Opioid Crisis Survey Discussion Essay

Opioid Crisis Survey Discussion Essay

2400 words due 9/29/2020 Opioid crisis survey discussion

Prompt 1 Opioid crisis survey discussion

1. (200 words) Describe the type of data that would need to be collected if you were to create a survey to assess the use of opioids in Anytown.

2. (200 words) Who would take the survey (researchers, nurses, and public health officials?)

3. (200 words) How would you analyze the data from the survey?

4. (200 words) Why is it important for researchers and public health officials to use surveys?Opioid Crisis Survey Discussion Essay


5. (200 words) How can researcher ensure that their survey produce unbiased data?

Prompt 2 Pathways to Safer Opioid Use Scenario

· Link to access scenario: https://health.gov/hcq/trainings/pathways/index.html

· Use the link above to complete the character role of the patient James Parker. You can work through this character more than once, making different decisions to alter the outcome. Once you have completed this role, answer the following:

1. (200 words) What decisions did you make?

2. (200 words) Did you change any of your answers?

3. (200 words) Did anything surprise you?

4. (200 words) As a public health professional, how can you work with patients affected by the opioid crisis?

5. (200 words) Now that you have completed the entire scenario, do you have a better understanding of the diverse perspective needed to combat Opioid epidemic?

6. (200 words) What steps can health workers, and public health officials take to reduce the individuals impacted by this epidemic?

7. (200 words) What governmental resource are available to assist in fighting this epidemic evaluate the effectiveness of these agencies? Opioid Crisis Survey Discussion Essay

Response should be in APA 7th edition with at least 5 credible source and subheadings

Economists use the term “opportunity cost” to acknowledge that using resources for one purpose reduces or eliminates the ability to use those resources for a different purpose. This concept, which has enormous societal implications, is perhaps best understood in the context of an individual family’s budget. If the refrigerator breaks and needs to be replaced, then the funds used for the replacement are no longer available for other purposes, such as paying for meals or gas for the car. The same is true in society, where governments operate within fixed budgets but face unexpected circumstances that require the immediate expenditure of resources, such as responding to a natural disaster.

The opioid epidemic is one of those circumstances in which the crisis has required an immediate response by state and local governments to “pick up the pieces” through the provision of social services at a magnitude and cost that were unthinkable prior to 1995. The amount of money spent on first responders and medical treatments and the number of children left parentless because of the epidemic is enormous.27-30 Few individuals question whether state governments should be responding to the social needs of their constituents; however, less has been written about what has been relinquished—that is, the true opportunity costs—because of this response, along with the broader impact that this has on states and their citizenry. This is an important omission and one that needs to be discussed, not only to compensate states, but also to engage more constituents in understanding how those who are not directly affected by the epidemic lose out as a result. Opioid Crisis Survey Discussion Essay

Every taxpayer should realize that the opportunity cost of having to expend resources on providing services related to the opioid epidemic has resulted in fewer or inferior services that add value and enhance the well-being of society. For example, with state budget money being diverted to the epidemic, less has been spent on repairing aging transportation infrastructure. Additionally, less money has been spent on public education, including the amount spent on teachers and students, likely exacerbating the large gap in education and performance that exists compared with other industrialized countries in areas like science, technology, engineering, and mathematics. Moreover, fewer resources have undoubtedly been available for economic development and investments in job creation for the future.

In short, much of the press coverage and public discourse about the opioid epidemic has been focused disproportionately on assigning blame and highlighting the direct costs, such as the most recent death count or the latest attempt to make naloxone treatment available to the public without a prescription. Much less attention has been placed on the fact that because of the opportunity costs, every American has borne the brunt and will continue to withstand the harmful effects of resources being diverted to the epidemic—funds that could have been made available for a more productive societal use if the opioid epidemic had been avoided. These damages are currently being considered in the pending multidistrict legislation in the Cleveland District,31 as well as in the myriad other lawsuits and settlements, such as in Oklahoma, where the state government is trying to recover expenditures from those alleged to have created the epidemic—primarily drug manufacturers and distributors—in efforts that are reminiscent of the tobacco settlement of 1998.32-37 Regardless of the outcome of these lawsuits, it seems certain that any damages that are awarded will not come close to covering the opportunity costs of the epidemic. In this sense, it is critical that constituents, community leaders, and politicians learn from this disaster and do everything in their power to ensure that the next similar preventable epidemic does not occur and further divert public resources that should otherwise be used to advance society. Opioid Crisis Survey Discussion Essay

Has the Federal Government Failed States by Inadequately Performing Its Fiduciary Responsibility?

Federalism in the United States means that the power and authority to govern are intentionally divided between the federal and state governments, with specific responsibilities delegated to each governmental unit. This concept is critical when we think about responsibilities in the opioid epidemic and whether various governmental entities charged with oversight have adequately performed their fiduciary responsibilities. Although state governments are responsible for certain areas, such as medical professional licensure and the regulation of health insurance within the state’s borders, other responsibilities related to the opioid epidemic fall to the federal government to organize and regulate on behalf of all states.

For example, rather than having 50 states independently regulate the safety and efficacy of pharmaceuticals, which would be quite costly, individual commonwealths, instead, defer to the FDA. In the case of the opioid epidemic, criticism has been directed at the FDA for the initial decision to approve prescription opioids; there was additional criticism for delaying to act after the addictive properties of these compounds became clear. The FDA has also been disparaged for failing to take action against drug manufacturers for the allegedly unethical and deceptive advertising that was used to market drugs.38 In response to this, a 2017 Consensus Report released by the National Academies to address prescription opioid misuse recommended that the FDA adopt stricter policies regarding how opioids are advertised to the public and to prescribers. Opioid Crisis Survey Discussion Essay

Has the FDA failed in its fiduciary responsibility to the states by not providing the appropriate oversight required? Equally important is the question of whether the FDA is capable of making the right decisions to prevent the next looming epidemic, which has the potential to wreak similar havoc on the states. These are complex questions that cannot be answered in this commentary; however, they are critical questions, and answering them will require the balanced consideration of several important points, 3 of which will be highlighted below.

First, as part of the scientific process for drug approval, historically, the FDA has focused on efficacy and safety.39 Addictive properties should certainly be considered part of a drug’s safety profile before it reaches market, but it is unclear whether the FDA’s approval process includes appropriate and durable mechanisms to account for the likelihood of patient addiction, particularly with such controlled substances as narcotics.40 The FDA did not identify these significant addictive risks and associated sequelae prior to the release of each opioid drug to market. Opioid Crisis Survey Discussion Essay

Second, as the alarming mortality rate rose, the devastation brought about by these drugs became clear, and the deceptive nature of opioid drug advertising by industry became more obvious.42 If the FDA becomes aware of drug advertising that is inconsistent with FDA-approved product labeling, it issues the drug manufacturer a written notice requesting that the material be withdrawn.39 However, beyond that, drug advertisements are not required to receive preapproval from the FDA prior to the release of the promotional material to the public. To prevent the next epidemic, a serious conversation about the FDA approval process, as well as about postapproval drug monitoring and management, is critically needed. In fact, it has been suggested and outlined in the 2017 consensus statement of the National Academies.39

Third, the FDA has been criticized for being “captured” by the very industry it is supposed to regulate—the pharmaceutical industry—based on how the FDA receives its financial resources from industry and the perceived favors associated with relationships between FDA regulators and industry.43 For example, news stories have documented how FDA employees who worked on opioid regulation accepted high-paying jobs with Purdue—the company at the epicenter of current lawsuits.44 This raises the question of whether appropriate procedures and firewalls are in place to prevent the ethical compromises that can occur when the regulator is “captured” by industry. Since states rely on the federal government to perform these critical roles, it is important to assess whether that will prevent the next epidemic. Opioid Crisis Survey Discussion Essay

Because all prescription opioid pain medications are subject to Automation of Reports and Consolidated Orders System reporting by distributors, the Drug Enforcement Administration (DEA) has rich data on the flow of opioids to pharmacies across the country. As reports have shown, these medications were flowing to pharmacies that were facilitating their illegal use or flooding certain communities with significantly higher volumes of pain medications than could be justified based on the health needs of the patient populations in these communities.45 Former senior administrators within the DEA argue that the agency had gathered thorough evidence documenting that certain opioid distributors were not in compliance with the Federal Controlled Substances Act,46 allegedly turning a blind eye to knowledge that the drugs they were distributing were being used for illegal purposes, thus catalyzing opioid addiction across the United States. Opioid Crisis Survey Discussion Essay

Can Professionals Be Trusted to Do the Right Thing?

Much of the criticism and blame for the opioid epidemic have been aimed at individuals and organizations that society generally holds in high regard as trusted professionals, tasked with protecting the health and welfare of patients and populations. For example, a New York State survey conducted by Siena College Research Institute in February 2018 demonstrated that most New Yorkers blame physicians for exacerbating the opioid epidemic by overprescribing opioid medications.50 News stories and reports from ongoing legal disputes report that some high-profile physicians took money from the pharmaceutical industry in exchange for promoting the long-term safety of opioids; that safety claim has subsequently been proved false.51

Many physicians face a difficult decision when weighing the necessity of treating a patient’s pain symptoms with the possibility of addiction if the patient is prescribed an opioid. Many still believe, however, that physician organizations at both the community and the national levels have not done enough to slow down or stop the epidemic.49,52,53 Some argue that these organizations had the expertise to recognize the addiction, mortality, and morbidity that were occurring in their communities, yet they failed to recognize the issue and act in an organized, timely fashion.54 This raises the important question of whether we can trust professionals to identify and detect problems of this magnitude early on and act in the best interests of the health of the patients and the population at large. Opioid Crisis Survey Discussion Essay

Other trusted professional organizations that are afforded autonomy by the government and the healthcare industry have been denounced. Most notable is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). JCAHO accredits hospitals to ensure that they practice safe and high-quality medicine. JCAHO accreditation is required for hospitals and other healthcare facilities to receive reimbursement through the federal government’s Medicare and Medicaid health insurance programs. Thus, hospitals tend to respond quickly and completely when JCAHO implements standards or requirements. With respect to the opioid epidemic, JCAHO has been criticized for pushing pain as a “fifth vital sign,” allegedly based on research and reports about pain that were funded by the manufacturers of opioids.55 Many, including state attorneys general, have argued that it was JCAHO’s focus on the need to measure, treat, and monitor pain, similar to measuring, treating, and monitoring hypertension, that created an excess demand for opioid medications that otherwise would not have been prescribed

Over the past 15 years, the rate of opioid pain reliever (OPR) use in the United States has soared. From 1999 to 2011, consumption of hydrocodone more than doubled and consumption of oxycodone increased by nearly 500% (42). During the same time frame, the OPR-related overdose death rate nearly quadrupled (15). According to the United States Centers for Disease Control and Prevention (CDC), the unprecedented increase in OPR consumption has led to the “worst drug overdose epidemic in [US] history” (58). Given the magnitude of the problem, in 2014 the CDC added opioid overdose prevention to its list of top five public health challenges (13). Opioid Crisis Survey Discussion Essay

Overdose mortality is not the only adverse public health outcome associated with increased OPR use. The rise in opioid consumption has also been associated with a sharp increase in emergency room visits for nonmedical OPR use (69) and in neonatal abstinence syndrome (57). Moreover, from 1997 to 2011, there was a 900% increase in individuals seeking treatment for addiction to OPRs (66, 68). The correlation between opioid sales, OPR-related overdose deaths, and treatment seeking for opioid addiction is striking (Figure 1).


Figure 1  Rates of OPR sales, OPR-related unintentional overdose deaths, and OPR addiction treatment admissions, 1999–2010. Abbreviation: OPR, opioid pain reliever. Source: 10.
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Addiction is defined as continued use of a drug despite negative consequences (1). Opioids are highly addictive because they induce euphoria (positive reinforcement) and cessation of chronic use produces dysphoria (negative reinforcement). Chronic exposure to opioids results in structural and functional changes in regions of the brain that mediate affect, impulse, reward, and motivation (83, 91). The disease of opioid addiction arises from repeated exposure to opioids and can occur in individuals using opioids to relieve pain and in nonmedical users. Opioid Crisis Survey Discussion Essay

Another important feature of the opioid addiction epidemic is the relationship between OPR use and heroin use. According to the federal government’s National Survey on Drug Use and Health (NSDUH), 4 out of 5 current heroin users report that their opioid use began with OPRs (54). Many of these individuals appear to be switching to heroin after becoming addicted to OPRs because heroin is less expensive on the black market. For example, in a recent sample of opioid-addicted individuals who switched from OPRs to heroin, 94% reported doing so because OPRs “were far more expensive and harder to obtain” (16, p. 24).

The increased prevalence of opioid addiction has also been associated with increases in heroin-related morbidity and mortality. For example, since 2001, heroin addiction treatment admissions for whites ages 20–34 have increased sharply (Figure 2). During this time frame, heroin overdose deaths among whites ages 18–44 increased by 171% (14). Opioid Crisis Survey Discussion Essay

Figure 2  Heroin admissions, by age group and race/ethnicity: 2001–2011. Source: 68.
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The current opioid addiction crisis is, in many ways, a replay of history. America’s first epidemic of opioid addiction occurred in the second half of the nineteenth century. In the 1840s, the estimated national supply of opium and morphine could have supported a maximum of 0.72 opioid-addicted individuals per 1,000 persons (18). Over the next 50 years, opioid consumption soared by 538%. It reached its peak in the mid-1890s, when the supply could have supported a maximum of ∼4.59 opioid-addicted individuals per 1,000 persons. The ceiling rate then began to decline, and by 1920 there were no more than 1.97 opioid-addicted individuals per 1,000 persons in the United States.

The epidemic had diverse origins. Mothers dosed themselves and their children with opium tinctures and patent medicines. Soldiers used opium and morphine to treat diarrhea and painful injuries. Drinkers alleviated hangovers with opioids. Chinese immigrants smoked opium, a practice that spread to the white underworld. But the main source of the epidemic was iatrogenic morphine addiction, which coincided with the spread of hypodermic medication during 1870–1895. The model opioid-addicted individual was a native-born white woman with a painful disorder, often of a chronic nature. Opioid Crisis Survey Discussion Essay

Nineteenth-century physicians addicted patients—and, not infrequently, themselves—because they had few alternatives to symptomatic treatment. Cures were scarce and the etiology of painful conditions was poorly understood. An injection of morphine almost magically alleviated symptoms, pleasing doctors and patients. Many patients continued to acquire and inject morphine, the sale of which was poorly controlled.

The revolutions in bacteriology and public health, which reduced diarrheal and other diseases commonly treated with opium; the development of alternative analgesics such as aspirin; stricter prescription laws; and admonitions about morphine in the lay and professional literature stemmed the addiction tide. One important lesson of the first narcotic epidemic is that physicians were educable. Indeed, by 1919, narcotic overprescribing was the hallmark of older, less-competent physicians. The younger, better-trained practitioners who replaced them were more circumspect about administering and prescribing opioids (5).

For the rest of the twentieth century, opioid addiction epidemics resulted from transient increases in the incidence of nonmedical heroin use in urban areas. After World War II, these epidemics disproportionately affected inner-city minority populations, such as the large, heavily publicized increase in ghetto heroin use and addiction at the end of the 1960s (24, 37). Opioid Crisis Survey Discussion Essay

In 1986 a paper describing the treatment of 38 chronic pain patients concluded that OPRs could be prescribed safely on a long-term basis (61). Despite its low-quality evidence, the paper was widely cited to support expanded use of opioids for chronic non-cancer pain. Opioid use increased gradually in the 1980s. In 1996, the rate of opioid use began accelerating rapidly (38). This acceleration was fueled in large part by the introduction in 1995 of OxyContin, an extended release formulation of oxycodone manufactured by Purdue Pharma.

Between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related educational programs through direct sponsorship or financial grants and launched a multifaceted campaign to encourage long-term use of OPRs for chronic non-cancer pain (86). As part of this campaign, Purdue provided financial support to the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards, the Joint Commission, pain patient groups, and other organizations (27). In turn, these groups all advocated for more aggressive identification and treatment of pain, especially use of OPRs. Opioid Crisis Survey Discussion Essay

For example, in 1995, the president of the American Pain Society introduced a campaign entitled “Pain is the Fifth Vital Sign” at the society’s annual meeting. This campaign encouraged health care professionals to assess pain with the “same zeal” as they do with vital signs and urged more aggressive use of opioids for chronic non-cancer pain (9). Shortly thereafter, the Veterans’ Affairs health system, as well as the Joint Commission, which accredits hospitals and other health care organizations, embraced the Pain is the Fifth Vital Sign campaign to increase the identification and treatment of pain, especially with OPRs. Similarly, the American Pain Society and the American Academy of Pain Medicine issued a consensus statement endorsing opioid use for chronic non-cancer pain (31). Although the statement cautioned against imprudent prescribing, this warning may have been overshadowed by assertions that the risk of addiction and tolerance was low, risk of opioid-induced respiratory depression was short-lived, and concerns about drug diversion and abuse should not constrain prescribing.

Prior to the introduction of OxyContin, many physicians were reluctant to prescribe OPRs on a long-term basis for common chronic conditions because of their concerns about addiction, tolerance, and physiological dependence (80). To overcome what they claimed to be “opiophobia,” physician-spokespersons for opioid manufacturers published papers and gave lectures in which they claimed that the medical community had been confusing addiction with “physical dependence.” They described addiction as rare and completely distinct from so-called “physical dependence,” which was said to be “clinically unimportant” (60, p. 300). They cited studies with serious methodological flaws to highlight the claim that the risk of addiction was less than 1% (28, 45, 52, 59, 62).Opioid Crisis Survey Discussion Essay

In addition to minimizing risks of OPRs, the campaign advanced by opioid manufacturers and pain organizations exaggerated the benefits of long-term OPR use. In fact, high-quality, long-term clinical trials demonstrating the safety and efficacy of OPRs for chronic non-cancer pain have never been conducted. Surveys of patients with chronic non-cancer pain receiving long-term OPRs suggest that most patients continued to experience significant chronic pain and dysfunction (25, 76). The CDC and some professional societies now warn clinicians to avoid prescribing OPRs for common chronic conditions (29).

Although increased opioid consumption over the past two decades has been driven largely by greater ambulatory use for chronic non-cancer pain (8), opioid use for acute pain among hospitalized patients has also increased sharply. A recent study found that physicians prescribed opioids in more than 50% of 1.14 million nonsurgical hospital admissions from 2009 to 2010, often in high doses (34). The Joint Commission’s adoption of the Pain is the Fifth Vital Sign campaign and federally mandated patient satisfaction surveys asking patients to rate how often hospital staff did “everything they could to help you with your pain” are noteworthy, given the association with increased hospital use of OPRs. Opioid Crisis Survey Discussion Essay

Policy makers and the media often characterize the opioid crisis as a problem of nonmedical OPR abuse by adolescents and young adults. However, several lines of evidence suggest that addiction occurring in both medical and nonmedical users, rather than abuse per se, is a key driver of opioid-related morbidity and mortality in medical and nonmedical OPR users.

Opioid Harms Are Not Limited to Nonmedical Users
Over the past decade, federal and state policy makers have attempted to reduce OPR abuse and OPR-related overdose deaths. Despite these efforts, morbidity and mortality associated with OPRs have continued to worsen in almost every US state (10). Thus far, these efforts have focused primarily on preserving access to OPRs for chronic pain patients while reducing nonmedical OPR use (89), defined as the use of a medication without a prescription, in a way other than as prescribed, or for the experience or feeling it causes. However, policy makers who focus solely on reducing nonmedical use are failing to appreciate the high opioid-related morbidity and mortality in pain patients receiving OPR prescriptions for medical purposes. Opioid Crisis Survey Discussion Essay

The incidence of nonmedical OPR use increased sharply in the late 1990s, peaking in 2002 with 2.7 million new nonmedical users. Since 2002, the incidence of nonmedical use has gradually declined to ∼1.8 million in 2012 (64, 70) (Figure 3). Although the number of new nonmedical users has declined, overdose deaths, addiction treatment admissions, and other adverse public health outcomes associated with OPR use have increased dramatically since 2002.

Figure 3  First-time nonmedical use of pain relievers. Source: 64, 70.
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A comparison of age groups of nonmedical OPR users to age groups suffering the highest rates of opioid-related morbidity and mortality suggests that strategies focused exclusively on reducing nonmedical OPR use are insufficient (Figure 4). Although past-month nonmedical use of OPRs is most common in teenagers and young adults between the ages of 15 and 24 (65), OPR overdose deaths occur most often in adults ages 45–54, and the age group that has experienced the greatest increase in overdose mortality over the past decade is 55–64 (15), an age group in which medical use of OPRs is common. Opioid overdoses appear to occur more frequently in medical OPR users than in young nonmedical users. For example, in a study of 254 unintentional opioid overdose decedents in Utah, 92% of the decedents had been receiving legitimate OPR prescriptions from health care providers for chronic pain (39).,Opioid Crisis Survey Discussion Essay