User:Elliequinones/Opioid epidemic in the United States

Impact[edit]

The high death rate by overdose, the spread of communicable diseases, and the economic burden are major issues caused by the epidemic, which has emerged as one of the worst drug crises in American history. More than 33,000 people died from overdoses in 2015, nearly equal to the number of deaths from car crashes with deaths from heroin alone more than from gun homicides. It has also left thousands of children suddenly in need of foster care after their parents have died from an overdose.

Addiction does not only affect the people taking the drug but the people around them, like families and relationships. Conflict is usually the number one problem between family members and the people abusing heroin, the fighting becomes an everyday routine. In Jeff Schonberg and Philippe Bourgois's ethnography, Righteous Dopefiend, they did a participant observation from 1994 to 2006, and they focused on the lives of the homeless heroin addicts in San Francisco, California. They found that for example, Sonny is still in contact with his family, but he doesn't live with them, and he vowed to himself that he will never let his family see him at his worst, but he goes to his family usually for holidays and important dates, and when he is with them he is sober. This kind of relationship isn't always the case though. They observed another example with Tina whose parents have completely cut off contact with her, and she is left on the streets with nobody except the family she has created in the homeless society.

A 2016 study showed the cost of prescription opioid overdoses, non-medical use, and dependence in the United States in 2013 was approximately $78.5 billion, most of which was attributed to health care and criminal justice spending, along with lost productivity. By 2015 the epidemic had worsened with overdose and with deaths doubling in the past decade. The White House stated on November 20, 2017 that in 2015 alone the opioid epidemic cost the United States an estimated $504 billion.

Two employees of the University of Notre Dame were killed in a murder-suicide over the refusal of Dr. Todd Graham, 56, to renew the opioid prescription for the wife of Mike Jarvis, 48. United States Representative Jackie Walorski sponsored a bill in the memory of the doctor who would not over-prescribe; the Dr. Todd Graham Pain Management Improvement Act is intended to address the opioid epidemic.

The National Safety Council calculated that the lifetime odds of dying from an opioid overdose (1 in 96) in 2017 were greater than the lifetime odds of dying in an automobile accident (1 in 103) in the United States.

The opioid epidemic, combined with the Patient Protection and Affordable Care Act, has led to a situation called the Florida shuffle, where a drug user moves between drug rehabilitation centers so those centers may bill the user's insurance company.

In one study, a decision analytical model of the US population aged 12 years or older found that "under the status quo, an estimated 484,429 individuals were projected to die of fatal opioid overdose" between 2020 and 2029. However, a combination of "reducing opioid prescribing, increasing naloxone distribution, and expanding treatment for opioid use disorder was associated with an estimated 179,151 lives saved when compared to the status quo."

Healthcare professionals are also among those heavily affected by this epidemic. Studies have been done to determine how well nursing students, nurses, and even doctors are prepared to treat patients affected by opioid addictions. The studies have pointed to the fact that nurses and other healthcare professionals are highly undertrained in this area. As a result many specific education programs have been proposed and implemented into nursing education institutions.

Naloxone[edit]

Naloxone, used to treat overdose patients

Naloxone (most commonly sold under the brand name Narcan) can be used as a rescue medication for opioid overdose or as a preventive measure for those wanting to stop using opiates. It is an opioid antagonist, meaning it binds to opioid receptors, which prevents them from being activated by opiates. It binds more strongly than other drugs, so that when someone is overdosing on opioids, naloxone can be administered, allowing it to take the place of the opioid drug in the person's receptors, turning them off. This blocks the effect of the receptors.

Many states have made Narcan available for purchase without a prescription. Additionally, police officers in many districts have begun carrying Narcan on a routine basis.

Take-home naloxone overdose prevention kits have shown promise in areas exhibiting rapid increases in opioid overdoses and deaths due to the increased availability of fentanyl and other synthetic opioids. Many counties offer Narcan training programs with the aim of educating the surrounding community on how to use Narcan. Early implementation of programs that widely distribute THN kits across these areas can substantially reduce the number of opioid overdose deaths. Additionally, persons at risk for opioid overdose did not engage in riskier, compensatory drug use as a result of having access to naloxone kits.

Further reading[edit]

• Emily Witt, "A Blizzard of Prescriptions" (review of Beth Macy, Dopesick, Head of Zeus, 2019; Chris McGreal, American Overdose: The Opioid Tragedy in Three Acts, Faber, 2018; Sam Quinones, Dreamland: The True Tale of America's Opiate Epidemic, Bloomsbury, 2016), London Review of Books, vol. 41, no. 7 (April 4, 2019), pp. 23–26. "OxyContin['s] lamentable [market] success was owed to a confluence of factors particular to the US. They include, but are not limited to: the country's dysfunctional privatised healthcare system, which makes it possible for addicts to accumulate doctors willing to prescribe painkillers in a way they can't in the UK; a corrupt regulatory agency [the Food and Drug Administration] beholden to the [pharmaceutical] industry it was tasked with regulating; a punitive legal paradigm that criminalises drug users instead of helping them; an abstinence-only approach to treating drug addiction that impedes evidence-based medication-assisted treatment; corporate greed; a political class that takes marching orders from the lobbyists of said corporations; entrenched poverty, joblessness and hopelessness; and a general epistemological failure when it comes to ideas about what 'drugs' are, which psychoactive chemicals are safe and which are dangerous, and what a drug dealer is supposed to look like. [This] prepared a consumer market for heroin. Hundreds of thousands of lives have been lost, each one of them a world." (Emily Witt, p. 23.)

References

Further Reading

Oliver, J. E., & Carlson, C. (2020). Misperceptions about the ‘Opioid Epidemic:’ exploring the facts. Pain Management Nursing, 21(1), 100–109. https://doi.org/10.1016/j.pmn.2019.05.004