Prescription Opioid Addiction (POA) is now viewed by many as a serious epidemic in the United States. Approximately 2.5 million of Americans over 12 years old abused opioids in 2012, and this trend is still increasing (Volkow et al. 2064). Additionally, the country has seen an increase in the number of older teenagers and young adults becoming opioid addicts. The profile of opioid addicts expands from teens to the elderly. POA does not discriminate as it crosses age and race demographics, socioeconomic statuses, and one of my immediate family members that I love dearly. Both national and state governments have realized that this epidemic has reached a crisis level and are actively proposing legislation and innovative programs targeted legislation at reducing POA (Kolodny et al. 560). Though POA has rapidly destroyed millions of lives and families over the last 10 years, the attention that this national crisis is currently getting on will only help elevate the urgency for solutions that deliver meaningful results.
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Therefore, this paper will focus on highlighting the severity of the current epidemic and identifying steps for combating it. In order to achieve the initial research objective, several research questions will be addressed:
- What are the prescription opioid addiction trends and statistics in America?
- What is the profile of a prescription opioid addict?
- Are prescription laws for opioid too loose and contributing to people becoming addicted to opioids?
- To help lower the rate that people become addicted to prescription opioids, what are some ways to change how opioids are prescribed?
- What are some other ways to help reduce prescription opioid addiction rates and treatment of those that are already addicted?
The major trends associated with POA include a gateway to using the highly addictive drug (heroin), the rise in death due to substances overdose, and the shift in the affected population. It has been estimated that the abuse of prescription opioids and heroin grew from slightly over 23% in 2008 to 41.8% in 2014 (Cicero et al. 1789). The two types of substances are closely connected as heroin addicts report that they started abusing drugs with prescribed opioids. The shift to heroin is often linked to the accessibility of this illicit substance, as it is easily available on the streets and cheaper than prescription opioids (Kolodny et al. 561). Though the abuse of prescription opioids decreased from 70% in 2010 to 50% in 2014, the heroin addiction rate more than doubled between 2008 and 2014 and reached 9% (compared to 4.3% in 2008) (Cicero et al. 1789). Although all opioids are highly addictive, oxycodone has become the most abused prescription opioid in America, as its usage has increased by almost 500% (Kolodny et al. 560).
Another alarming trend is the number of overdose deaths associated with the use of opioids. It has grown by 200% since 2000 (Rudd et al. 1323). In 2010, 16,651 people died as a result of prescription opioid overdose (Volkow et al. 2063). Approximately 80% of deaths associated with the use of prescription opioids and over 90% of deaths associated with the use of heroin overdose were classified as “unintentional,” while the rest of the cases were “attributed predominantly to suicide” and “undetermined intent” (Volkow et al. 2064).
A new alarming trend shows that over 1.4 million people between the age of 15 and 25 are prescription opioids and heroin abusers (Kolodny et al. 564). The majority of this population abusing opioids is doing so without legitimate prescriptions and for nonmedical purposes (to get high and in an altered state) (Kolodny et al. 565). The increase in use of prescription opioids, such as oxycodone, is readily available to this younger population compared to alcohol or other opioids. For people aged 45 to 54, the use of the prescription opioids and overdoses is not growing (Kolodny et al. 564). For people aged 55 to 64 in age, the use of prescription opioids is increasing, and suicides are common overdose deaths (Kolodny et al. 564).
To develop effective strategies for addressing the prescription opioid addiction epidemic, it is important to understand who is being impacted by the crisis. Throughout America, prescription opioids are cutting across all races and social classes of the population, which makes narrowing to a one-size-fits-all solution unrealistic. Research has identified some areas that might be worth further understanding. People under the age of 25 try prescription opioids, like oxycodone, for fun because of peer pressure from those that do use these highly addicted illegal drugs. This group seeks relaxation and altered psychological states when they use opioids (Kolodny et al. 565). They are also unlikely to pay much attention to possible health problems and risks associated with the drugs because they receive most of their information from misinformed peers who already have displayed poor judgment.
As for people aged between 45 and 54, these are main users of prescription opioids who seek treatment of pain. Their pain is usually associated with chronic conditions such as cancer or injuries such as back surgery. Women in this group are more likely to see doctors to treat their pain compared to men (Kolodny et al. 563). Older adults aged between 55 and 64 becoming addicted to prescription opioids at an increasing rate (West et al. 120). There is also an increase in accidental overdose deaths among white females in this age group (Kolodny et al. 564).
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For these last two groups of people (over 45 years old), the main driver in getting opioid prescriptions is to treat pain, which is often associated with the development of depressive symptoms and other psychological issues. These groups often misuse prescription opioids, as they can take more pills than prescribed or use the substance for a prolonged period (West et al. 119). Though they have some information concerning such side effects as addiction, in many cases, healthcare professionals and pharmaceutical companies conceal and divert important data, which makes patients in pain believe that the risks of addiction are minimal (Kolodny et al. 562, 566). Healthcare professionals and pharmaceutical companies have done a poor job informing consumers of how highly addictive prescription opioids really are.
To understand legislation and laws around prescription opioids use, it is important to know that opioids have been available for a long time. In the second half of the nineteenth century, opioids began to be prescribed to treat a variety of issues: pain, sleep disorders, diarrhea, and even hangovers. Essentially, doctors started to give opioids on a more regular basis than patients were experiencing symptoms (Kolodny et al. 564). As a result, there was an increase in the rate of people suffering from POA, which, in turn, resulted in the development strict laws concerning the use of opioids and heroin. These regulations existed up to the 1980s when opioids were prescribed to treat pain in chronic conditions such as cancer or end-of-life pain (Franklin et al. 463).
However, during that period, a series of studies about the long-term use of opioids were conducted. The studies found that opioids were prescribed and used properly. In this way, they were not associated with severe health issues such as addiction and their use could be beneficial for a larger population including treatment of nonchronic pain (Franklin et al. 463). The studies stressed that pain was a health issue that should be treated accordingly. As a result pharmaceutical companies launched extensive campaigns promoting opioids as safe and proper treatment plans. Additionally, legislation at the national and state level began to make opioids prescription regulations looser so that more people could have access to them. For example, in Washington State, regulations were altered in 1999 and allowed healthcare professionals to prescribe opioids in any quantities (Franklin et al. 464). In fall of 2016, an opioid addict in my family was prescribed 150 oxycodone by a doctor in Maryland during a routine visit.
Because the prescription opioid situation has approached epidemic proportions in the United States, appropriate parties are working toward fixing the problem. For example, in Washington State, the Agency Medical Directors’ Group in collaboration with pain management experts developed opioid and dosage prescribing guidelines as an educational pilot (Franklin et al. 464). This program was launched in 2007. In 2013, opioids prescribing guidelines for emergency rooms were introduced by the New York City Department of Health and Mental Hygiene (Kolodny et al. 566). Other states went even further and passed legislation requiring mandatory prescriber education (Kolodny et al. 566). Educational programs do a good job informing healthcare professionals about the dangers associated with substance use and encouraging them to be cautious when prescribing opioids. However, manufacturers continue to actively market and sponsor programs that focus on the benefits of using opioids (Kolodny et al. 566). Clearly, the existing regulations are ineffective and insufficient, which helped to drive the prescription opioid epidemic in the United States. Federal and state governments actions have been limited and inconsistent in taking the right steps to stop the epidemic.
Most recently, however, researchers, officials, healthcare professionals, and the concerned public grew more focused on addressing ways to change the process of prescribing opioids. Many of these stakeholders stress the need to introduce strict legislation that would significantly restrict the use of opioids (Volkow et al. 2066). It is believed that refocusing on prescribing opioids to treat cancer and end-of-life pain only is the appropriate option.
Additionally, increasing the number of state opioids prescription and monitoring programs have proved to be effective in significantly decreasing the rate of opioids use (Franklin et al. 465). These programs provide oversight of healthcare providers through the use of databases so that they are more closely monitored in their prescription practices. The main goal of these programs is to ensure that healthcare professionals do not prescribe such substances excessively. To get the most out of these programs, they need to be mandated and strictly controlled. Such states as New York, Tennessee, and Kentucky implemented legislation requiring the mandatory use of prescription data available (Kolodny et al. 566). These efforts have already translated in the increase in the use of data and the decrease in the consumption of prescription opioids.
Ideally, the new administration in Washington, DC, will enact federal sponsored programs that will help to curve this epidemic. For example, programs that prohibit the ability of lobbyists for opioid manufacturers suggest regulatory language changes. Another viable option is to reduce federal aid to states that fail to enact their own aggressive regulatory changes and increase the quantity of programs available to curb the epidemic. A final federal option is to have opioid manufacturers pay a tax for all people that enter addiction centers for opioids. These funds would be used to support addiction treatment and education programs.
Still, there are other ways to reduce prescription opioid addiction rates. New innovate practices for tackling the prescription opioids epidemic are also needed as part of the solution. Rather than providing opioids as the first resort of treatment, there is a need for increased availability and treatment options for alternative pain management programs such as acupuncture, meditation, massage, transcutaneous electrical nerve stimulation, etc. These options should be low cost and covered by insurance companies. A good example of someone trying to make a difference is The University of New Mexico. In 2011, they launched the program “UW Telepain/ECHO,” which offered pain management consultation. Other state organizations and hundreds of providers joined this initiative to combat the current epidemic (Franklin et al. 466).
Programs for expanding education regarding the harmful effects of drugs, addiction, and consequences of drugs are increasing at middle schools and high schools across the country. Schools systems also have social worker resources available so that prompt referrals can be made. There is a focus on increasing drug education in juvenile detention and other community centers.
Other incentives involve pharmacotherapies involving the use of methadone, naltrexone, and buprenorphine. This medication helps in controlling cravings (buprenorphine and methadone) and preventing the addicts from feeling opioids use effects (naltrexone) (Kolodny et al. 568). These programs have proved to be effective and are widely used in many states (Patrick et al. 1329). There is also an increase in the number of organizations providing free naloxone to addicts and family members of people suffering from POA (Kolodny et al. 569).
As far as psychosocial approaches are concerned, these include mutual-help programs such as family counseling, 12-Step treatment programs, and residential and outpatient treatment programs for people specifically addicted to opioids (Kolodny et al. 568). It is essential to mention that healthcare system is addressing the POA epidemic and offering increased access to psychological support (Kolodny et al. 568). The cost of psychological support for breaking the addiction and maintaining sobriety is lower for insurance companies than maintaining coverage for an addict.
In addition, it is also necessary to mention such incentives as numerous syringe service programs. These programs encourage those using (and especially addicted to) opioids to use the substance in a safer manner. These programs are specifically beneficial for teenagers and young adults who might not have the money to buy new sterile tools and pay little attention to their own safety (Kolodny et al. 569). They have proved to be effective in addressing such associated health issues as Hepatitis C and HIV/AIDS spread, which have also become quite a significant healthcare concern recently.
Finally, there are some unconventional strategies for overcoming the epidemic. One of such programs is based on increasing availability of telemedicine due to its popularity and effectiveness. In 2016, President Barack Obama supported the idea of financing the initiative, which aims at increasing awareness about opioid addiction in rural areas (Abbasi 808). Telemedicine initiative is an educational campaign that focuses on the necessity to make rural people know that opioid addiction can be fought. In addition, it will be supplemented by introducing mobile health units that will visit distant areas and consult people whenever necessary (Abbasi 808). As for now, it is launched in Virginia only.
The prescription opioid addiction epidemic has become a serious healthcare issue in America. Large populations become addicted to opioids irrespective of race, ethnicity, and socioeconomic status. Ironically, healthcare system contributes to the spread of the epidemic. Ineffective legislation and loose regulations have become the premise for the increase in opioids consumption and overdose deaths. Manufacturers’ focus on their profits has resulted in the shift in the society that took place at the end of the 20th century. Many people, including healthcare professionals, started believing that the benefits of opioids use outweigh potential dangers. Nevertheless, it is apparent that the attitude towards opioids is changing. The federal and state governments are introducing prescription guidelines. Organizations develop monitoring programs as well as pharmacological and psychosocial treatment programs. The efforts of governmental organizations, healthcare associations, non-profit programs, and individuals appear to have begun working toward a common goal, and the prescription opioid problem will be solved in the future.
Abbasi, J. “Opioid Epidemic in Appalachia Receives USDA Telemedicine Funding.” JAMA, vol. 316, no. 8, 2016, p. 808.
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