Current Strategies To Reduce Opioid Abuse
The beginning of the 1990s brought some hope to the medical community, due to the introduction of the opioid drugs, which were known to treat the pain of the sick people in community. The cancer patients began to live less painful lives, along with severe injury victims.
What’s more, the pharmaceuticals making these drugs assured America that opioid pain relievers were safe for consumption, since they were not addictive. Therefore, the medical community would not have to deal with drug abuse issues. Upon this clarification, healthcare providers took the chance to help the sick, in the name of making America great.
Unfortunately, the exact opposite happened. The drugs worked and helped people for a while, thus increasing its use among the United States patients. Consequently, some people took advantage of this prescription high rate after noticing that the drug was quite psychoactive and thus obtained the drugs wrong according to their medications.
The abuse of opioid prescription drugs began and grew out of control. People that were not sick at all began having access to these drugs to use them for recreational uses. Within a decade, opioid drug addicts were all over the place and the U.S administration began seeing the depth of the problem.
Currently, the United States is facing an opioid epidemic, since chronic pain management in the past was conducted in all the wrong ways. Some verified statistics conclude that nearly a hundred and fifteen people die on a daily basis because of opioid overdose.
This high death count arises because millions of Americans use opioids to manage their pain, even when it is not chronic. Clinicians have been prescribing the drug with the intentions of helping patients suffering from severe pain, without under treating it or being contributors of the drug abuse problem.
Unfortunately, the majority end up addicted to the drugs since they tend to cause some euphoric effects. These opioids have helped a great number of people to survive on a daily basis with pain. However, it has also caused the destruction of many others lives as well.
Due to the acknowledgement of the problem that prescription opioids are dangerous, the United States government is working towards the reduction of opioid abuse through various strategies. These means involve various entities that work continuously to ensure that the problem continues to diminish day by day.
This article will shed light on these current strategies that are in play to reduce opioid abuse. Since the problem began with prescription opioid abuse, the first strategies focus on the prescription opioids, then the rest focus on other opioids that are commonly abused.
What Are Opioids?
Opioids refer to certain narcotic drugs that people consume and also abuse for personal reasons. The prescription opioids are not illegal like heroin and fentanyl. However, their access must be restricted to ensure that the wrong consumers do not acquire them.
The legal opioids, which are the prescription medications, are very useful to patients that have to deal with chronic pain on a daily basis. Therefore, one has to go to a health care setting, get diagnosed, and begin treatment by receiving a prescription to obtain the drugs from a pharmacy.
These drugs act by manipulating the pain receptors, which are present in almost all parts of the body. They also do cause so euphoric effects, and thus attract the people that need to get high. They obviously tend to misuse them. They latter fall into addiction like all other abusers of psychoactive substances.
The opioid abuse crisis that calls for strategies to counter it began with the usage of opioids medication that were described to patients and then graduated to misuse in the long run. As time went by, patients could not rely on prescription medications alone and so the majority began using the illegal opioids.
The following is the chronological order of these events in phases:
A sharp increase in the prescription of opioids hit America in early 1990s, as the medical community worked hard towards relieving patients’ chronic pain. It relied on the assurance for the pharmaceutical companies that the drugs were safe for patients, with no addictive effects.
However, it did not take long to experience the consequences. Later in the decade, deaths related to the medication began rising. The administration at the time tried controlling the situation by limiting the prescription rate.
However, since there were many opioid addicts by 1999, the controlling measure simply led them to divert to heroin. Therefore, controlling the problem through prescription restriction hardly worked.
Heroin was available as it was well distributed by drug dealers in the streets and thus facilitated the diversion from prescription medication. It became quite famous that its use and the deaths it cause were quite high by 2010.
All sexes could consume it regardless of their socio-economic group or age bracket. The deaths that occurred were due to overdosing, since the tolerance for opioids continued rising among the consumers. They could hardly control their intake. An increase of two hundred and eighty-six percent of the deaths was experienced between 2002 and 2013.
Many of its consumers injected it into their blood vessels. Several of them could hardly afford to purchase the syringes and needles on a regular basis and so they shared among themselves. Consequently, this behavior facilitated the spread of HIV, as well as other blood stream, hear and skin infections. Hepatitis B and C were also transmitted widely.
As heroin consumers continued with the opioid abuse trend, other opted to consume fentanyl instead. However, these were not lucky since they became prey to drug dealers that manufactured illicit fentanyl to get more money.
By 2016, this drug had caused a further increase in opioid related deaths, since over twenty thousand lost their lives. Racism was high at the beginning of all this opioid consumption and abuse habit. Therefore, the White community was the most affected.
Effects Of Opioid Abuse
Any psychoactive substance has to cause some effects after consumption. This takes place because drugs generally change the functioning of various body systems to cause euphoria. So in the presence or absence of the drug, the damages done upon organs must reveal themselves in a way.
The following are the common short and long-term effects of all opioids:
- Respiratory depression
- Work disruption
- Low sex hormone levels
- Likelihood to get involved in accidents.
- intestinal bloating
- the cardiovascular effects include decreased blood pressure and cardiac function and widened blood vessels
- in the long term, consumers experience problems with their gastrointestinal, immune, respiratory, endocrine musculo skeletal and central nervous systems.
Statistics Regarding Opioid Abuse
The gravity of opioid abuse in the United States is quite alarming and thus threatens the growth of the nation due to the death of productive people that can adequately provide labor through skills. The following are some of the statistics regarding the consumption of opioids.
- In 2016, there were more than two hundred and fourteen million opioid prescriptions made by health providers.
- Several patients, one on five, receive prescription opioids for pain that is not severe. These prescriptions are long-term, thus facilitate the possibility of developing addiction.
- Roughly eleven million people misused prescription opioids in 2016
- Patients, ranging from twenty-one to twenty-nine percent, consuming the prescription drugs abuse them. Upon discouragement to continue, they result to other opioids like heroin.
- Consequently, eight to twelve percent suffer from opioid use disorder.
- Eighty percent of the heroin users confessed to have begun the tendency with prescription opioids
- The emergency departments receive roughly one thousand people to receive treatment for prescription opioid misuse daily.
Current Strategies To Reduce Prescription Opioid Abuse
Responding to the spread of the opioid abuse problems has involved various entities such as the government regulatory agencies, law enforcement, health care providers and pharmaceutical companies, among others.
To combat the problem of drug abuse in the United States, the Office of National Drug Control Policy (ONDCP), was created by the 1988 Anti-Drug Abuse Act. The agency received the mandate to address prescription opioids misuse, as well as heroin abuse.
The entities that also got involved in this fight include the US Department of Health and Human Services (HHS), National Institute of Health (NIH), which is a HHS reliable component, the Central Disease Control (CDC), Food and Drug Administration (FDA) and the Health Resources and Services Administration (HRSA).
Before embarking on how to reduce the prescription opioid abuse in the United States, the Veterans Health Administration office and Department of Defense Health Affairs, American Pain Society, the American Society of Interventional Pain Physicians and the American Academy of Pain Medicine set up some practice guidelines.
These entities recommend the thorough evaluation of a patient before any prescription of opioids is made. Such thorough evaluation involves the following activities;
- the assessment of the pain impact upon the individual,
- physical examination that is directed,
- a good and reliable review of previous treatments,
- a look at any history regarding drugs and
- an assessment regarding the coexisting conditions or diseases.
- Additionally, it is important for any patient to go through baseline urine drug monitoring (UDM), where it is appropriate
Reduction Approaches To Prescription Opioid Abuse
The entities involved in addressing the prescription opioid abuse problem came up with several approaches together, to try and find means to stabilize the drug abuse problem. They came up with the following approaches, which seem to be quite effective in reducing the opioid abuse issue:
- Education Targeting The Patients And Physicans
For the patients and physicians to understand the value of reducing the opioid abuse problem, they need education and so the relevant entities continually take the initiative to do so. This opioid abuse reduction mitigation measure begins with educating physicians regarding safe opioid prescription.
The universal prescription system that the physicians are advised to use in pain medication allow them to effectively treat patients that suffer from severe pain, while ensuring that there are no cases of drug abuse. This approached relies on the patient’s initial comprehensive assessment, as well as regular monitoring of those using the drug.
The Substance Abuse and Mental Health Services Administration further insists that physicians must receive education regarding Screening, Brief Intervention, Referral and Treatment (SBIRT) guidelines for ill people that have substance abuse disorders, as well as those that could abuse drugs if exposed to them. Promotion of these measures involves SBIRT training sessions.
The patients are also provided with health information regarding the safe use of opioids. This provision takes place through educational and training sessions of safe opioid usage, which also includes information about their storage as well as safe disposal when no longer useful or needed.
- The Utilization Of Monitoring Programs
The prescription monitoring programs are quite strict on prescription and distribution of opioid medications. They are data collection systems that can tell the specific physicians that are allowed to make the prescriptions for each patient. This information also includes the number of pharmacies that are allowed to dispense the opioids to patients.
These prescription monitoring programs seem effective in reducing opioid abuse, since they collect information regarding the prescriber, the distributing pharmacy, the name and concentration of the product, and also the dose and amount of the dispensed medicine.
These programs are currently operational in about thirty-three states, since they are administered on a state by state basis. They are also in various implementation stages in about seven other states in the U.S. According to the implementers of these programs, this strategy is good at limiting the opioid prescription to pharmacy-shoppers and doctor-shoppers.
- The Prevention Of Inappropriate Prescribing And Medical Mistakes
The detection of the inappropriate prescription of opioids as well as the commission of medical errors goes a long way in minimizing the abuse of opioids. The medical errors include; the incorrect selection of patients, off-label use, wrong indication and dosage and errors of conversion.
Preventing wrongly made prescriptions and medical errors is accomplished by the utilization of algorithms that enable the identification of mismatches between diagnoses and medication. They do not mainly target prosecuting prescribers, but instead educate them on the honest errors made in safe practices of opioid prescription. Ultimately, they help these persons to avoid issues like malpractice lawsuits.
- The Usage Of Patient’s Photo Identification In The Relevant Pharmacies
Identity theft has largely contributed to the problem of prescription opioid abuse in the United States, since abusers use the prescription of other patients to acquire the drugs from the pharmacies. Therefore, pharmacies are required to verify the buyers of the drugs before producing them, through the photo identification of the patients.
Therefore, the patients are required to always carry their photo identifications; otherwise they may not receive the medications. However, this approach is likely to attract fraud, since some people may create fake identifications, using the names of dead patients.
To avoid this, as well as insurance fraud, the insurers are required by the Government accountability Office to remove the deceased physicians and patients from their systems. This will avoid paying claims for controlled substances fraudulent prescriptions, purportedly written for deceased patients by deceased physicians.
- Referral Of Patients To The Pain Specialists
Another option to reduce the opioid abuse menace is encouraging referrals to multidisciplinary pain management programs, as well as addiction specialists’ referral resources. While doing so, the health care providers that are involved are asked to conduct routine urine drug tests.
This may be costly in the short-term. However, since they play a significant role in helping detect and in correctly managing patients at risk of opioid abuse, what matters is the cost reduction in the long-term.
- The Utilization Of The Abuse-Deterrent Opioid Formulations
The opioid manufacturers are also involved in addressing the prescription opioid abuse problem. They are developing new opioid formulations that have abuse deterrent properties, thus discouraging their misuse. These manufacturers are utilizing several approaches, like the fortress, neutralizing and aversive.
The fortress approach ensures that the various opioid medications maintain their extended-release characteristics, even when crushed or dissolved. The neutralizing approach works for the medications whose formulation can be easily altered. If one attempts to tamper with the formulation, there is the release of a neutralizing antagonist. In the aversive approach, the opioid is created to have an aversive agent that causes unpleasant side effects, upon the ingestion of large quantities.
Current Strategies To Reduce Opioid Drug Abuse
As the strategies mentioned above work towards reducing the abuse of prescription opioids, there are other approaches that target reducing the abuse of other opioid drugs like heroin. As soon as the prescription opioid drugs began being scarce for the drug addicts, many turned to heroin, since it is cheaper and also very available in the streets.
Therefore, the opioid drug abuse problem became worse because consumers created a huge demand for heroin and the distributor were more than happy to supply. This led to a major drug epidemic. This also caught the U.S administration’s attention and so the CDC, HHS, NIH AND HRSA have begun implementing individual measures to help in reducing the drug abuse issue.
The CDC is very committed towards the fight towards the overall opioid abuse issue. It does so by supporting various communities in multiple states, as they collect data, notice outbreaks, provide necessary care and respond to the cases of overdosing.
The CDC mainly focuses on the following actions;
- Improving understanding and response to opioid abuse through improvement of the tracking trends, not forgetting the data quality. It identifies the area that needs urgent help with prevention efforts by collecting and analyzing any relevant data.
- It equips states with necessary prevention effort resources
- It enables the improvement of patient safety by focusing on evidence based decision making. Thus it supports health systems with data, tools and guidance.
- It encourages the making of better and safer choices among the patients while raising awareness about opioid misuse and overdose.
- It also partners with public safety officials to cater for the illicit opioids issue since it is growing rapidly.
The HHS priorities in fighting opioid abuse include:
- Ensuring that there are better advanced practices that can be used in pain management
- Providing support for research on pain and addiction to opioids
- Surveillance of the public health to facilitate people’s advanced understanding on the opioid abuse crisis
- Managing overdose cases through promoting the usage of reversal drugs
- Ensuring that treatment and recovery service are improved and well accessible.
In the United States, the NIH leads in medical research. So it is involved in the treatment of opioid use disorder. Together with pharmaceutical companies, it focuses on the following:
- Medications and technologies that are relevant in the treatment of opioid use disorders.
- Management of pain through non-addictive strategies that are safe and also effective
- Improvement of the reversal drugs and the overdose prevention.
HRSA caters for matters regarding training, technical assistance and resources. Therefore, it uses the following approaches to address the opioid crisis.
- It expands the primary care access by funding the expansion of health care settings in the various US communities.
- It focuses on providing substance abuse treatment to the frontier, rural and underserved communities.
- It connects the stake holders to the relevant opioid related resources.
- It shares the most effective regionals practices and approaches.
- It ensures that the primary care professionals receive ample training on the opioid use disorder.
- It addresses matters regarding the overdoses and poisoning that involve opioids.
In conclusion, the opioid abuse has become quite a huge problem that could take the U.S to its knees in the future, if nothing is done. Lucky, the administration is working hard towards mitigating the problem and has help from some non-governmental organizations, aside from the multiple health entities.
The various strategies that aim at reducing the rate of opioid abuse seem to be working, which is good for all citizens and the nation’s future. As an individual, it is better to participate by being cautious about the opioid use disorder, especially if you are a patient that requires these drugs for pain management.