Table of Contents
Opioid Epidemic in the United States
Over the past fifteen years, our nation has been greatly affected by the abuse of opioids. It has become a public heath and safety threat. Because of how large of an impact this abuse has been on our nation, a risk evaluation and mitigation strategy has been set in place to provide safety for the American citizens. Opioid overuse has not only affected the lives of families by overdoses, but it has impacted our health care system. In this paper, you will discover how greatly the opioid epidemic of the United States has affected our healthcare system over the years, currently, and how we hope to change it for our future. It is in my best interest to make others aware of the status of the opioid crisis. And with awareness, a hope that this crisis will better for our future generations.
Opioid Abuse: A State of Emergency
Since the start of the 21st century, opioid abuse and dependence has taken on a whole new level of suffering. Not only has it effected families by tripling in its death toll over the last decade, but it has severely impacted our economy.
Opioid Epidemic Development & the Combat Against It
Prescription opioids have been a primary resource to treat patients who were suffering from pain that is not related to cancer. In fact, most opioid prescriptions were geared to those who suffered musculoskeletal connective tissue issues, headaches, and nerve pain. With such a wide range of patients to treat with these chronic issues, physicians prescribed opioids with the assurance by pharmaceutical companies that they were deemed to be low in risk of addiction. As addiction began to rise, policies were developed to suppress the number of prescribed opioids. This regulatory measure then triggered a spike in heroine overdoses, as chronic pain patients yearned for opioid usage. Heroine is an illegal and lethal drug which takes the lives of many. How do we stop this rapidly growing urge for opioids in our nation? In 2009, the FDA strategically placed a risk management program on opioid drug products.
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Later in 2011, a plan of action was signed through the Obama administration in hopes of invigilating and educating on prescription drugs. Safety requirements were set to perimeter those who received opioid medications, counseling for those same individuals for use and risks, and how to assess for addiction and tolerance. At first, these measures were voluntary, in hopes that physicians would see the new regulations as a good thing and not an inconvenience. But, eventually the measures on physicians became mandatory, otherwise physicians were unable to prescribe opioid medications if they were not willing to participate in theses mandates.
The Affordable Care Act Involvement
President Obama recognized the opioid crisis in our nation, and it became a top concern in how to battle it. “In 2015, there were more than 2.6 million Americans with opioid use disorder (OUD). During the same year, more than 33,000 Americans died of overdoses involving one or more opioids, corresponding to an age-adjusted opioid related death rate of 10.4 per 1.00,000 —more than triple the rate in 2000. The U.S. now accounts for about a quarter of the world’s drug-related deaths” (Wen, 2017). Obama asked the congress for $1.1 billion to aid in access to treatment and his requests was granted. One billion dollars was then given to states for preventative measures over the course of 2 years.
State Involvement
Most states have reviewed their existing laws and programs in attempt to help in diminishing the lives lost to overdosing on opioids. An example of a revisited law would be the syringe services program that was first established in the 80’s, that is now gaining favor due to the rise in heroine usage. An HIV and Hepatitis C outbreak caused by the usage of needles of those who would inject prescription opioids also plagued our nation. By placing the syringe service program in effect, it is in hopes to deter further fatalities and continued submerging of HIV and Hepatitis C. Many other acts have been taken by states to continue this fight to the slaughter of lives.
The different policies that are being used by states:
- Response
- Policies
- Targeted Group
- Encouraging appropriate prescribing
- Prescription limits
- PDMP’s
- Prescriber education
- Prescribers
- Prescribers, pharmacists
- Prescribers
- Educating the public and raising awareness
- Public education campaigns
- Drug take-back programs
- General public
- Patients prescribed opioids
- Expanding access to addiction treatment and harm-reduction services
- Medicaid coverage of medication-based treatment
- Non-medication treatment
- Syringe services programs
- People with OUD
- People with OUD
- People who inject drugs
- Responding to overdoses
- Naloxone access
- Naloxone training
- Good Samaritan Laws
- Pharmacists, general public, people who use opioids
- Bystanders, general public, people who use opioids
- Bystanders, general public
Providing penalties for traffickers, treatment for those who need it:
- Criminal penalties
- Treatment and diversion
- Opioid traffickers, dealers
- People who use opioids
- Civil litigation and disciplinary action
- Lawsuits against companies
- Leal and disciplinary action against medical professionals
- Pharmaceutical companies, distributors
- Medical professionals(Parker, 2018).
All states have initiated prescription drug monitoring programs. Every state, being different in their regulations have caused a variance in the outcomes of the limitations. Some states have seen a decrease in opioid prescriptions, and some have seen a decrease in deaths caused by overdosing. A nationwide rule of thumb of prescription authorizations for opioids is seven days. It is in hopes that it will decrease the chances of pills being passed to others if the number of pills prescribed is not needed for the individual it was prescribed to.
In an effort to prevent death in case of an overdose, every state has a law to access an opioid antagonist named naloxone. Naloxone was not legal without a prescription, but as of 2017 most states allow pharmacists to dispense it without a prescription. Training on naloxone kits is offered to give proper education on how to use it. Because of fear of getting arrested, most people do not call 911 when there is an overdose happening. To eradicate that fear, good Samaritan laws were first introduced by New Mexico to protect those who called and give a person who was over dosing a chance to get help.
One of the biggest changes, in my opinion have been the disciplinary measures that medical professionals now face. The medical licensing boards have set new standards for medical professionals to live by. Lawsuits pertaining to medical malpractice and incurring fines have dismantled the opioid prescription increase. Investigative and disciplinary measures have been set by the state medical licensing boards, causing a deterrence in a medical professional’s authorization in opioid prescriptions. How will this effect the quality of care for those who benefit from opioid medications?
Alternatives
People with opioid use disorder can be treated by medication assisted treatment along with psychosocial treatment. There are three medications that the FDA has allowed for this use. The medications the FDA has authorized are called; methadone, buprenorphine, and naltrexone. This method of alternative has proven to be effective and tailored to deter from criminal acts and decompresses illicit drug use. “Despite this evidence, only 1 in 10 Americans with substance use disorders receive treatment [1]. Nearly one-third of all those who did not seek treatment cite cost or lack of insurance coverage as a reason [1]. The treatment gap represents a substantial inefficiency for American taxpayers given that treatment can pay for itself by averting the medical morbidity mortality—including HIV infection, overdoses, and hepatitis C—services utilization, and criminality associated with substance abuse [9]. According to the National Institutes of Health, every $1 invested in addiction treatment saves society $12” (Wen, 2017).
Future Expectations
How will the opioid epidemic end? This is a big question and the question that is vital to our healthcare system and economy. With the opioid epidemic deriving from the treatment of chronic pain patients, chronic pain should be deeply investigated. What causes chronic pain? How does it affect those who endure it?
Dr. Krane explores these questions on his Ted Talk called The Mystery of Chronic Pain. Dr. Krane indicates that chronic pain is treated as a symptom. Remedied by pain medication, agonizing physical or occupational therapy, and anesthetics to block over active nerves which never treat the cause of pain. Those who suffer from chronic pain also need to go through psychotherapy just to deal with the pain they’re enduring. Dr. Krane explores the idea that chronic pain should be treated like a disease and be given disease modifying drugs to calm over active nerves (Krane, 2011). Dr. Krane’s theory should be further explored to help the cause of the opioid epidemic. Getting to the root of the issue will enable our nation to heal from this overdose crisis. It is imperative that other alternatives like Dr. Krane’s to be explored. It could save lives, our economy and ultimately, our country’s health.
Conclusion
The opioid epidemic has taken a grueling amount of lives, at the cost of the health of our nation. It has been deemed as a national state of emergency and a major concern through the Affordable Care Act. Protective measures have taken into effect in the areas of state mandates. As the states work to lowering the prescription opioid rate by fines and disciplinary actions, medication alternatives have been released. There is great hope for change in the future of opioid abuse and dependency. One way to change that is to get to the root of the cause and remedy of chronic pain and to treat it as a disease and not a symptom. With increased awareness to the public, I hope that access to treatment in chronic pain will change lives, and our future generations.
Starting this class, I didn’t know what to expect. I was nervous and excited to finally gain traction in the field I love most; the healthcare field. I found our class to be very interesting and gained an understanding of the organization and delivery of our health care system. From managed care, to Medicare, public health issues, to healthcare advancement, this class covered a lot of ground to better understand how vast our healthcare system is. It is very political and complex, and I hope to impact my family, community, and the world with this understanding.
References
- Krane, E. (n.d.). The mystery of chronic pain. Retrieved February 8, 2019, from https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain
- Losby, J. L., Hyatt, J. D., Kanter, M. H., Baldwin, G., & Matsuoka, D. (2017). Safer and more appropriate opioid prescribing: a large healthcare system’s comprehensive approach. Journal of Evaluation in Clinical Practice, 23(6), 1173–1179. https://doi.org/10.1111/jep.12756
- Parker, A. M., Strunk, D., & Fiellin, D. A. (2018). State Responses to the Opioid Crisis. Journal of Law, Medicine & Ethics, 46(2), 367–381. https://doi.org/10.1177/1073110518782946
- PORADA, S. (2011). REMS: red tape, or a remedy for opioid abuse? Journal of Family Practice, 60, S55–S62. Retrieved from http://0-search.ebscohost.com.librarycatalog.fresno.edu/login.aspx?direct=true&AuthType=ip,uid,url&db=a9h&AN=67147182&site=eds-live
- Sarpatwari, A., Sinha, M. S., & Kesselheim, A. S. (2017). The Opioid Epidemic: Fixing a Broken Pharmaceutical Market. Harvard Law & Policy Review, 11(2), 463–484. Retrieved from http://0 search.ebscohost.com.librarycatalog.fresno.edu/login.aspx?direct=true&db=a9h&AN=129760385&site=ehost-live
- Smith, D. E. (2017). Medicalizing the Opioid Epidemic in the U.S. in the Era of Health Care Reform. Journal of Psychoactive Drugs, 49(2), 95–101. https://doi.org/10.1080/02791072.2017.1295334
- The Impact of the Opioid Crisis on the Healthcare System. (2016, September 1). Retrieved February 8, 2019, from https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/FH White Paper – The Impact of the Opioid Crisis on the Healthcare System – Sept 2016-5972407510d1f.pdf
- Wen, L. S., Behrle, E. B., & Tsai, A. C. (2017). Evaluating the impact of Affordable Care Act repeal on America’s opioid epidemic. PLoS Medicine, 14(8), 1–4. https://doi.org/10.1371/journal.pmed.1002380
