Running head: OPIOID EPIDEMIC
The Opioid Crisis: An Unwelcomed Epidemic and How We Say Goodbye
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OPIOID EPIDEMIC
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The Opioid Crisis: An Unwelcomed Epidemic And How We Say Goodbye
The opioid epidemic emerged from evolving compulsions to treat pain by prescribing
opioids. This began more than 20 years ago, creating an escalation of supply (Presidents
Commission, 2017), forcing the United States Department of Health and Human Services to
declare a public health emergency and announce strategies to combat the opioid epidemic.
Support systems helping those struggling, such as family structures and treatment programs,
need assistance throughout this crisis. Examining socioeconomic and health factors affecting
individuals, past and present initiatives, and measuring initiative outcomes, helps understand
opioid abuse and dissolve. The current state of the epidemic demands an urgent response.
Measuring outcomes remains a challenge and requires attention itself, yet progress is made every
day.
Opioids Discriminate All
Opioids do not discriminate, ignoring socioeconomic status, ethnicity, and health status.
Opioid addiction is not only using opioids heavily, physiological, psychological, and social
influence are intricate and inveterate (Jackson et al., 2014). Braveman, et al. (2005) report,
socioeconomic effects of this addiction include work and school productivity decreasing, while
crimes, divorce, domestic violence, and child abuse increase.
The subjective measuring started as way to control surgical and cancer pains has now
ignited an epidemic affecting people all over the world. Increasing opioid supply led to
escalation of opioid-related misuse, diversion, use disorder, overdose deaths, and the advent of
deadly fentanyl analogs (Presidents Commission, 2017). Prescribing can be mapped regionally
with Alabama physicians prescribing the most opioids at 121% in 2016. This occurrence cannot
be explained by the underlying health of regional populations (Opioids Portal, 2018). The opioid
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crisis within the United States (U.S.) reached epidemic proportions (Presidents Commission,
2017), increasing from 33,091 opioid related deaths in 2015 to 42,249 opioid-related deaths in
2016 (Opioids Portal, 2018). In 2017, 115 Americans died every day from opioid overdose, from
either prescribed or illicit possession (Opioids Portal, 2018), causing the opioid epidemic to
become a national emergency (Broglio & Matzo, 2018).
Opioids supply the brain with synthetic endorphins intensifying positive feelings. This
bliss creates dependency, presenting with depression and malaise when opioids are not in use.
Victims experience irrepressible urges satisfied by escalating opioid use (Kasarla, 2017). The
physical and emotional symptoms accompanying this addiction put a strain on support systems.
Fostering these systems encourages opioid misuse defeat.
Combatting The Opioid Crisis
Evidence-based strategies to combat the opioid crisis is warranted to identify creditable
and cost-effective solutions. Addressing the opioid crisis imposes a fine balance between
prevention, intervention and community mobilization (McIver, 2017). Facilitating federal, state
and local programs, aimed at preventing and treating opioid addiction, are essential to demolish
the opioid epidemic.
Initiatives Already in Effect
Unabating initiatives include managing chronic pain appropriately, titration of opioid
prescriptions, overdose reversal with rescue medications, such as Naloxone, and education for
physicians, community coalitions, like the Community Anti-Drug Coalitions of America. A
valued overdose prevention program, Project Lazarus, helped the rural community of Wilkes
County, North Carolina lower their opioid overdose death rate from 46.6 per 100,000 in 2009 to
29.0 per 100,000 in 2010 (Albert et al., 2011). Legislative developments with guidelines for
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physician prescribing practices have resulted in improvements. Syringe exchange programs exist
in 41 states and naloxone access laws are in all 50 states. Prescription drug monitoring programs
(PDMP) enable statewide electronic data collection of controlled substance prescribing and
dispensing opioids (Using Prescription, 2018). In accordance with the Drug Enforcement
Association (DEA), California executed the first PDMP in 1939. All 50 states operate effective
PDMPs.
Initiatives Beginning Combat
In 2016, Rhode Island Department of Corrections became the first state correctional
system to initiate screening persons for opioid use disorders (OUDs) and offering approved
medications for treatment. Private sectors have stepped, assisting in this crisis. The first privatesector partner, Merck Foundation, pledged a two million dollar grant to Marshall Health, to
tackle opioid abuse in West Virginia (Merck Foundation, 2018). Regulating opioid disbursement
directly minimizes acquisition of opioids. Limiting access to prescribing opioids led to a three
year decrease in opioid prescription rates (Cicero, 2018).
Conquering The Opioid Crisis
Measuring Misuse
Outcome indicators to monitor opioid misuse include examining the opioid prescriptions,
overdoses, and adoption of medication-assisted therapy (MAT). Measuring success of these
indictors on a national level is difficult because related data is documented differently per state
agency, city and facilities (Presidents Commission, 2017). Implementation of MAT studies are
sponsored federally (Presidents Commission, 2017) stimulating a study for opioid use disorder
with MAT, conducted by the Centers for Disease Control and Prevention (CDC). Recruitment
began in the winter of 2017 and final analysis will be concluded in the summer of 2021
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(Medication-Assisted, 2018). The studies’ goals include examining patient and program
characteristics associated with positive outcomes, health and patient outcome differences
between MAT and counseling only treatment (Medication-Assisted, 2018).
Eliminating Misuse
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the
regulating body where medications used in MAT are dispensed. Physicians must enroll in the
buprenorphine waiver program, created within the Drug Addiction Treatment Act of 2000
(DATA-2000), to obtain capabilities to prescribe buprenorphine. Medication use in MAT are
dispensed through SAMHSA. SAMHSA monitors physician and program data daily and displays
statistics on physician enrollment.
Measuring Success
Between September and October 2018, around 886 practitioners have enrolled in MAT
program, 16,112 practitioners have enrolled within the last year, totaling 55,315 practitioners
currently enrolled in MAT (Programs, 2018). Currently, opioid abuse is front and center health
issue in the U.S. The CDC and added opioid overdose prevention to the top five public health
challenges in 2014. The CDCs annual surveillance report of drug-related risks and outcomes
conclude that opioid prescribing and high-dose prescribing continued to decrease through 2017
(Annual Surveillance, 2018). Between 2006 and 2017, the yearly prescribing rate for high dosage
opioid prescriptions decreased 56.5% overall (Annual Surveillance, 2018). An estimated 2.2
million persons in the U.S., in 2016 reported receiving treatment in the past year to reduce or
stop illicit or prescription drug use, or for medical problems associated with illicit drug use
(Annual Surveillance, 2018).
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References
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National Academy of Medicine launches action collaborative to counter opioid epidemic: Publicprivate partnership will coordinate initiatives across sectors to drive collective solutions
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