Significance of The Opioid Crisis

Significance of The Opioid Crisis 


In October, 2017 President Donald J. Trump declared the opioid crisis a nationwide public health emergency. The public health nurse is in a unique position to lead, develop, and implement programs to address this crisis. For this presentation, the learner will:Significance of The Opioid Crisis Essay

Examine the significance of the opioid crisis in the learner’s home state (CALIFORNIA)
Analyze and discuss the different approaches that the state is using to address this public health emergency (e.g. addiction prevention education, medication disposal programs naloxone distribution programs, needle exchange programs, mental health and addiction services, partnerships among health and law enforcement agencies).
Identify or create a program that you feel would benefit the local community. Present an overview of the program, identify the goal of the program, provide objectives for the program, describe the planned interventions, identify the community stakeholders who should be a part of the planning process, discuss how the program will be monitored and evaluated, identify potential challenges and methods for engaging the community, and discuss budget needs to launch the program.
Discuss the role of the public health nurse as a community advocate, leader, and change agent. Significance of The Opioid Crisis Essay
This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title, introduction, conclusion and reference slide, with detailed speaker notes and recorded audio comments for all content slides. Use at least four scholarly sources and make certain to review the module’s Signature Assignment Rubric before starting your presentation.

There is an alarming reality in the world of modern medicine: patients are dying in unprecedented numbers from therapies prescribed to treat pain. More striking still is that this is happening throughout the world.

Globally, prescription opioid pain relievers are among the most commonly misused and abused medicines. In North America, Australia and New Zealand, their illicit use outpaces that of heroin, which produces a similar high[1]. And, like heroin, the consequences of recreational use of these products poses serious health risks, including death.Significance of The Opioid Crisis Essay

Collective action is needed from governments, medicine regulators and healthcare professionals to stop this epidemic from growing.

How the problem began
The rise of the global prescription opioid epidemic started in the 1990s. At that time, pain specialists and advocacy organisations in the United States began to argue that the nation faced an epidemic of untreated pain. In turn, the American Pain Society advocated for the recognition of pain as the “fifth vital sign” and an increasing number of professional and consumer groups pushed for the increased use of opioids for pain management. Coinciding with this shift in medical perspective was the introduction and extensive marketing of OxyContin (oxycodone) for the treatment of non-malignant pain. OxyContin sales representatives visited doctors across the United States, leaving them with gifts, free patient samples, and invitations to all-expenses-paid symposia — all actions that are known to impact prescribing[2]. The widespread adoption of opioids for pain relief was further facilitated by marketing strategies that downplayed OxyContin’s addictive potential and targeted primary care doctors[3], who continue to prescribe the majority of opioid pain relievers in many nations[4].Significance of The Opioid Crisis Essay

The shift towards opioids for pain management led to a dramatic increase in prescription opioid production. From 1996 to 2012, global OxyContin sales increased from US$48m to over US$2.4bn[3]. The worldwide increase in OxyContin parallels that of other opioids, such as morphine and codeine, which, similarly, experienced an unprecedented rise in production and sales[5]. Over the same period, the number of prescriptions written for opioids increased in many nations. In the United States, the number of prescriptions written for opioids increased by 300% between 1991 and 2009. In Canada, the number of prescriptions written for oxycodone increased by 850% between 1991 and 2007[6].Significance of The Opioid Crisis Essay

The United States has been at the forefront in terms of prescription opioid consumption. In 2009, the United States consumed 99% of the world’s hydrocodone, 60% of the world’s hydromorphone, and 81% of the world’s oxycodone[5]. Yet while the magnitude of the prescription opioid abuse varies among nations, there is no question that the problem is a global one. The rising trend of problematic prescription opioid use has been found in Canada, Australia and Europe.[7] For example, in 2011, 5% of all patients entering drug treatment programmes in Europe reported prescription opioids as their primary drug. More concerning is that the current estimate of the global extent of the problem is likely to be an underestimate given the absence of data collected throughout much of the world[8].Significance of The Opioid Crisis Essay

What drove the soaring rates of addiction?
The increased morbidity and death from these products is a result of the degree to which they have been prescribed. For example, there are striking parallels between admissions to addiction treatment facilities, overdose deaths, and the volume of opioids prescribed in the United States over the past 15 years[9]. This increase in opioid volume is similarly evident in Canada, Australia and New Zealand, where, as in the United States, increases in opioid prescribing dwarf any plausible changes in the prevalence of pain[10].

Many factors contribute to high rates of prescribing, including a lack of consensus regarding the appropriate use and dosing of these medicines, demand for the products among patients who have opioid dependency or are otherwise abusing or diverting these products and, in the United States, the rise of for-profit clinics whose physicians may prescribe opioid products cavalierly and beyond the evidence base[11]. Of course, the prominent role of pharmaceutical companies in advertising opioid pain relievers should not be overlooked, nor the historic under-treatment of pain that has motivated at times well intentioned efforts to improve the use of prescription analgesics, including opioids.Significance of The Opioid Crisis Essay

Although many of these factors have also contributed to opioid-related morbidity and death beyond the United States, there are other drivers that are unique to particular countries and their systems of healthcare delivery. In many countries, the problem stems in part from a lack of supervised medicines consumption in drug treatment programmes[12].

For instance, throughout the 1990s, England and Scotland experienced rising numbers of deaths linked to methadone, prescribed almost entirely through opioid substitution programmes. The death toll only began to decline when the UK established regulations requiring methadone consumption to be supervised in treatment centres and community pharmacies[13].

New South Wales, Australia, experienced a similar problem because of regulations allowing patients to leave drug treatment programmes with prescribed methadone. In that state, between 1990 and 1995, 54% of methadone-related deaths occurred in patients enrolled in methadone maintenance programmes, while the remaining 46% of methadone-related deaths occurred because of a diversion of the medicine from patients in the programme to other users[14].Significance of The Opioid Crisis Essay

In other countries, the consumption of opioid pain relievers is closely tied to the availability of heroin[12]. For example, in 2001, the shortage of heroin on the illegal drug market in Europe resulted in the abuse of illegally produced fentanyl in Estonia[15]. Similarly, this heroin shortage was linked to the rise of illicit buprenorphine use in Finland, where addicts obtained the medicine from maintenance treatment programmes[16]. Even in the United States, the relationship between the availability and abuse of prescription opioids and heroin has become apparent in recent years, as local reductions in opioid prescribing following legislative action have been associated with increased heroin distribution and abuse[17].Significance of The Opioid Crisis Essay

In all countries, drug diversion, defined as the illegal transfer of a pharmaceutical from a legitimate source to an illicit one, is also a significant contributor to the epidemic. Although diversion may take any number of forms, ranging from pharmacy robberies to prescription forgeries, the most common origin of diverted opioid pain relievers is a doctor’s prescription[18]. From this origin, opioids may enter the black market to be sold by drug dealers, may be taken from the drug cabinets of relatives, or may be shared and traded with friends[19].

Solutions to the problem
The epidemic has been a long time in the making, and there are no magic bullets that will quickly restore a more balanced use of opioids in clinical practice. Fortunately, it is hard to find a stakeholder that does not acknowledge the scope of the epidemic. And these stakeholders, which in the United States include regulators such as the US Food and Drug Administration (FDA), payers such as health plans and large employers, pharmaceutical manufacturers, state policymakers, as well as provider and patient groups, are all active in their own ways in an attempt to address opioid-related injuries and deaths.Significance of The Opioid Crisis Essay

For example, during the past decade, the FDA has undertaken a variety of initiatives in an effort to improve the risk-benefit balance of opioids, including strengthening warnings on the drug label, expanding patient and prescriber educational campaigns, “upscheduling” hydrocodone so that patients were no longer able to refill a prescription automatically but instead required a new prescription from a prescriber, and issuing guidance for the pharmaceutical industry regarding the development of abuse-deterrent formulations of opioid products[20]. Although the policy impact of most of these interventions is unclear, those that have been tested have shown mixed results. For example, the recent formulation of abuse deterrent OxyContin in August 2010 was associated with a 36% decrease in the use of that medicine coupled with a 42% increase in the use of heroin over the same time frame. Therefore, while this reformulation of a widely abused opioid may have succeeded in reducing its abuse, research suggests that there may have been important unintended consequences from such new technologies[21].Significance of The Opioid Crisis Essay

Several countries have invested in prescription drug monitoring programmes. Although they serve many different roles for clinicians and law enforcement, one of their main functions is to allow pharmacists and prescribers to access patients’ prescription histories in order to identify suspicious use. Currently, parts of the United States, Canada, Europe and Australia have implemented these programmes in an effort to curb prescription opioid diversion[22].

Although most of these programmes have yet to be tested for their efficacy, studies of their use in some US states have shown promising results[23]. Unfortunately, we are still a long way from experiencing the full potential of these programmes. A recent survey of physicians in the United States found that only 53% of doctors used these programmes, while 22% were not aware that the programmes were available to them[24]. Canada faces a similar problem of having prescription monitoring programmes in many of its provinces but falling short of informing its medical providers of the existence and appropriate use of these programmes[25].Significance of The Opioid Crisis Essay

Insurance companies have responded in a number of ways, including creating their own methods of surveillance with analytic tools that allow for real-time assessment of a patient’s risk of abusing prescription opioids. These programmes are intended to help case managers intervene on potentially dangerous situations before they develop, with a goal of reducing healthcare expenditures and improving outcomes, a non-trivial task given that the annual healthcare costs of opioid abusers are on average 6.6 times higher than those of non-abusers[26]. Providers and patient groups have responded by spreading awareness of the growing epidemic, calling for changes in how these drugs are labelled, and demanding recall of high potency opioids with a high abuse potential.Significance of The Opioid Crisis Essay

We still need to treat pain
In the midst of the opioid abuse epidemic, we must acknowledge that both acute and chronic pain remain untreated in most of the world[27]. Even in the United States, where morphine, oxycodone, and hydromorphone consumption is greater than their combined consumption in all other nations, pain continues to be poorly managed, with disadvantaged populations facing the bulk of this under-treatment[28].Significance of The Opioid Crisis Essay


A major part of the solution, then, must begin with addressing knowledge gaps in pain management. The bulk of this epidemic is driven by the inappropriate treatment of pain, defined through both the under-treatment of pain and the overprescription of opioids in cases where the risks outweigh the benefits. This is especially true for the management of chronic pain, which affects one in five adults worldwide[27], and for which there has been much misunderstanding regarding effective treatments[29]. Only once we begin to address the problem of under-education and misinformation in pain management can we begin to curb this epidemic.

The appropriate management of a patient’s pain is a complicated task, one that should not be oversimplified by characterising patients as either suffering from pain or seeking drugs. On account of the addictive nature of opioids, many patients receiving these prescriptions for clinically approved indications develop opioid dependency.Significance of The Opioid Crisis Essay

Recently, signals have emerged suggesting that opioid prescribing in the United States may have reached an inflection point[30],[31]. Such information, if verified by additional investigations, would be welcome news, and may lead to a similar turnaround in the rates of injuries and deaths from these products.

Some have cautioned that reigning in runaway opioid use will threaten individuals’ access to pain treatments. Such arguments are specious. High quality care for patients in pain is not threatened by efforts to reduce inappropriate use of opioids. Instead, it is vital that they are only prescribed when necessary.Significance of The Opioid Crisis Essay

U.S. Opioid Epidemic Argument Proposal: Source Analysis
Over the last 20 years, addiction and abuse of opioids and other prescription pain killers
has become a major crisis here in the United States. Since the late 1990s, the number of cases of
misuse and deaths in relation to these drugs has skyrocket throughout the nation, and according
to the Center for Disease Control (CDC), “66% [of drug overdoses] are opioid related.” It is clear
that pharmaceutical companies and many health care professionals are failing to recognize the
risks associated with this popular method of pain management. However, through extensive
research I have aimed to develop a thorough understanding of this topic in order to confidently
argue specific courses of actions that must be taken by our nation’s health care professionals in
order to solve this serious issue. The sources I have picked to utilize in constructing my proposal
are written by extremely qualified individuals and organizations, and provide credible and
significant facts and statistics that I will use to support my claims in Paper 3.Significance of The Opioid Crisis Essay
In the first article, “America’s Addiction to Opioids: Heroin and Prescription Drug
Abuse” published by the National Institute on Drug Abuse (NIDA), I was able to locate many
useful facts and statistics on my topic. The author begins by explaining exactly how the crisis
arose, claiming that pharmaceutical companies are the main players in the rise of the epidemic,
and the rest of the medical community is simply adding fuel to the fire. By providing strong
evidence as to how these parties are at fault regarding this crisis, this source will enable me to
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better make the claim that they should also be held responsible for fixing it. This piece also
outlines what the U.S. Department of Health and Human Services is currently doing to try and
control the epidemic, with the only flaw being that it does not state how effectively these
methods are working. However, by referencing this list in coordination with my other research
sources, I will be able to determine the most beneficial courses of actions. One major element I
used to determine that this was a powerful source is the fact that the site is run by a national
organization with the sole purpose of informing readers about drug abuse and prevention.
Recently revised in February of this year, the information given in this article is also clearly
relevant and up to date. Furthermore, there are many links throughout this article that lead to
other scholarly sources. By exploring these I can further increase my knowledge and
understanding on each topic covered, which will assure a strong and credible argument.
My next source is also published by an extremely credible and well known national
organization. “Opioid Crisis”, and article published by the Center for Disease Control and
Prevention, provides multiple related pages explaining the various aspects of my topic. The first
of these, titled “Understanding the Epidemic” supplies many facts and statistics that outlines both
the causes and severity of the problem at hand. There is an abundance of relative statistics
providing data on opioid prescription as well as overdose and addiction. I will reference this
page, along with one devoted entirely to quantitative charts and analysis, while making my
proposal in order to assure my argument make coherent sense to the readers. One specific way
this site allows me to do this is by enabling me to make logical and strong correlations to support
my claims. Another very useful section provided by the CDC in this source is a list of overdose
preventions. By clicking on any one of these, the site supplies detailed information on each
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prevention tactic. I will use this information while constructing my own proposal in order to
generate solutions that are supported by the opinions of qualified professionals.
My third source is an article written by Raeford E. Brown JR (MD) and Paul Sloan (MD),
and published by the International Anesthesia Research Society (IARS). Its title, “The Opioid
Crisis in the United States: Chronic Pain Physicians Are the Answer, Not the Cause”Significance of The Opioid Crisis Essay
demonstrates one reason I found it useful. This author does not place the blame on physicians,
but rather discusses societal problems that they claim are the true factors in causing this
epidemic. By providing statistics that address potential causes such as mental illness, societal
pressure, and the increase in illicit drugs crossing the border in to the U.S., this source forces me
to explore an entirely different viewpoint. Different causes require different solutions, and
therefore this article encouraged me to broaden my area of research, and subsequently my scope
of knowledge on my subject. Another very useful aspect of this article is its focus on how other
nations are handling the same problem. This allows me to generate new and innovative ideas on
possible solutions that were not discussed in my previous research. However, this source has
weaknesses that will force me to take further steps to verify the information given. Considering
that all members of IARS are physicians or other health care professionals, and both authors of
this specific article are doctors themselves, it is certainly possible that their statements are biased.
Though in another sense, being run by professionals in the field assure the article is at the least
My last source, published on, is another useful article that provides new,
interesting ideas and information that I will undoubtedly find useful in writing my proposal.
Titled “The U.S. Opioid Crisis: How Can We Remedy”, this piece it is written by Walker Ray,
MD and Tim Norbeck, two individuals with in depth knowledge on the situation at hand. It
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summarizes the problem at hand, and focuses mainly on why and how the medical community
must strive to reverse the opioid crisis. The authors of this piece are both extremely qualified,
both having over 40 years of honorable experience in the medical field. Making for an even more
credible source, Dr. Ray is himself a member of the board of Physicians Foundations, which
assures his proposed solutions are not only realistic possibilities, but also likely very effective.
This article also offers steps that the public can take to combat the problem, rather than just
focusing on health care professionals. This will allow me to propose an argument that applies to
everyone, not just a select few. It will furthermore provide me with as many potential solutions
as possible to reference throughout my research.
These four sources provide an abundance of useful information that I will use to develop
a strong proposal regarding the opioid addiction crisis here in the United States. The first two
articles, published by the NIDA and the CDC, provide detailed facts and statistics that clearly
depict the severity of the issue at hand, and therefore the imperative necessity that something be
done to solve it. The first three sources mentioned also provide background information as to
how this problem arose in the first place, which is very useful in determining how to prevent and
reverse its tragic effects. Each article offers logical and potentially effective methods to solving
the opioid crisis, which will allow me to propose the best possible courses of action. Each of my
sources is written by extremely qualified authors, and published by well-respected organizations.
However, both the article from as well as from IARS are written by doctors, and
therefore claims made in these will need to be further researched in order to assure they are not
written simply in their best interest. Overall, the ideas provided by all four sources are wellsupported, and the facts and statistics provided come from quality, credible sources. I will utilize Significance of The Opioid Crisis Essay
this information gathered throughout my research to construct a strong proposal stating what the
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nation’s health care professionals must do in order to solve the dangerous and growing opioid
epidemic Significance of The Opioid Crisis Essay

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