The opioid epidemic

Answer

Abstract

The opioid epidemic has risen in the United States with escalated consequences. This has primarily occurred because of the high chronic pain prevalence and its associated costs. The increase in the epidemic has been partly because of the steps taken to enhance the use of opioids and the campaign against insufficient pain treatment. Although many scholars argue that the use of opioid drugs is critical in handling chronic pain, the consequences are becoming more devastating with several fatalities linked to the drug overdose widely reported across the US. This has created the need to develop a holistic approach toward the problem that will entail bringing on board both private and public stakeholders including the pharmaceuticals and the government to ensure formulation of feasible policies. Furthermore, it has necessitated efforts for a policy level in tackling the rising opioid abuse outbreak distracting concentration and financing from chronic pain administration. Whereas prescriptions of opioids have reduced, the injury to patients who are suffering in pain like suicide and overdose demise keep rising, hence replicating a policy imbalance amongst strong prescription regulation and feeble pain and psychological health treatment extension.

Combating the Opiate Crisis in the United States of America

Opioid use as a pain management strategy has become an opioid epidemic with adverse effects on society. According to the 2016 report by the Department of Health and Human Services, over two million individuals in America have opioid use disorder originating from opioids prescriptions, particularly with an increasing surge in heroin-associated disorder (Dowell et al., 2016). Studies on individuals recovering from heroin addiction have shown trends of premature deaths because of overdose and post disorder effects (Tauben, 2017). Therefore, for these trends to be reverted, there is a need for a unified effort by the health sector agencies and the medical contingent to establish policies and implementation strategies for the prescription and use of the opioids to reduce pain while avoiding devastating health-related consequences and disorders. 

Further, adopting policies requiring a patient's assessment before an opioid prescription is beneficial when developing a treatment plan that synchronizes the individual conditions and response to pain reduction therapies (Knudsen, 2015). The current crisis remains an epidemic in the United States, as it led to approximately 42,000 deaths in 2016 alone (Centers for Disease Control and Prevention (CDC), 2017c). Opioid crisis is devastating and impacts on families and communities is disparate. According to National Institute on Drug Abuse (2018), 21-29 percent of patients who use opioids to manage chronic pain, misuse the medication. The opioid misuse and abuse, as well as heroin abuse and addiction have both led to significant hardships on the lives of victims, their families and the society at large.

Defining the Problem and Supporting Evidence

Opioid prescription as a pain management medication has over the years turned dangerous for the public’s health with adverse consequences. According to the 2019 National Survey on Drug Use and Health, over 130,000 individuals succumb daily to opioid-related overdoses, with over ten million people misusing prescription opioids in 2018 alone (Seth et al., 2018). Further, a report by the Department of Health and Human Services records a worrying trend with over two million Americans having opioid use disorder, which explains the fact that heroin abuse, is at an all-time high in America (Centers for Disease Control and Prevention Opioid Overdose, 2017). Therefore, in response to the misuse and abuse of opioids, a policy initiative that would lend itself to APRN practice is proposed, promoted and defended in this section.

Considering that the opioid crisis in the United States is a complicated issue, many stakeholders effort is required to combat the problem. In this case, the clear stakeholders are the government and all its medical agencies, and the communities, the patients, professional bodies, educators, and the criminal justice system (Centers for Disease Control and Prevention Opioid Overdose, 2017). Both the public and the private stakeholders should work together in a partnership approach that focuses on different but related methods to an opiate crisis like the medical, societal, and regulatory mechanisms that provide an alternative pain-relieving medication free from opioid contents (Johnston et al., 2019). Similarly, the cooperation should cover all sectors of the society, such as the education sector, to combat opioid-related complications and fatalities as no single stakeholder can solve the crisis singlehandedly.

High expectation for pain relief by patients has increased the opiate crisis over the years. In the early 2000s, medical practitioners used behavioral pain-relieving therapies such as oral dissolving strips and nasal sprays, which were later discovered to have adverse cardiovascular risks and toxicities (Tauben, 2017). These discoveries slowly opened up for the use of opioid drugs in a concerted scheme involving the suppliers and physicians, where the suppliers sneak in the medications to the clinics at a fee. Despite the efforts put in place by the medical regulatory boards to reduce unregulated opioid prescriptions and heroin use, deaths attributed to heroin overdose have significantly tripled with an ever-expanding pool of vulnerable individuals for the exploitation.

Another factor attributed to the opioid epidemic is poverty. Poverty and substance abuse go hand in hand, at the extreme bolstered by mental disorders and poor living conditions. According to various economic research conducted in America, low-income families tend to lean towards manufacturing and service jobs, some characterized by high chances of physical injury and harm such as military service (National Academies of Sciences, Engineering, and Medicine. 2017).

Therefore, there is sufficient evidence linking the numerous deaths reported annually to opioid misuse. Research by the various agencies such as the National Agency on drug use and health 2018 give a troubling report on the opioid epidemic status with a significant section of the population grappling with opioid addiction or addiction from related drugs (Seth et al., 2018). Therefore, it is apparent that the crisis has reached an all-time worse that demands policy response from the government and all stakeholders.

Existing Policy

There are several plausible efforts by the United States government to combat the opioid epidemic. Recently, President Trump declared opioid overdose a National crisis that should attract the attention of all the stakeholders to make any meaningful gain in the drug fight. Reducing the mortality rate from opioid and drug abuse requires goodwill and effort from the politicians, the society, and the business community (Centers for Disease Control and Prevention Opioid Overdose, 2017). Besides, the government agency, the National Institute on drug abuse in designing a long-term intervention measure, has come up with an approach that demands parental participation to prevent exposure at infantry. Likewise, the 2010 Affordable Care Act allowed for a comprehensive pain management approach requiring the health caregivers, the insurance companies, and the citizens to work together in a transformation process that will ensure the identification of pain, and appropriate medical assessment and treatment. Furthermore, the efforts have entailed building capacity within the local government including my state Illinois for a proper fight to the problem (Centers for Disease Control and Prevention Opioid Overdose, 2017).  

Unfortunately, these policies do not adequately address the problems because of the weak government policies, free-trade policies that contributed to the opioid epidemic, foreign policy that majorly affects activities in states and the most dangerous drugs to come to the US from other nations, and the illegal drug business (Goldschein, 2011). The government is needed for intervention in the opioid crisis, which has been linked to decades of mortality (Jalal et al., 2018). The overdose deaths have been rising constantly since 1979, despite the drug primacy. That is why more measures are needed to tackle the structural determinants of the epidemic. Frequently owing the high overdose rate, can be handled from the national level by adequate supply of naloxone, social support, agonist maintenance treatment for addiction to opiods (United Nations Office on Drugs and Crime (UNODC), 2005). 

Ending prescription opioid abuse and other related nonmedical usage requires a joint effort from the stakeholders in coming up with clear goals and objectives necessary in the anti-opioid abuse crusade. For example, the collaborative approach by the National Institute on Drug abuse can work together with the educators and the patients to raise awareness of the dangers of drug misuse (Johnston et al., 2019). The Advance Practice Registered Nurse should be involved in the education process to ensure they are able to assess, diagnose and manage patients with opioid addiction. Moreover, more efforts should be directed towards developing a curriculum that emphasizes competency in pain management techniques and effective implementation, sealing all the loopholes in the supply and prescription of the pain medications. Additionally, the Federal Drug Enforcement agency should carry out empowerment exercises for parents and guardians as the first contact point in mitigating opioid misuse.

Selecting the Evaluation Criteria

There is a criteria that if met, the opioid use and abuse crisis will be partially resolved or even mitigated. A commission on Drug Addiction and the Opioid Crisis by President Trump released its final report in November 2017. It featured a long list of various recommendations for policies such as more federal funding, alterations on guidelines for drug prescriptions and education of the provider, increased efforts focused on drug takebacks, better treatment and efforts for comfortable recovery, and more research and development resources (Mericle, 2017).

By comparing various states approaches on prescription of opioids, a huge difference is noted. The rural states have higher numbers of prescriptions, more especially in the South (Keyes et al., 2014). Also, opioid overdose is addressed as an increasing public health concern across the US as well as states. States have to take action attempting to reduce the overuse of medication.

These policies impose strict limitations on time and content, as well as authority to do the prescriptions. Mid-level practitioners (MLPs), nurse practitioners, physician assistants, and optometrists are professionals with the highest authority to give opioids prescriptions (Drug Enforcement Agency/Diversion Control Division, 2018). Massachusetts was the first state to introduce a law that limited first-time opioid dose prescriptions to not more than 7 days (National Conference of State Legislators, 2018).

Currently, massive efforts are made at the policy level in tackling the rising opioid abuse outbreak distracting concentration and financing from chronic pain administration. Among the problems of policy creation and execution is the indeterminate effect and probability for extensive implications unintentional as its creation. Hence, sustained appraisal and review of policy effectiveness are crucial.

Construct the Options

Center for Medicare & Medicaid Services (CMS) is executing policies to enhance opioid use disorder (OUD) access therapy services equipped by opioid therapy programs (OTPs). OTPs treat persons with OUD using drugs and other services. This new Medicare Part B advantage was authorized under the Substance Use-Disorder Prevention that facilitates support for patients and people law that on October 24, 2018, President Trump signed into law (Abuse et al., 2016).

CDC is a Health and Human Services (HHS) agency that is funded by Congress to prevent to rising opioid epidemic by publishing various evidence-focused best practices rule for opioids prescription in aligning with the National Pain Strategy (NPS) (Gross & Gordon, 2019). CDC supports NPS efforts by issuing guidelines for primary care providers and advocate for a multi-modal and non-opioid method (Painter, 2017).

National Pain Strategy (NPS) was formed from the IOM 2011 report that advocated for a cultural change in pain sensitization, prevention, and care and suggested the creation of a comprehensive populace health-level approach to tackle these issues (Gross & Gordon, 2019). To enhance the amount and quality of what is recognized on chronic pain in the US populace, the NPS suggests particular steps in enhancing the information precision on chronic pain dominance, effect, treatment, to encourage populace-level intervention assessment and emerging needs identification.

Projected Outcomes