of a lot of literature with greater ease. After establishing a basic technical foundation for the research, I consulted both the library and the Internet for any available resources related to the topic. Of course, it is impossible for a person to consult all the available resources in such a limited time however; I made sure that I do my best. Another predicament I encountered during this phase was the volume of resources to consult versus the comprehensiveness of literature survey. The volume of resources, both in the library and over the Internet, was found to be extraordinary and it was impossible for me to consult all of the resources without compromising comprehensiveness of the analysis. Therefore, I decided to select the most important resources very careful consideration and based my restricted my research to those resources only. As described before, this was done to avoid losing comprehensive nature of the resultant analysis. Furthermore, the resources I could not do justice with, were suggested to team members in the team meetings to avoid outright ignorance of the resources discovered during this process.

Due to the rigorous approach I adopted during the initial, I was considered to be the most influential member of the group mainly due to the technical strength of my arguments. This fact along with the responsibility of being the team leader put extra pressure on me to deliver extraordinary performance and caused occasional nostalgic behavior. However, seeing the bigger picture always helped me stay motivated towards the objectives and the potential gains from the success of this project. During the second phase of the project, a lot of team meetings were held to discuss the literature explored and perform a rigorous analysis. As each team member was involved in their individual literature survey, they appeared to have their own views about the literature its importance to influence the analysis. As with any other groups, it did result in disagreements and conflicts but they were resolved with mutual consent and professional maturity.

As mentioned before, I had added responsibilities as the leader of the team. My responsibilities as team leader meant I had to work harder and lead from the front. In order to accomplish this objective, I spent more time in the initial phase to strengthen my technical knowledge thereby improving the strength of my arguments in the team meetings. Furthermore, I was also responsible for resolving conflicts and documenting the results of team meetings including the analysis of the literature survey. Due to this, I had a lot of work to do which was a very tough job. However, considering the greater benefits both for the team and for me, it was encouraging to complete the job on hand. Having said this, the project has been a great learning experience for me from a lot of different perspectives. I improved my knowledge of stock markets and their role in the growth of economy of any country to a great deal. Furthermore, I had the great opportunity to brush-up my project management skills, which would not have been easy if not supported by the energetic yet cooperative team I had the opportunity to work with. Finally, I had the opportunity to improve my technical report writing skills, which is envisioned to help me with my future career. Conclusively, I am pleased to reach this stage of project where I have the satisfaction that we have completed the project without any major disaster and I am satisfied with the performance of all the individuals of the group. Overall, it has been a memorable experience.

Group dynamics and learning from the experience

Group projects can be difficult as compared to individual ones mainly because of the number and variety of stakeholders involved. It is more like a group of people rowing a boat in a river. If the entire group decides to row in the same direction, the journey can be easier and performed at some speed even if the river is flowing in the opposite direction. However if the group has disagreement over the direction of journey then the entire effort can be inconclusive. In view of these pitfalls of group projects, we agreed on a protocol to be followed throughout this project. As part of this protocol, decided to select a team leader who would overlook the progress of the project, conduct team meetings and resolve any disagreements to preserve the coherence within the team. At the start, it might have seemed to be a crazy idea and a joke, however, it’s worth was certainly established during the later phases of the project. As I was the team leader, I had two different insights into the group activities; as a member and as the leader. As a member, I tried to work as hard as possible to accomplish the work assigned to me as I have mentioned in the previous section. This was a well thought and conscious effort to establish my role in the team as the leader. However, I must admit that the team has been very cooperative which made my job easier as the leader. Having said this, it is common to have disagreements within a group, which might result in disruption of coherence thereby damaging work progress. In our case, there were heated debates during team meetings mainly due to the enthusiasm and excitement of the team members for the project. However, I feel pleased to report that no disruption was caused to the work progress but it did put extra pressure on me to maintain the enthusiasm in the team and help team members contribute to the project in a constructive manner.

Another matter of concern was the relatively large number of team members; we were six in the group. Given the scope of the project, it was difficult to breakdown the project activities into as many as the number of team members therefore, we ended up having overlapping tasks. It was productive to have different opinions about the project, however, there were occasions during the course of the project where one or more members felt being left behind and isolated. However, some encouragement from others did help them get along with the others in the group, which was important to maintain the coherence within the group. As described in earlier sections, my hard work about the basic knowledge of stock markets added exploration of articles did help me maintain a positive and constructive role in the group both as a member and as the leader of the team. The response of the group was positive most of the time, which shows good working relations with group members enhance performance. As a leader, group responded in a very good way. My views were treated with great respect and always regarded as the best ones. This encouraged me to dig deep and work even more than required. But less competition can also lead to low quality of work, which I believe did not happen in my case.

Lessons for future projects

As the leader of the project, I regard this project as a success and a great learning experience for all the team members. During the project, I have acquired useful experience, which, I believe will benefit me in future assignments as well in many ways. Key lessons learned from this project are listed below.

For some time in my career, I had been detached from any research activity. In this project, I had a great opportunity to improve my research skills. Exploring literature and developing critical analysis from it is useful skill and I believe it will help me in my future.

Stock markets are an integral and important part of any economy. The knowledge acquired in this project has provided me to develop an insight into its role and I envision it to help me in future projects as well.

I was selected to act as the team leader for this project, which helped me acquire basic project and people management skills. I envisage them to be helpful in my future.

Due to the extensive initial phase of the project, we were encountered with few difficulties regarding time keeping and meeting deadlines. However, they were brief enough to cause any major disruptions. Having said that, it was a learning experience for future projects.

As part of the project, I had experience of working with a team and as a team player. There were times when I realized that I was going ahead of the team however, as a team member and the team leader, I had to stay synchronized with the team. This helped the team overall to stay motivated and also helped me to act as a team player and play my role to guide the team when necessary.

Conclusion

It is always a pleasure to conclude a project on a positive note. In the case of this project, it is special for several reasons. Firstly, as I am on course to rejuvenate my career, this is the first project of its nature where I had a chance to improve a number of skills. Secondly, I had a great opportunity to build fundamental knowledge about stock markets and their significance for the growth of any economy. Finally, I had added responsibility for this project as the team leader and I believe I have done my best for the job. Due to this added responsibility, I wanted this project to be a success even more.

Furthermore, this project approves of the importance of team effort and project planning for the success of any project. I strongly believe that the project could not have been completed without the enthusiasm, excitement and energy contributed by all the team members. Furthermore, I have also learned the importance of project planning. I believe that it was very important to formulate the principles and methodology early in the project without which it would have been very difficult to manage the amount of workload involved in this project within the time allowed. Finally, I would like to thank all the team members and others for their help and contributions towards this project. I believe all these people have helped me maximize the learning opportunity available during this project and therefore have made it a special one for me.

Opioids are a class of drugs that are used in the management of pain, and they represent a breakthrough in palliative medicine. Some major developments in the administration of these drugs have enabled them to be among the prescription drugs in health institutions. The drugs, however, have a characteristic of being euphoric and addictive, and patients have developed physical and psychological dependence during treatment. Most of the factors causing dependence of opioids are mainly centered on the individual using them for pain management, and include the use of other psychoactive drugs and pre-existing mental conditions. Bio-psychosocial stressors are also established predisposing factors for opioid abuse. The abuse has fatal effects on some of the patients with other patients developing lifelong complications. Investigations that may be used to monitor and detect opioids use and abuse include the use of urine sampling. Some of the interventional methods include behavior therapy.

Introduction

Opioids have widely been used in the, management of chronic pain in many health institutions, with the drugs being prescribed to other patients for management of some categories of acute pain. A major challenge that has emerged with the use of these drugs, however, is the addiction and dependence associated with them. The problem has caused financial and health problems for the patients who are unlucky to develop the dependence. On a global assessment of the problem, the economy is greatly affected with opioid dependence contributing significantly to the health budget. The people at risk of developing opioid dependence include the individuals with chronic pain and those with other underlying mental disorders or substance use disorders. This paper examines the abuse of prescription opioids, the effects to the patients and some of the complications that the dependence associated with it may have on them.

Opioid abuse

Opioids have been used extensively in the management of pain, and this is because they contain analgesic and euphoric properties (Knisely et al., 2008). Some of the factors that have also facilitated the increase in the use of opioids in the management of chronic pain as Portenoy states include the “introduction of high-dose, extended release oral tablet formulations of opioids with good bioavailability” (1996). This means that the drugs can easily be prescribed to patients, as opposed to the traditional methods which required monitored in-patient medication. The abuse of prescribed opioids has been on the rise in the recent past, with some researchers observing that the use surpassed street narcotics in the US (Webster, & Webster, 2005). Webster and Webster, states that the epidemic use of these drugs has raised concerns in the ruling class and “In April 2011, the White House unveiled a multi-agency plan aimed at reducing the “epidemic” of prescription drug abuse in the United States” (2005).

Opioid abuse is recognized as one of the major psychiatric conditions, and there exists guidelines on the classification and treatment of the same. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) is the reference book that physicians and psychiatrists use to identify and classify substance abuse. According to the document, diagnostic criteria for substance abuse include physical dependence, tolerance, and 5 additional behaviors associated with illicit drug use (Knisely et al., 2008). however, both therapeutic and non-therapeutic use of opioids are associated with tolerance and physical dependence, and a patient rightfully receiving opioids as treatment may be erroneously classified as having the condition. With the challenge being established, the American Pain and Addiction Societies came up with a consensus document that identifies 4 criteria for addiction as being “impaired control over drug use, compulsive use, continued use despite harm, and craving” (Knisely et al., 2008).

Some of the studies done in the US indicate a high prevalence of opioid abuse among the outpatients on prescription therapy, and an average of 20% of patients on long-term opioid therapy abuse the opioids (Wasan et al., 2007). Studies also show a relevant difference in the gender and age of the patients abusing the drugs with more men than women being involved, and the problem being prevalent among the younger generation of patients (Wasan et al., 2007). Some of the major opioids that are abused are hydrocodone and oxycodone, with three quarters of the patients abusing these two drugs. The cost of opioid abuse is also reported to be high, and the average cost of treating patients in the health system is greater than that for treating non-abusers. This is because the patients who are dependent on the opioids frequently have other comorbidities, and thus the higher costs of treatment.

With the increase in the number of patients on long-term treatment for chronic conditions, there has been reported increase in fatalities from the overdose of the opioids. Opioids are known to cause respiratory depression and embarrassment, and patients who overdose these drugs are then prone to succumb as a result. It is therefore important that among the measures that are put in place to prevent opioid abuse, healthcare providers must ensure that they do not give patients more of the medication than they should get.

Reasons for abuse and misuse

Opioids are a class of drugs that are at the top of the ladder of pain management and are a final result in chronic pain (Knisely et al., 2008). As such, the drugs are prescribed for patients with chronic pain such as cancer patients, patients with other chronic conditions and patients being palliated for other terminal illnesses. The drugs are also used in the management of acute pain that is very intense in the absence of other analgesics. In the management of these conditions, the use of opioids is under prescription, and only health workers mandated to prescribe them may do so.

Even under prescription, opioid abuse and misuse is reported among the patients and health workers. Some of the reasons behind the abuse include self medication, misuse and abuse as a result of addiction, use of the opioids for reward, and the diversion of use for profit (Knisely et al., 2008). Some of the patients usually obtain prescription forms from the healthcare providers and continue to alter the details so as to have the dose altered for their own benefit. In the course of the treatment, the patient may then end up with higher doses of the drug than was originally intended, and if this happens for a number of times the patient may become dependent.

On e may develop two kinds of dependence, and this is similar to any other substance dependence including alcohol. One type of dependence is physical dependence where a patient experiences withdrawal symptoms when they skip the drug and are unable to perform their daily activities. The other type of dependence is psychological dependence, and a patient feels the urge to use the drug even without any physical symptoms. The other cause of abuse for opioids is where a patient sells the drug or provides it to their family and friends for profit, who in turn end up being addicted to the drug.

Some patients have also been reported to use the opioids as a reward, and this is also a major cause of concern. The health system is also to blame for the abuse associated with these drugs. Despite scanty evidence showing the efficacy of the opioids in reducing the effects of chronic pain, the researchers have not been able to demonstrate added advantage for using them in some conditions. They have also been faulted for their lack of long-term effectiveness. There also exists little evidence showing the safety profile of the drugs based on randomized control trials.

Some of the psychosocial factors that influence the development of opioid abuse include the age of the patients, the character and intensity of the pain for which the patient is receiving therapy and the presence of other psychiatric disorders in the patient. As indicated above, a patient with an existing psychiatric condition or an underlying dependence on some of the other medications is at a higher risk of developing dependence to opioids compared to other individuals. It is also observed that the presence of comorbidities and the seriousness of the illness in a patient being managed with opioids may be a contributing factor to abuse of the opioids.

Possible Solutions

Due to the large number of reported cases of abuse of opioids, health institutions pharmacological regulatory bodies and governments around the world have set up measures to ensure that the public health concern is mitigated. In health institutions, the first measure set up is the screening of patients suspected to be dependent and abusing opioids. A number of methods have been developed to screen patients for any risk factors for abuse before initiation of opioids for chronic pain management. There are also screening methods for patients already on treatment with opioids and in general, the methods focus on family and social history of the patient. Any psychosocial stressors that are significant in the causation of opioid abuse such as mental conditions are considered.

There are also a number of tests which are used to assess the abuse of opioids, with the most commonly used being the urine drug test. The test is preferred because it offers a non-invasive and relatively cheap way of assessing the adherence to treatment. It is also sensitive to the use of opioids, and drug levels are detectable 1-3 days after the first exposure to the drugs. According to Wasan et al, the test provides objective documentation of treatment compliance and also offers a method of screening opioids abuse in patients on chronic pain management (2007). The other measure that has assisted in the efforts to reduce the abuse associated with opioids is the monitoring of the practices in prescription of the opioids. Health practitioners prescribing opioids are encouraged to observe prescription practices that do not encourage abuse. One of them is evaluation of patient’s social status before handing the opioids to the patients, and evaluation of the psychosocial stressors.

An extensive educational program is also being utilized in many places, and this is provided to both health practitioners and the patients on chronic pain control with opioids. Since most of the abuses and addictions that are associated with opioids are a reflection of the individual’s behavior, behavioral therapy is another interventional method that is used. According to Ballantyne, “Behavioral interventions with close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance” (2003).

Conclusion

Prescription opioids abuse has been on the increase over the last number of years, and this has been a major cause of health concern. As reported above, opioids are increasingly used in the management of chronic pain, and patients on this therapy have been found to have a preponderance to abuse them psychosocial stressors are discussed as a major cause of the abuse. Some of the other causes of opioids abuse have also been discussed, and so have the possible solutions and measures being used to counter the heath problem.