One of the controversial issues in United States is the increased misuse and over prescription of opioids witnessed for the last 10 years. According to the report released by National Institute on Drug Abuse, opioid is one of the drugs commonly abused by the adults in the U.S (Olsen, 2016). The drug is mainly used as a pain reliever. Statistics show that the use of opioid drug rose by a margin of 300% increase from 1999 to 2016. On the other hand, the number of deaths arising from opioid overdose increased from 4000 to 16,600 in the same time frame. Current research shows that deaths resulting from opioid overdose in the U.S have surpassed the ones caused by the road accidents. Furthermore, opioid overdose related deaths are more than those of heroin and cocaine combined (Olsen, 2016).
Public health nursing deals with the improvement of population-based outcomes geared towards ensuring all members of the community lead healthy lives. The public health nurses are charged with the responsibility of enhancing population-based health outcomes. They promote early detection of common disorders and also provide reliable healthy and safety information to the people they serve (Rntomsnedu.org., 2018). . The misuse and over prescription of opioid medication is a relevant issue in community health nursing which requires the nurses to identify the cause of the issue and come with the ways of curbing the problem. By so doing, the public health nurses will be able to promote the health and safety of the populations they serve. In solving the problem of misuse and over prescription of opioid drugs, the parties involved that is clinicians, patients and pharmacists should take part. For instance, the doctors can easily non-medical use of drugs such as opioids and take the necessary steps towards preventing the patient from misusing the drug. The paper addresses the misuse and over prescription of opioid drugs and shows the two conflicting sides of opioid medications.
The over-prescription and misuse of opioid medications
The United States is facing a crisis of opioid overdose and opioid addiction which has resulted in an unprecedented mortality level. Among the people who misuse opioid are vulnerable and economically stressed adults in the society. Research shows that the United States is the leading country in the world in terms of per capita opioid consumption (Pacula & Powell, 2018). The authorities have made significant efforts in introducing pills that are hard to manipulate as well as limiting opioid prescription. However, the process of limiting opioid prescription failed because the addicts only shifted to more accessible and less expensive drugs such as street heroin. More potent and cheaper opioid including its derivatives have appeared flooded the market due to “iron law of prohibition” The introduction of these products has increased the fatal overdose rates worsening the situation. (Pacula & Powell, 2018).
Currently, addiction is a health challenge which requires early intervention. The politicians and media have been in the forefront exerting pressure on the relevant authorities to address the issue. According to the experts in the National Institute on Drug Abuse, all stakeholders should join hands to help in curbing opioid-related deaths in the United States. Moreover, the Global Commission on drug policy has called for the decriminalization of those in possession of the drugs, including the low-level actors in the illicit drug market. The countries that adopted decriminalization process some decades ago have recorded a reduction in opioid misuse and overdose (Hasak et al. 2018). The Global commission has gone ahead to call for the elimination of all illicit drug markets through regulating individual drugs carefully based on their harm.
Based on the current statistics, about 64,000 people died in 2016 in the United States alone as a result of drug overdose. Majority of these deaths were caused by opioid drug overdose and misuse which include the various forms of fentanyl. Most of the deaths caused by opioid overdose were as a result of a combination of opioid and other drugs such as alcohol. The epidemic has claimed more lives in the United States than that of road accidents annually. Statistics shows that 90% of the total population of addicts is composed of the white people (Pacula & Powell, 2018). Opioid addiction causes poverty. The observation made by Politicians and media is true since the opioid addiction is highly concentrated among poor people or those who are financially stressed (Pacula & Powell, 2018).
Two Opposing Sides
Are u concerned with 100 million U.S citizens suffering from chronic pain or are you more interested in the public health crisis arising from opioid abuse which take the lives of thousands of Americans every year? The policy makers and public health experts should strike a balance between these needs as they implement more restrictions on the opioids (Vox, 2018). However, to do so, the people must have comprehensive knowledge of both sides of the arguments as presented by Stanford debate.
According to a report released in 2011 by the institute of Medicine, more than 100 million American citizens are suffering from chronic disease. The number might be extremely high but includes every American in chronic pain spectrum ranging from those who suffer silently to the ones who are unable to move because of severe pain all over the body. As a result, Mackey is really concerned about the issue and argues that it is not necessary to subject painkillers such as opioids to too much restrictions (Vox, 2018). Mackey argues that pain killers are important in alleviating short term pain in people, and are also used in treating chronic pain in some patients. On the other hand, Mackey acknowledges the fact that long term harms can outdo the long-term benefits of a product. The argument is well supported by the evidence in the Annals of Internal Medicine (Vox, 2018).
According to JAMA Psychiatry 2014 study, addiction to prescription painkillers can also lead to the abuse of other drugs such as heroin (Harris et.al, 2013). Additionally, a CDC analysis conducted in 2015 pointed out that human beings are addicted to prescription painkillers 40 times more than they are addicted to heroin. According to Lembke, there is no evidence which can support the use of opioids in treating chronic pain (Vox, 2018). Therefore, this explains some of the disadvantages associated with the use opioids and why the production of such products should be limited as possible.
Proposed Solutions to the Problem
There are various ways to address the challenge of the abuse of prescription opioid drugs. Some of the remedies are discussed below.
Educating physicians and Patients
The physicians and patients needs a comprehensive education on safe opioid prescribing. Physicians need to adopt universal precaution system in pain medicine as this helps in minimizing the risk patients abuse of the opioids. Besides, the system allows the physicians to effectively treat the patients with pain (Hahn, 2011). The method relies on a detailed patient’s initial assessment and frequent monitoring of patients prescribed to the opioid medication. Payers significantly benefit from encouraging universal precautions because opioid prescription is not only a crucial health need but also has reasonable impacts on the cost of the healthcare. Payers provide the medical professionals registered in their insurance companies with training materials or even training sessions hence enhancing this approach (Hahn, 2011).
According to Substance Abuse and Mental Health Services, physicians should be offered with relevant training on SBIRT (Screening, Brief Intervention, Referral and Treatment) guidelines for the sick people with substance abuse defects and those who are at a danger of drug abuse. Opioid treatment contracts have also been found to address the challenge. They are usually written commitments between the healthcare specialist and the patient which stipulates the terms of treatment, and how the patient should comply with the treatment (Hahn, 2011). Besides, providing patients with health information regarding the safe use of opioid helps in minimizing the risk of opioid abuse. The patients need to be trained on how to use opioids safely including safe storage methods and disposal of pharmaceutical products that are no longer in use (Hahn, 2011).
Prescription Monitoring Programs
These are systems of collecting data that help in the determination of the number of clinicians who prescribe opioids for every patient. Besides, the programs help in determining the number of pharmacies which dispense the opioids for a particular patient. The administration of the prescription monitoring programs is done by the state and has been adopted by 33 states, and more than 7 states are in the implementation stages. The programs gathers information on the prescriber, the name of the product, dose, and amount of drug dispensed, the concentration and pharmacy which dispensed the product. Research shows that these programs alleviates drug abuse practices (Hahn, 2011). The reports from prescription monitoring programs limits the process of opioid prescription to only “pharmacy-shoppers” and “doctor-shoppers”. Upon the attainment of the threshold limit in the patient, appropriate measures are taken which includes notifying all the health practitioners who have prescribed opioid to the patient, and reducing the number of pharmacies used by the patient to only one. Additionally, the programs also inform the patient of any malicious activity, and refer the patient to law enforcement agencies for scrutiny where appropriate (Hahn, 2011).
Prevention of medical errors and inappropriate prescription
The methods of detecting inappropriate methods of opioid prescription and medication errors which includes incorrect patient selection, incorrect dosage, off-label use, conversion errors and indication errors are essential in minimizing risks. The process is accomplished by setting algorithms which aid in the identification of the mismatches between the dose and diagnoses. The main objective of these measures is to educate prescribers who might have caused honest errors in the process of prescribing opioids and guide them in avoiding malpractice lawsuits. The act of setting up systems in the offices of the prescribers reduces medication errors and promotes safe opioid prescribing (Hahn, 2011).
The policy makers and public health experts need to strike a balance between the benefits and limitations of opioid use as they impose restrictions on the use of opioids. According to the institute of medicine, 2011 report, more than 100 million are experiencing pain and thus opioids are important in reducing some of these pains. Furthermore, Mackey argues that pain killers are important in alleviating short term pain in people, and are also used in treating chronic pain in some patients (Vox, 2018). However, Lembke contradicts this information by pointing out that there is no evidence which can support the use of opioids in treating chronic pain. The JAMA Psychiatry 2014 report shows that addiction to prescription painkillers can also lead to the abuse of other drugs such as heroin explaining some of the disadvantages of opioids. In my position, opioids are important pain alleviating medications and hence they should not be limited considering the large number of people, 100 million Americans writhing in pain.
The public health nurses are charged with the responsibility of enhancing population-based health outcomes. They promote early detection of common disorders and also provide reliable healthy and safety information to the people they serve. The misuse and over prescription of opioid medication is a relevant issue in community health nursing. Therefore, as a public health nurse I am required to identify the causes of the issue and come with the ways of curbing the problem. By so doing, I will be able to promote the health and safety of the populations I serve. Some of the challenges that I faced as I wrote the paper include problems in gaining access to the required newspapers, journals and magazines. Furthermore, distinguishing the contradicting information of the misuse and over prescription of opioids was a challenge.