The Rise Of The Opioid Epidemic

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In 2016, the amount of deaths caused by drug overdose is significantly greater than the total number of American deaths that occurred in the Vietnam War. The more disturbing part is that most of these deaths are caused by opioids obtained through illicit means. Injection and blowing powder directly into the nose, also known as snorting, are the common and preferred routes for opioid abuse (Skolnick, 2018). These methods result in rapid delivery to the brain, producing dopamine which gives the individual a feeling of pressure. As opioid use disorder is a pressing issue nationwide, different discourse communities are trying to help end this widespread disorder. Dr. Vivek Murthy, a physician, and a former U.S. Surgeon General wrote a letter to clinicians, asking for their help to build a movement to stimulate change. On the side of the spectrum, the American Psychological Association (APA), posted a response to President Trump’s plan to address the opioid epidemic. The response is a call for action on policymakers and peers to elicit change in various areas concerning the epidemic. In Dr. Murthy’s letter, he called for Americans to have access to the opioid overdose reversal medication, naloxone (Murthy, 2016). This step is crucial because it can save the lives of many people, but it also reduces the stigma associated with opioid use disorder or substance use disorder in general. Now, health providers have the authority and ability to monitor prescription histories. Though naloxone helps people recovering from opioid use disorder, it does nothing to prevent the disorder firsthand. To continue answering President Trump’s call, we need to dispatch new methods of intervention through evidence-based recovery programs as well as increasing awareness of the severity of opioid use disorder through community-based approaches.

The purpose of using community-based approaches for opioid use disorder is to prevent the use of opioids in the first place. There are three different types of interventions: universal, selective and indicated. Universal intervention is the first type of intervention and it is the one that is being used currently. Universal intervention states that the medical community, pharmacy, and dentistry community should limit exposure to potent painkillers with the help of prescription drug monitoring programs. Other factors that require community intervention are social factors like lack of hope and purpose. To increase hope within the community, policies for quality education, employment, reliable housing, and justice reforms support recovery (Fraser & Plescia, 2019).

Selective intervention is directed toward people who are in communities that have a higher than average risk of developing an addiction. Research shows that children who go through unfavorable circumstances and face childhood trauma have a higher risk of future drug use. Some evidence-based interventions that can be implemented include home visitations and early childhood programs. These interventions are shown to decrease the unfavorable circumstances for children. Other factors that contribute to a higher risk of addiction are unemployment, lack of educational or economic opportunity, and no family support. In this population, community-based approaches such as job and skills training, using trauma-informed care and changing prevention methods in jails and prisons (Fraser & Plescia, 2019).

Indicated intervention is for those who are already in the early stages of addiction. Individuals in these situations are screened for whether they are trying to obtain opioids illegally and are also monitored through prescription drug monitoring programs. To use a community-based approach, individuals are being helped by taking part in syringe and needle exchange programs, where people are being recommended by public health professionals (Fraser & Plescia, 2019). Regardless of the method used for prevention, clinicians, as well as communities, should address the opioid use disorder and why individuals use opioids or any drug in the first place. From there, action can be taken after seeing the problem from both a clinical and community perspective.

Primary prevention of opioid use disorder depends on the public health principle of primary intervention being combined with the health care system, which consists of people and institutions that deliver health care services to meet the health needs of specific populations. The prevention has not been taking place as often with the help of the health care system because there is confusion on what is required for the prevention to be effective. For primary prevention to be effective, three requirements need to be met.

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The first requirement is having a preclinical phase where individuals with a higher risk of opioid use disorder are identified and their advancement in continuing to use the opioid is stopped. Doing this first step ensures that individuals are identified in the beginning stages of the disorder (Strand & Eukel, 2019). Since opioid use disorder is continuous and chronic, identifying the individuals with specific risk factors allows clinicians to provide evidence-based care that is presented to the individual without stigma. De-stigmatization of opioid use disorder is crucial in primary prevention as it makes the individual feel more comfortable with tackling an important issue.

The second requirement is having a tool that can identify these high-risk individuals. One tool that can be used is the Opioid Risk Tool (ORT), which classifies individuals receiving a prescription that prevents the usage of opioids (Strand & Eukel, 2019). Though it seems like a great tool to have, it must be easily accessible, cost-effective, and satisfactory for those going through primary prevention. An ORT was used as a part of the North Dakota ONE Rx project and was shown to be easily carried out in local pharmacies while being effective in identifying high-risk individuals with opioid use disorder (Strand & Eukel, 2019).

The third requirement is that an ORT must be used within a population that has a lot of high-risk individuals that are more likely to have opioid use disorder. Using an audience that has prevalent individuals and resources for an ORT increases the accuracy of the results (Strand & Eukel, 2019). An example of such prevalent individuals would be those exposed to prescription opioid medication as well as patients with chronic pain in general. Identifying the population helps further evaluate their risk for opioid use disorder.

To combine the ORT and community-based interventions, community support services like community pharmacy initiatives involving ORTs can show promising results. One instance of this is shown in North Dakota, where a long training on opioid use disorder was administered and the trained pharmacists were given the resources needed to successfully carry out the project. Through ONE Rx in North Dakota, the pharmacists were given proper tools to screen for opioid use disorder with the ORT. Upon screening and based on the results from the screening, patients are taught the means of intervention, benefits of naloxone and are given resources to reach out within the community. This program in North Dakota had successful results and it shows that more opportunities and proper education should be given to community pharmacists so they can help the high-risk individuals (Strand & Eukel, 2019). ONE Rx doesn’t force positive patient behaviors, but it rather helps them reach out for counseling, patient educations, and other referrals if needed.

Primary prevention is shown to be a great first step to identifying high-risk individuals as that is the current problem the United States is facing. With the help of naloxone, community-based approaches to intervention as well as using an Opioid Risk Tool, clinicians as well as pharmacists can combine forces to potentially help reduce the casualties that occur from an overdose of opioids.  

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