From: Tempe, AZ
School: Arizona State University
The Opioid Epidemic
Opioids kill individuals at an alarming rate. In 2017, someone in the United States died from an opioid overdose every eleven minutes (Hedegaard et al. n.p.). The onset of opioid use began in the late 1800s; Mothers used opioids as an ailment to treat “themselves and their children,” soldiers took opioids during the war, and people used them to ease hangovers (Kolodny et al. 561). As time goes on, opioids, both illicit and non-illicit, have become more prevalent. When visiting the doctor for pain, an individual can expect to receive some type of opioid, even when it may not be necessary. Recently, news reporters have been talking about the staggering rates of individuals overdosing on fentanyl and the dangers of this drug. Heroin is also heard of as a common highly addictive illegal drug. With more Americans being aware of opioid addiction through the use of media, there is something that can be done to help combat opioid addiction. In order to prevent opioid overdose fatalities in the United States’ rural areas, there needs to be an increase in access to medication-assisted treatment (MAT) in rural communities.
There are many contributing factors that have caused addiction and overdose of opioid drugs to become an epidemic in the United States. The addiction to opioids can be primarily linked back to physicians not being able to treat pain. Andrew Kolodny et al. explain that from the 1800-1900s, medical professionals did not know much about how to treat or the cause of diseases or pain; however, they discovered that morphine mitigated pain, making everyone happy, but often left patients and sometimes physicians addicted (561). Because there was no well-known solution for pain and illness, physicians prescribed opioids to patients to make them happy. Giving patients opioids, like morphine, came at a cost because it sometimes made doctors and patients addicted. Physicians desire to keep their patients satisfied. If they did not know how to cure the pain or illness, but prescribing medication would relieve the symptoms, this would allow them to feel like they succeeded in curing the problem. Prescribing opioids to patients, because physicians did not know how to cure pain, was one of the first major contributing factors of the opioid epidemic. Furthermore, overprescribing prescription opioids have added to the opioid epidemic. In 1980, a one-paragraph study found that only four of 11,882 patients who were prescribed prescription opioids became addicted; therefore, it is uncommon to become addicted to opioids (Porter and Jick 123). Physicians relied on this study’s inaccurate evidence to excessively prescribe opioids because they considered it uncommon for patients to get addicted. The increase in physicians promoting opioids increased the number of individuals getting hooked. Nowadays, more people know the dangers of taking opioids, but in the 1980s physicians had no idea. Physicians practiced faulty techniques because they cited the wrong evidence. This study caused many physicians to over-prescribe opioid medications thinking that it would not harm patients.
The final factor of the increased use of opioid drugs was the release of the drug OxyContin. Kolodny et al. discover that the “acceleration [of opioid use] was fueled in large part by the introduction in 1995 of OxyContin… manufactured by Purdue Pharma” (562). The debut of OxyContin, a brand name of the drug oxycodone, sparked many doctors to order these unneeded prescriptions for their patients. The newly released drug caused an increase of opioid abuse because this drug was highly advertised to treat illness and pain. The increased advertisement and marketing of OxyContin are associated with elevated prescribing rates (Hadland et al. 8). Advertising is very influential and, in this case, was appealing to consumers and physicians. Just like anything new, not much is known about the side effects or even the long term effects of the products on an individual’s body. Physicians presumably knew little about OxyContin and therefore, thought it was okay to commonly administer to various individuals. Overall, many different factors added to the opioid epidemic including prescription opioids being overprescribed, knowing little about the cause and treatment of pain, a study stating that opioids are safe, and a new highly-advertised prescription opioid being introduced.
Pharmaceutical companies including, Purdue Pharma, are one of many companies benefiting from individuals getting addicted to opioids. In a court case, it was found that Purdue made millions off of getting more patients to use their drug, OxyContin, after they tricked both patients and physicians to purchase them (United States Superior Court 2). Purdue is being sued for having known about the harm that their drug is causing others. Through prescribing this medication and getting millions addicted, it has allowed for Purdue and their top officials to make a tremendous profit. Pharmacies and hospitals charge an enormous amount of money for small amounts of opioids. OxyContin is not the only opioid prescription drug that patients can get addicted to. There are many more brands of oxycodone and other prescription opioids that profit from prescription opioid addiction. These pharmaceutical companies are fueling and profiting from the epidemic.
Illicit and non-illicit opioid drugs are the direct source of opioid fatalities. In a study, Abby Alpert et al. find that the OxyContin reformulation created harsher measures on the distribution, so users switched to other opioids including heroin and fentanyl, which are easier to overdose on (30-31). Even though a policy like this was attempting to make it harder to get prescription drugs, addicts figured out a way to get illegal opioids instead. Illegal opioids, like fentanyl, are easier to overdose on because when sold on the streets, individuals who buy them do not know how potent the drug is. The effort to make prescription opioids tougher to attain and use did work, but the people who used opioids just moved to other types of opioids. Restricting prescription drugs was a sensible idea; however, if individuals are restricted from doing something, they will find a way to push past the barrier. Just like when a child is told they can not do something, they find a way to do it. This attempt at combating opioid overdose fatalities is indirectly contributing to the problem because individuals using prescription drugs will begin to use dangerous, illegal opioids.
Opioid addiction is a major issue that rural communities are facing. Robin Ghertner and Lincoln Grove point out that “opioid sales per capita were around 50 percent higher in rural areas than in small and large metropolitan counties” (5). People purchase illegal and prescription opioids at a higher rate in rural areas than in urban areas. This higher amount of opioid access in rural regions can be attributed to several ideas. Katherine M. Keyes et al. suggested that the increasing use of opioids per person in rural communities is because people have closer-knit relationships so opioids are dispersed more rapidly, opioids are prescribed more, and the stressful atmosphere and “economic deprivation” puts people at risk for doing drugs (55). With statistics attesting that there are more sold opioids in rural areas, it can be attributed to the accessibility of opioids in these areas. Individuals in rural communities often know most of the people in their town because there are fewer people. This enables these individuals to share opioids and be aware of who has them for sale. Because living in a rural area can also leave people with lower income in poverty, individuals have higher stress. Added stress and lower income lead to the use of drugs in order to take away the pain. Additionally, treatment for addiction is lacking in rural communities. When looking at how many physicians are able to administer medication for opioid treatment, there are few. The data shows 82.5 percent of rural counties have no physician that is able to administer the medication (Rosenblatt et al. 25). There is a tremendous need waiting to be met in rural communities. This factor makes it extremely hard for addicts to get help. If individuals are unable to get help, there will never be a decline in opioid use. Since there is a high rate of opioid sales in rural areas, because of factors caused by living there and a significant lack of treatment for opioid addicts, the problem remains unchanged.
The opioid epidemic has an effect on loads of people, which causes the government to take immediate action. The government has been attempting to combat this problem before and after it was declared an epidemic in the United States. The Comprehensive Addiction Recovery Act (CARA), enacted in 2016, provides various government agencies with grant money to help with opioid addiction through treatment and campaigns warning about the harmful side effects of opioids (United States Congress, 114-198). This act gives proof that there is a severe need to solve this crisis. It even sets apart money to give to agencies to take remedial actions. With this act being current, it explicates to the country the strong need to assist this problem. The government is attempting to control and decrease opioid addiction and overdose fatalities because of the massive impact it has on Americans. Overall, governmental support is a valuable part of combating the opioid crisis.
This problem affects many aspects of the United States; one of the biggest aspects is the economy. There is a remarkable amount of money being spent in regard to all parts of the opioid epidemic. Curtis S. Florence et al. identify the expense “for opioid-related overdose, abuse and dependence was over $78.5 ($70.1-87.3) billion” being spent on criminal justice, treatment, healthcare, and more related to opioids (6). The addiction to opioids in America affects not only people financially but also health care, treatment, and law facilities. Addicted individuals, and even loved ones, are financially burdened by the costs of opioids and everything involved with the addiction and recovery process. Family members can be burdened financially by the stress of wanting to help their addicted family member get treatment. Addiction to opioids comes with a hefty price tag. Through decreasing fatality and addiction rates of opioids, it will positively impact people’s finances and the economy.
Addiction to opioids can have many harmful effects on a person. Opioid addicts are harming their bodies when they partake in the usage of drugs. The National Institute of Drug Abuse explains that the short-term effects of prescription opioids have on the body include drowsiness and slowed breathing (“Prescription” 2), and when an individual becomes addicted, they can go through withdrawals and have severe painful symptoms (“Prescription” 4). Opioids have horrible effects on anyone’s body. These prescription opioids depress the body’s normal functioning and must be taken carefully in order to avoid getting hooked on them. Illegal opioid drugs are even easier to get addicted to. As a user continues to take these highly addictive drugs, they build up a tolerance. Having a tolerance to a drug makes it so that every time the individual takes the drug, they need a little more to experience the same high. After a while, using the drug excessively can cause the body to shut down and result in an overdose. The body also creates a dependency on the drug. If individuals attempt to stop using the drug, they will go through withdrawal. Symptoms can be agonizing and make the person feel as though they are dying. Opioids have extremely negative short-term effects on a person’s body. In the long run, opioid addiction impacts society. Ghertner and Grove claim that counties with “higher poverty and unemployment rates generally had higher rates of retail opioid sales… as well as drug overdose deaths” (5). If opioid fatalities and sales keep increasing, there could potentially be an elevated poverty and unemployment rate. Generally, once individuals become addicted to drugs, they will do anything to get the drugs again. Consequently, they may deplete their savings because they are spending a large portion of their money on drugs. Addicts will have a difficult time maintaining a job and keeping up with the demands of their job because soon they only will care about the next time they can intake the drug. Addiction to opioids has both short-term and long-term effects on many areas of the individual’s life.
In the past, the government has tried to step in and put a halt to the rising opioid addiction and overdose rates. The Drug Addiction Treatment Act of 2000 (DATA 2000) was put into effect to attempt to give more addicts access to MAT by allowing physicians to become waived and administer the treatment medication (United States Congress 106-441). This act seeks to give physicians the ability to provide the medication that opioid addicts could use to get off of the drugs. This act is feasible because there does not have to be a set medical facility for opioid addicts to get treatment. Addicts could potentially be treated through a family doctor. This would allow them more accessible treatment options by not having to go to a specific facility. While this act had very good intentions, there was a lack of physicians who became DATA waived, making it unsuccessful. C. Holly A. Andrilla et al. report from a study that the barriers for physicians not utilizing the DATA 2000 are not having enough time in the office, being unsure about managing opioid addicts, facing obstacles with the setup and support of the program, and not wanting to draw addicts to their business (361). These barriers make physicians not want to participate in becoming a waivered facility that can administer treatment medication because it is extra work. Many physicians do not feel the need to go out of their way to help addicted people. Although this act was not as successful as the government hoped, it is still a proficient option that, with the right support, would be able to be successfully added to medical facilities.
There are several solutions that are being introduced to help fight the opioid crisis in rural communities; one option is expanding access to MAT. According to the National Institute on Drug Abuse, MAT treats opioid addiction with medication, Methadone and Buprenorphine, that will help to lessen or cease withdrawal symptoms when the addict is attempting to stop using opioids (“Medications” 5). If there is gained access to treatment for addicted individuals in rural areas, they will more likely seek treatment. Individuals generally are unable to get off of drugs by themselves because of the tormenting withdrawal symptoms. The medication given to the patient during treatment will block the receptors that make the individual feel like he or she needs the drugs. Alleviating these symptoms will aid individuals in not having a desire to take the drug anymore. Ending opioid addiction will assist in lessening the number of people that overdose. Overdosing can be put to a stop if there are more treatment facilities that can end individuals’ opioid addiction.
Another highly talked about solution to help solve the opioid crisis is the distribution of Naloxone. The Overdose Education and Naloxone Distribution (OEND) aids addicts and others around them on how “to prevent, recognize, and [respond] to overdoses” (Walley et al. 4). Through the OEND program, individuals can be rescued through a nasal spray once they have overdosed. This program distributes Naloxone, trains people on how to use it, and educates individuals on how to prevent opioid addiction. Through these steps, this program can reduce the number of deaths that opioid addiction brings because it rescues people who have already overdosed through raising the overdosers respiratory function. Naloxone is essentially a reversal medication for after an opioid overdose; it counteracts the chemicals from opioids. Alexander Y. Walley et al. find that the “implementation of OEND [is] associated with lower rates of opioid related deaths from overdose” (4). Naloxone is proven to save individuals lives and decrease overdose fatalities. Although Naloxone saves lives, it still does not deal with the root of the problem. Once someone overdoses they can be saved by Naloxone; however, they still may continue using opioids. Increasing access to MAT will change people’s paths of using opioids and aid them in coming clean. Increasing distribution of Naloxone will help decrease deaths, but it will not help the problem at hand, which is opioid addiction.
Another solution that has been proposed to combat the opioid epidemic is to stop overprescription through the implementation of prescription drug monitoring programs. These programs decrease opioid prescription by 30 percent (Bao et al. 6). By putting these programs into action, it will be easier to catch individuals who are getting over prescribed opioids or have an addiction. Prescription drug monitoring programs track medications that have been prescribed any time by any physician. It can flag individuals who have been prescribed opioids from other medical facilities and show individuals who are jumping from doctor to doctor to get more prescription opioids. This program is a great way to stop overprescribing and addiction to prescription opioids. However, using a prescription drug monitoring program only decreases the addiction to prescription drugs, while increasing MAT will help addicts addicted to any type of opioid. Prescription drugs do not kill as many people as do other types of opioids. The study finds that heroin and synthetic opioids, including fentanyl, kill approximately 14 people per 100,000 while prescription drugs kill about four people per 100,000 (Hedegaard et al. 4). Implementing prescription drug monitoring programs is a valid solution that will help to control the opioid crisis, but a better solution would be one that helps all aspects of addiction to opioids. Expanding access to treatment of opioid addiction will be a better use of resources than an idea that only prevents prescription drug addiction. Prescription drug monitoring programs do not help the majority of people; therefore, a solution that does will be more effective.
The most valid and feasible plan of action to decrease opioid overdose fatalities is the increased access to MAT. Robert P. Schwartz et al. discover that the “average annual overdose deaths decreased by 37% after buprenorphine became available” (919). Because MAT is proven to save lives, it is a worthwhile solution. MAT has the ability to stop the root of the opioid addiction problem by preventing individuals from overdosing. This will make a long-lasting impact on society. If a lot of addicts are no longer addicted to opioids then the number of individuals doing drugs will decrease. The demand for opioids will lessen, which will reduce the overall number of drugs being sold and the number of people becoming addicts. Improving access for addicts to get treatment will save countless lives. Currently, there are not enough licensed facilities that are able to administer MAT. Christopher M. Jones et al. conducted a study that suggests while MAT facilities have expanded, there is still a gap of capacity (61) being estimated at 1.3-1.4 million people who are unable to receive treatment (57). With the gap being so large, it shows that not everyone is able to get the treatment he or she needs. Individuals in rural areas who are unable to receive treatment and continue to suffer have the option to get clean if there is an increase in these facilities. Increasing access to MAT will decrease fatalities from opioid overdosing and is greatly needed throughout the United States because the capacity of MAT facilities is fewer than the demand for them.
Increasing access to MAT facilities is feasible because the government has set aside a chunk of money, and there are groups that are able to carry out this solution. The government has set aside a lot of money to help opioid addiction in the United States. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities act gives “more than $396 million to 1,232 community health centers, 120 rural community organizations” (“President Donald”). In order to increase access to more MAT facilities in rural areas, it needs to be funded by the government. Money going towards the opioid crisis will be put to good use by increasing MAT facilities in rural areas. While there is a need for more medical facilities in rural areas, an increase of DATA-waived physicians is a feasible way to effectively increase MAT treatment. To make it even better, “the DATA-waiver course is free by SAMHSA” (Moran et al. 12); this will allow for more physicians to become capable of treating patients. Through government funding, programs will be able to support medical facilities financially and, additionally, give them rewards for becoming DATA waived, if needed. To conclude, increased access to MAT facilities is reasonable because, with financial support from the government, medical facilities that administer MAT can be added medication.
Universities and various institutions will be the implementers of a MAT program in rural areas. The Agency for Healthcare Research Quality reports that the American Institute of Research, University of Colorado, and other universities have already been granted money and set up programs designed to train physicians in rural areas to become MAT certified and able to administer the medication (“Increasing Access”). This program can be used widely to help solve the opioid epidemic. With government funding, more universities and institutions will be able to carry out the same programs that only a handful of universities have tested. This solution is sensible because it is proven to work, specific groups willing to implement it, and it is financially attainable. The money will be given to universities close to rural areas and some farther away, too. Universities will train primary care physicians in rural communities to be MAT certified. They will also give support to the physicians and enable them to contact other MAT-certified physicians around them. Overall, the ability to implement this program will yield faster success in solving the opioid crisis.
There is a massive need for a solution to the opioid crisis, especially in rural areas. MAT is lacking in rural areas and is leaving addicts with limited to no access to treatment. Increasing access to treatment can drastically help decrease opioid fatalities. There was a absence of knowledge about how to treat pain, a push by pharmaceutical companies to sell opioids, and a large use and access of illicit opioid drugs, which contributes to the cause of overdose fatalities. The government has taken a lot of steps to attempt to solve the growing opioid crisis. The lack of capacity proves there is a problem, and statistical evidence supports that MAT is a valid and feasible solution. It can be implemented through a program that universities have tested before and can use government funding. To conclude, increasing access to MAT will be successful, as well as, help individuals who are struggling with opioid addiction in rural areas. This will decrease the current six deaths per hour that opioids cause in the United States.
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