The Rapidly Growing Opioid Epidemic: The Effectiveness of Harm Reduction Approaches and The Role of RPNs
Currently, the opioid crisis in the Lower Mainland has significantly increased, growing at a rapid pace in society, showcasing that an opioid epidemic is occurring causing a public health emergency (Government of Canada, 2018). Opioid overdose deaths are the number one leading cause of death in British Columbia (Walley, Xuan, Hackman, Quinn, Doe-Simkins, Sorensen-Alawad, Ozonoff, 2013), while still growing nationally. This paper will describe how harm reduction strategies are put in place to effectively prevent unexpected overdose deaths, how utilizing these strategies benefit the public and finally, the essential role of the RPN in contributing to future polciy and legislation changes.
Opioids are drugs that can be prescribed or taken illegally to act on the nervous system to control and relieve pain by producing euphoria. Opioids are highly addictive and can be abused if taken incorrectly and continuously, leading to physical dependance and severe withdrawal symptoms (Opioids, 2019). Addiction is a chronic but treatable medical condition, which can cause death, disease and disability, globally if not treated (Austin & Boyd, 2019. p 573). Addiction does not occur by choice instead it can occur for various reasons but most commonly individuals take opioids for pain relief eventually getting hooked because of the potency and physical dependance of the drug, progressing and worsening the addiction (Austin & Boyd, 2019). Addiction is a vicious, repetitive and continuous cycle, because individuals try to wean off opioids but withdrawal symptoms make it much worse to effectively stop using. From the horrible withdrawal symptoms to the physical dependance and craving of opioids, the cycle of addiction continues, further increasing individual’s chances of overdose and eventually death.
Critical Social Theory
Critical social theory is a concept referring to the differences between individuals relating to socially determined status (Right, 2019). This theory relating to course content and the opioid epidemic explains that although individuals can change their environment and other lifestyle components, some individuals are unable to find support and resources to help their addiction. For example, those living in poverty or facing homelessness have a greater challenge of overcoming addiction and successfully becoming clean because these individuals are already at a disadvantage with the resources they have available (Allen et al, 2014). Critical social theory describes that inequality between people, and the various challenges faced each day, is what identifies whether or not an individual is able to overcome certain obstacles. Further, alongside poverty is unemployment; without a job in this day and age, it’s difficult for an individual to even fend for basic resources and supports such as clean water, food and shelter which is a basic yet critical necessity to survive. Individuals facing homelessness and addiction have one main concern which is to stay alive and carrying on with the vicious cycle of addiction, leading to further harm such as unsafe injecting or inhalation of opioids and even cycle of violence in prostitution for some. The combination of these constraints together make it near impossible to end the ever growing opioid epidemic.
Determinants of Health
Social and economic determinants of health contribute to addiction, further negatively impacting an individual’s life. Social determinants include age, birthplace, lives, place of employment, and access to health services (Allen, Balfour, Bell & Marmot, 2014). Social disparities for those facing addiction and substance use have an increased chance of living their current lifestyle because of the inability and means to seek and provide for themselves in order to be healthier and have a better lifestyle (Allen et al, 2014). For example, those living in poverty and without basic necessities, will have increased health concerns where resources are limited because of their current circumstances. Poverty in relation to health is crucial because social determinants and disparities, such as the right resources for those unable to seek medical help or find alternative resources to help their addiction and lifestyle, is a key reason for the situations and outcomes of individuals.
Harm Reduction Approaches
Although there are many opposing factors for those unable to access treatment for addiction and recovery, the government has a few strategic plans that are beneficial in aiding those who have been using for years and have tried numerous treatments to effectively stop using however, were unsuccessful. The Federal Health Minister of BC considered expanding treatment options such as heroin-assisted treatment (HAT) and hydro-morphone (Boyd, Murray, MacPherson, 2017). A clinic in Downtown Vancouver, CrossTown Clinic, supplies medical grade heroin and legal hydro-morphone for individuals and has already reached its maximum occupancy. The use of HAT is that individuals are able to inject healthy amounts of opioids so that they can still live to the best of their ability each day, while still using opioids. Medical grade heroin and legal hydro-morphone through the government is beneficial as it provides safe and clean injection sites with doctors, nurses, social workers and pharmacists available on hand, measuring out exact doses so that individuals don’t experience withdrawal or get ‘too high’ (CrossTown Clinic, 2017). Furthermore, in late 2016 a few unauthorized safe injection tents were also put in place to help with the opioids crisis so that users could come in and use substances in a clean environment where individuals would be present in case of an overdose emergency.
Alongside this, many individuals have also started to carry around a Naloxone kit, which helps reverse overdoses and has shown to be an effective tool in preventing overdose deaths in the community. Carrying naloxone kits are important because often times individuals are present when medical overdoses occur so if people are equipped and prepared to handle a medical emergency until medical professionals arrive, the rates of deaths due to overdose will decrease, reducing the opioid epidemic plaguing the community. Moreover, naloxone kits are crucial and an important harm reduction tool.
Policies and Legislation
Currently, new policies and legislations such as Safe Injection Facilities (SIF) are starting to spread worldwide so that it can be a beneficial harm reduction tool. These SIF’s are helpful because it has been reported that since the opening of SIF in Downtown Vancouver, there have been no deaths reported inside (The Opioid Crisis, 2017). This is a huge benefit as the opioid overdose deaths have been increasing each year, showcasing that almost 4 people die each day from overdoses, a completely preventable tragedy (The Opioid Crisis, 2017). It’s evidenced that no deaths due to overdose have occurred in SIF, because SIF help reverse a significant amount of overdoses showcasing the effectiveness of these sites. The implementation of SIF is one of the first steps for harm reduction for numbers to steadily maintain and then decrease in the upcoming years to overcome this tragic crisis (BC Coroners Service, 2019).
Project Tainted and Project Trooper are two different projects taking place between October 2014 and March 2015, that spent over $800,000 to target Fentanyl distributors to the DTES, Metro Vancouver, Alberta and the Yukon (The Opioid Crisis, 2017. p 19-22). These two projects were crucial as they targeted the drug trade at the core to help with the opioid epidemic from reaching greater heights by decreasing the number of distributors and amount of contaminated drugs coming into the Lower Mainland.
Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, & Alexander describe that primary, secondary and tertiary levels for preventing and curbing the opioid epidemic should be put in place to effectively overcome this crisis (Kolodny et al, 2015). This article explains that health care professionals should be more cautious about who they are prescribing pain medications to, as well as providing extensive patient education regarding opioids and addiction as this is usually the primary cause for addiction (Kolodny et al, 2015). Secondary prevention includes identifying habits of addiction and getting a health screening performed to prevent further dependance. Tertiary prevention involves therapeutic and rehabilitative measures once opioid addiction is established (Kolodny et al, 2015 p. 1); the tertiary stage is crucial for preventing opioid overdose deaths and any other medical and severe physical and mental deterioration and complications. Nurses and health care professionals should provide and educate individuals with effective and affordable treatment options and other resources needed. Alongside resources and tertiary prevention, harm reduction should be highlighted and demonstrated for those continuing to use which includes clean needles and safe/hygienic environments such as SIF.
Furthermore, in the United States a bill has been passed from the house of senate for President Donald Trump to sign, ‘The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act’ (Garvin, 2018); this bill is significant and crucial for the future of society regarding the opioid epidemic; firstly, additional funding towards further continuing education for medical professionals is critical as this will provide a greater understanding of addiction and addictive habits with opioids for those prescribing them. This in turn impacts the number of individuals being prescribed opioids, decreasing future numbers of addiction and substance use. Not only that, this bill will also provide funding for federal research for new pain management therapies. Researching alternative therapies rather than prescribing opioids which are highly addictive, will provide individuals with other options which are less harmful decreasing the chances of addiction, in turn impacting the opioid epidemic.
Role of RPN
RPN’s role in the opioid crisis is to be as hands on as possible when educating and caring for those with substance use. RPN’s have to abide by the individual’s right to live at risk and although nurses are unable to stop individuals from using they are required to provide thorough education regarding the topic, and resources to individuals who will continue to use. Examples of some resources are clean needles, locations of safe injection facilities and naloxone kits; users should be told where to access naloxone kits and how to help those around them in case of a medical emergency. Further, RPN’s should provide professional care without judgment and bias for those suffering and continuing with their daily habits and lifestyle.
Future Implications and Policies
Future implications for further change is to provide the public with more education regarding this topic and how to overcome and prevent such tragedies as a community. Other implications needed are more harm reduction resources available to those on the DTES such as, increased shelters and SROs where individuals are able to start treatment or live comfortably. Although this could be a far stretch, there should also be more clinics such as CrossTown Clinic for those suffering as it is shown to be highly effective.
To conclude, the opioid epidemic has been ongoing for years and continues to rise each day. Although there are harm reduction approaches in place, there just isn’t enough resources and funding for this crisis in the Lower Mainland in order to prevent the numerous overdoses a day. Safe Injection Facilities are more widespread worldwide however, other initiatives such as clinics for those who use continuously at a safe and healthy range would benefit so that they can function each day to their best abilities rather than suffering from withdrawals and worsening their addictions and continuing on with the vicious cycle of addiction.
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