Home Care and Treatment Desperately Seeking Solutions to Reduce Opioid Crisis in America

Desperately Seeking Solutions to Reduce Opioid Crisis in America

National Drug Threats and the Challenges it Poses for Public Health

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“If we’re just substituting one opioid for another, we’re not moving the dial much,” --- Secretary of Heath and Human Services, Tom Price

Every year, The Drug Enforcement Administration reports on the trafficking and abuse of illicit drug use in the United States. If you’re wondering what constitutes illicit drug use, the answer is simple. It is the misuse of both illegal and controlled prescribed drugs and informs events like overdosing, drug poisoning, violent crimes, unintentional and intentional injuries, international involvement and death (Drug Enforcement Administration Strategic Intelligence, 2016).

Over the course of a 10-year time frame, the DEA has described the current national drug threat as the greatest of all time. This trend was ignited by cocaine use in 2007, which labeled the drug as a substance most often illegally consumed and distributed across the United States. The circumstances transpiring the distribution and use of cocaine remained stable until 2010 when more challenging problems surfaced. First, cocaine use began to see a significant decline, and then the use of heroin proceeded its reign as the primary drug of concern for our issue of national drug threats. This, however, hasn’t been the only present danger for our nation in terms of illicit drug use; controlled prescription drugs are also representing a devastating time for America due to its chronic misuse and combination with the substance heroin.

From as early as 1999, the Centers for Disease Control and Prevention began reporting that more than six out of ten drug overdose deaths were linked to opioid use. In subsequent years, overdose-related deaths linked to opioid use quadrupled. Among the drugs listed in overdosing statistics, the combined misuse of prescription opioids like oxycodone, hydrocodone, and methadone mixed with the street drug heroin are the most pressing.

As it now stands, ninety-one Americans die daily from opioid overdosing and many of those drugs are being legally prescribed. Historically, opioids were prescribed to treat medical conditions where moderate-to-severe pain followed the diagnosis or in situations where surgery or injuries were present to control the amount of discomfort the patient may be experiencing. In our modern society, opioids aren’t just being prescribed to patients with a diagnosis like cancer, but to those who complain of other forms of chronic inflammation. This is a widely accepted common practice for those in the medical profession.

Major setbacks surface for public health due to this type of common administration of opioids. Evidence supporting the long-term effectiveness of opioid use in minor illnesses is lacking. Yet, the information that has been made available discusses the concerns for serious risk of addiction, abuse and overdosing among those who are prescribed opioid medications. The CDC lists common side effects like increased tolerance (needing more of the substance to detour pain), physical dependency, increased sensitivity to pain and other symptoms that can easily be associated with lethargy. Unfortunately, this list only accounts for a few areas that are affected by patients who misuse and/or mix prescribed opioids with street drugs. The reality of the situation is that even when patients take opioid medications per their physician’s instructions, the same side effects associated with misuse can occur and present unforeseeable health risk later on.

Among HeathyPeople’s leading health indicators, substance abuse is estimated to exceed $600 billion annually. As a result, the burden that the national drug threat poses on our system of public health emerges as an expenditure in the offices of local primary care physicians, in health departments, hospital emergency rooms, urgent care clinics and any other facility that manages healthcare. The logical response holds true that whether an opioid is legal or illegal, it can contribute to many adverse health outcomes and pose public health risks.

No one initially visits a clinic complaining about problems with addiction. Instead, the population is presented with conditions associated with cardiovascular disease, complications in pregnancy, underage pregnancies, complications associated with HIV/AIDS, sexually transmitted diseases, domestic violence and child abuse cases, vehicular crashes, homicide and suicide cases. Ultimately, the underlying cause is the addiction, yet the statistics or treatments will never be classified as just a complication of opioid mixing and addiction, nor should it ever be.

In turn, this elevates chronic and communicable disease statistics alongside those associated with substance abuse. It signals a sense of urgency among networking public health agencies and requires an intervention to mediate rising community health challenges. Inevitably, underlying opioid addiction may never signal a shift towards facilities and interventions that reduce addiction risks, while symptoms remain in a hidden state.

Perhaps, the easiest and most economical solution to end the opioid epidemic is to reduce the rate at which opioids are accessible. An evaluation made by the National Drug Enforcement Administration, however, argues that the complexities of the issue stems far beyond US soils. Studies are reporting that regional use of prescribed opioids can’t be justified by the underlying health status of those in the population (CDC, 2016). Despite, the quarter of a billion opioid prescriptions written in 2013 (CDC, 2016), the magnitude of the opioid epidemic has increased so significantly across the U.S. that heroin use alone affects both men and women, most age groups, and all income levels (CDC, 2016).

Despite these public health challenges, there is still a light at the end of the tunnel; opioid use disorder can be diagnosed after specific criteria has been witness by a provider. Some of the signs are patterned opioid use that causes clinically significant distress, unsuccessful attempts to control the use of opioids, social difficulties and unfulfilled obligation at work, school, or home (CDC, 2016). There are also medication-assisted treatments (MAT) that aid those with opioid addiction concerns, which includes the use of prescription drugs without a prescription or in situations when medications aren’t consumed as directed by the physician (CDC, 2016). MAT therapies combine the use of the medications methadone, buprenorphine, or naltrexone along with counseling and behavioral therapies (CDC, 2016).

MAT therapy has been deemed an effective mode of treatment for opioid addiction and is also cost-effective. Undoubtedly, it is also one of the most underutilized methods of treatment. There were over 2.5 million Americans in the 12-years and older age demographic that abused or were dependent on opioids, but less than 1 million of those individuals received medication-assisted treatments (Volkow, N.D., Frieden, T.R., Hyde, P.S., & Cha, S.S., 2014).

There is a long-standing debate over the opioid crisis in America as to whether opioid additions should be treated administering other prescription medication.

At a meeting held on May 10, 2017 at the State House in Maine, U.S. Secretary of Health and Human Services Tom Price, agreed that substance abuse is a disease and the crisis is a public health issue, not an issue of criminal justice. Decidedly, that is where the agreement ends, Price doesn’t support the option of medication-assisted treatment to end the opioid epidemic: “If we’re just substituting one opioid for another, we’re not moving the dial much” (Jacobs, 2017). Despite, the differing views on solutions to the opioid crisis, answers to the challenge are already in the woodwork. President Trump and New Jersey Governor Chris Christie established a commission back in March to solidify solutions for reducing opioid abuse.The report is expected by the end of the year.

To learn more about this topic please read “Trump’s health secretary isn’t a fan of the ‘gold standard’ substance-use treatment – bad news for the opioid crisis.”

 

References:

CDC. (2016, December 16). Retrieved from Opioid Overdose: Understanding the Epidemic: https://www.cdc.gov/drugoverdose/epidemic/index.html

Drug Enforcement Administration Strategic Intelligence. (2016, November). U.S Department of Justice Drug Enforcement Administration: 2016 National Drug Threat Assessment Summary. Washington D.C.: DEA Strategic Intelligence Section. Retrieved from https://www.dea.gov/resource-center/2016%20NDTA%20Summary.pdf

HealthyPeople. (2017, June 20). Retrieved from Substance Abuse: Overview and Impact: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Substance-Abuse

Jacobs, H. (2017, May 10). Business Insider: Politics. Retrieved from Trump’s health secretary isn’t a fan of the ‘gold standard’ substance-use treatment – bad news for the opioid crisis: http://www.businessinsider.com/hhs-secretary-tom-price-medication-assisted-treatment-suboxone-news-opioid-crisis-2017-5

Volkow, N.D., Frieden, T.R., Hyde, P.S., & Cha, S.S. (2014). Medication-Assisted Therapies —Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine, 370(22), 2063-2066. doi: 10.1056/NEJMp1402780.

 

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