The United States trumps all other nations in general opioid levels, consuming 99% of the global supply of hydrocodone, 81% of all oxycodone, and 60% of hydromorphone (Lyapustina & Alexander, 2015, para. 6). In the US, over 130 people die each day as a result of opioid overdose (National Institute, 2019, para. 2). Perhaps, then, there is no better country to use to give merit to the argument that the tragedies related to opioid overdose and abuse may be almost solely to blame on the overprescription and increasing availability of these drugs.
According to the Pharmaceutical Journal, the opioid epidemic was brought about in the 1990s in the United States. The journal highlights the rising awareness of untreated pain that occurred at this time as the precursor for the mass prescription and circulation of opioids such as oxycodone, hydrocodone and hydromorphone. This gave rise to a huge increase in the amount of prescription opioids being produced, as well as the number of prescriptions written for opioids. OxyContin (oxycodone) sales were at $48 million in 1991, and were more than $2.4 billion in 2012. Likewise, there was a 300% increase in the number of opioid prescriptions from 1991 to 2009 (Lyapustina & Alexander, 2015, para. 5). As a result of the significantly increased amounts of opioids now being prescribed, there are also very high rates of abuse for these drugs.
Of people in the US who receive opioid prescriptions, an estimated 21-29 percent of people misuse the drugs. Further, 8-12 percent of US citizens being prescribed opioids will develop an opioid use disorder (National Institute, 2019, para. 4). Data such as these prove that there is an undeniably strong correlation in the US between the amount of prescriptions being issued for opioids, and the amount of abusers of opioids. The Pharmaceutical Journal identifies several reasons why this may be the case including clinics that profit off of opioid sales, the pharmaceutical advertising of opioids, and the drug diversion of opioids.
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These key problems lead many to conclude that the obvious solution is to impose significant restrictions on the ability of pharmacies and doctors to prescribe opioids. The Journal identifies several steps that have already been taken to discourage the availability of these drugs, such as the FDA requiring containers to have increasingly detailed warning labels, and “upscheduling” hydrocodone so that the prescription cannot be directly refilled without an additional prescription order by the provider (Lyapustina & Alexander, 2015, para. 15).
This journal, while factually based, still serves to provide an opinion on the issue, which was objective and presented rationally. The authors expressed their support for initiatives, whether legislative or private, that promote responsible and more limited prescription of opioid drugs for pain relief.
Still, it is important to keep in mind that the arguments regarding opioid access are inherently complex. Based on this it is reasonable to assume that any source which expresses unconditional support for either perspective without legitimizing any opposing viewpoints has a reduction in credibility. Therefore, it is vital to rely on sources which are able to formulate an argument while still retaining a certain level of objectivity.
In this instance, the authors expressed their support of initiatives to reduce opioid access, but still acknowledged the possible negative externalities of these actions, such as rising rates of heroin usage in response to limited access of prescribed opioids. Additionally, the authors acknowledged the argument that certain populations still do not have ample access to medical pain relief, and emphasized that opioid drugs being prescribed responsibly includes prescribing them to individuals who need it. In doing this, the author was able to provide a thorough analysis of the opioid epidemic with little bias evident in her evaluation, contributing to the validity of the source.
Many may argue that the mainstream media in the US is quick to demonize opioids, and to portray them as a substance to avoid whenever possible. While this is a legitimate concern, there are also areas in the US which have adapted an approach that is more nuanced, and attempts to tackle social and educational dimensions of the opioid crisis rather than relying solely on reducing opioid access.
A prime example of this approach can be found in Ohio, who in the recent years has undertaken an aggressive, multi-fold program to combat the opioid epidemic that their state faced. The Journal of the American Pharmacists Association (Penm, Mackinnon, Boone, Ciaccia, McNamee, & Winstanley, 2017) conducted a case study on Ohio’s program in order to further understand the goals and effects of this program.
This case study examines recent policies put in place in Ohio in response to the growing opioid epidemic, as well as the effectiveness of these measures. Ohio has experienced increasing rates of opioid abuse, and its rates of unintentional opioid-related drug overdoses are the fifth-highest in the US. In an effort to address this issue, Ohio governor John Kasich established a Governor’s Cabinet Opiate Action Team (GCOAT) in 2011, who have implemented numerous policies to achieve three primary objectives: 1) ensure that opioids are used more responsibly, 2) reduce the amount of opioids supplied to patients, and 3) make naloxone more accessible.
The new guidelines surrounding opioid use and prescription have seemed to be successful in helping to reduce rates of opioid drug overdose. In 2011, deaths from opioid overdoses made up 45% of all drug-overdose fatalities in Ohio, which was reduced to 22% in 2015. However, it is worth mentioning that the overall rates of drug-overdose fatalities in Ohio also increased during this time period, hitting an all-time high in 2015, though this is thought to be largely due to the increased distribution of the drug fentanyl on a state level.
Additionally, it seemed that there was some reported hesitance with fully adopting the movement to increase patient and clinical access to naloxone, as many healthcare providers felt as though this would serve as a “safety net” for opioid users, or give them a false sense of security. Other healthcare providers pointed to the relatively high costs of naloxone as a barrier to significantly increasing its circulation. Further, results indicating that deaths from opioid overdose have decreased as a proportion of total deaths from drug overdose may have been skewed by the fact that drugs such as fentanyl increased in its abuse levels during the same time period that the initiative to combat the opioid crisis were taken.
Despite the imperfections that can be identified within this study, it is indisputable that the study provides solid evidence to support the idea that an aggressive, multi-faceted legislative initiative to combating the opioid epidemic can indeed be effective. The measures taken to reduce opioid-related deaths were varied in their approach, and ranged from campaigns to decrease social stigma surrounding distribution of the drug naloxone, to the widespread revoking of medical licenses, if the owner was found to have disregarded prior opioid prescription guidelines. This initiative attacked the issue on a social, legislative and medical level, and was quite thorough and well-thought out in its nature.
This study supports the idea that while legislation and guidelines to decrease the amount of opioid prescriptions have many benefits, it is necessary to also employ other initiatives in conjunction with these efforts. Specifically, this study highlights the importance of also addressing the opioid crisis on a social level, as well as increasing people’s ability to administer life-saving drugs in the event of an opioid drug overdose. This suggests that the opioid epidemic is more complex than it may initially appear, and that the best approach to combating it is a multi-faceted one.
Canada
Similar to Ohio, a more creative approach is being used to combat opioid abuse in Canada. Rather than simply relying on restricting access to opioids or imposing harsher punishments on those who abuse the drugs, Canada has focused on using funds to increase overall public health in an effort to reduce usage.
The opioid epidemic is most prevalent in North America, and while the US receives the most media coverage on this issue, the Lancet Public Health journal states that the Canadian opioid crisis is “equally devastating” (The Lancet Public Health, 2018, para. 1). An estimated 4,000 deaths in Canada were caused by opioid overdoses in 2017. According to the Lancet, many initiatives have been taken to address this crisis, and one of the most significant measures has been making naloxone more accessible, in efforts to reduce the rates of opioid fatalities.
Naloxone, an opioid antagonist, is used to quickly reverse opioid overdose This tactic has brought relative success, as shown by a study conducted by Michael Irvine and colleagues. The study took place from January 1, 2016 to October 31, 2016, and investigated the effectiveness of increased naloxone kit distribution in reducing opioid overdoses. Based on their findings, the researchers estimated that for every 65 kits that were distributed, 1 death was averted, and that for every 10 kits that were actually used, 1 death was averted (The Lancet Public Health, 2018, para. 2).
This article focuses specifically on the proposal made by the Canadian Mental Health Association (CMHA) that Canada adapts an approach which would emphasize the health aspect of opioid drugs rather than incriminating abusers. In other words, the CMHA recommends spending funds to tackle the epidemic on increasing public health quality rather than increasing criminal regulations. Interestingly, the language used by the CMHA to discuss the opioid crisis was quite similar to that of leading officials in Ohio: the “complexity” of the issue was referred to frequently, as well as the idea that the most effective way to tackle it will be using a “multi-faceted” approach, addressing the issue on both a medical and social level. This language alone demonstrated significant parallels in the perspectives of Ohio and Canadian officials regarding the opioid crisis.
While an article is arguably less objective than a given academic journal, this article was published by a Public Health organization, which is more reliable than a mainstream media outlet may be. Additionally, the plan which created the foundation of the article was proposed by the Canadian Mental Health Organization, which includes a board of expert researchers.
With this being said, while the article used a plentiful amount of quantitative data and statistics to support the idea that there is a significant opioid epidemic in Canada, less factual evidence was used to support the idea that the proposal made could be beneficial. For example, since Portugal was referenced as a nation that has adapted a similar policy to the one proposed, it would have been useful to include any evidence of their success in the article.
Despite the weaknesses of the source, which are limited in nature, the information provided in this article is invaluable in that it helps to provide a more global viewpoint. As Canada is the nation that consumes the second-highest amount of opioids, and is facing an epidemic similar to that of the US, it was telling to compare the general approaches used in these nations.
It is interesting to see the contrast between proposed solutions between the majority of the US and Canada, because, although the nations are both in North America and are geographically adjacent, they seem to be exploring different types of approaches to tackling the epidemic.
This source supports the idea that action does need to be taken to reduce the amount of opioids circulated, but suggests that the problem is more complex and must be evaluated from a social level as well. This viewpoint is in line with several other sources I have evaluated.
Europe
The opioid epidemic that the US and Canada are facing is caused by several key prescription drugs, including oxycodone, methadone and hydrocodone. At the same time, Europe is now facing a “silent opioid epidemic” (Finnegan, 2018, title) in which a prominent, more mild opioid being used is Codeine, which can be received over-the-counter in many European Union nations. This is referred to as a “hidden addiction” (Finnegan, 2018, para. 3) and recent studies have shown a significant amount of reliance on this drug from regular users. Although it has proven difficult to find specific data on codeine consumption, researchers estimate that consumption levels have risen by approximately 27% in the last decade. Furthermore, this addiction covers a widespread age-range and socioeconomic span, from children who took cough drops with Codeine at a young age, to women who have taken Codeine to help lessen their anxiety.
There are several proposed solutions to address this issue, such as increasing the training for doctors so that they are better able to identify if patients have Codeine dependency. It seems that this may be the most vital initiative to take. CODEMISUSED has conducted a study, and, after surveying about 400 medical professionals, found that “77% of doctors regularly reviewed patients prescribed codeine, but only 21% said they were confident in identifying codeine dependence.” (Finnegan, 2018, para. 16).
This demonstrates that even the most expert individuals currently lack the ability to ensure that patients are not misusing codeine, which is a problem that should be regarded urgently. Some steps have already been taken to reduce the amounts of Codeine that can be given to a patient in a certain time period, and creating public campaigns to inform patients about the risks of taking Codeine, although there is not yet sufficient data available to evaluate the success of these measures.
The research used in this article was funded by the EU, and conducted by reputable universities such as King’s College in London. The article relies heavily on statistical evidence and studies on Codeine usage. Still, there is a natural barrier to obtaining this information, as there is a relative lack of data on the consumption of Codeine.
A drawback to this article, though, is the lack of data provided on whether or not the current implemented measures have been successful in reducing the rates of Codeine usage. This would have been beneficial in evaluating the effectiveness of different approaches to addressing the opioid epidemic.
This article gives a very unique perspective on the opioid epidemic. Not only does it focus on an area that is less highly-publicized in comparison to the United States and Canada, but it also evaluates the impact of a more mild opioid, which is more prevalent in the EU. It is interesting that, with the different method of allocation used for this over-the-counter drug, there are slightly different problems and proposed solutions to address the issue.
