Category: Opioid Epidemic

The opioid epidemic has claimed over 400,000 lives since 1999 and is the leading narcotic killer in America (Understanding the Epidemic). It kills 142 Americans every day and leaves millions of people addicted to the drug for their entire life. It is not slowing down anytime soon (How the Opioid Epidemic is Changing Emergency Care). The opioid epidemic affects people from all walks of life negatively by destroying families, causing an increase in homelessness and crime, and creating health problems that lead to death.

The opioid epidemic has hit America in three waves: The increase in the prescription of opioids, the increase in opioid-related deaths, and the rise of synthetic opioids (Understanding the Epidemic). The first wave began in the nineties when pharmaceutical companies started pushing Doctors to prescribe their patients opioid medications as a treatment for pain (History of the Opioid Epidemic). Before this, Doctors were very wary of prescribing any opioids to their patients because they were aware of the side effects that could lead to addiction (Rummans, Burton, and Dawson 346). However, they went against this because the pharmaceutical companies assured Doctors that the risk level of their patients getting addicted was very low. (Rummans, Burton and Dawson 346). Dr. Thomas Frieden, the Director of the Centers for Disease Control and Prevention, says, “Opioids are not safe. These are probably the single most dangerous class of medications that there is. There is no other medication that kills so many people as opioids. There is no other medication which within a week can condemn someone to a life of addiction.”

In 1990 there were 2 million to 3 million prescriptions of opioids, and in 1999 it jumped to 11 million, and since then, it has been growing (Rummans, Burton and Dawson 346). Dr. Andrew Kolodny, the Co-Director of Opioid Policy Research at Brandeis University, said, “They were able to take this old generic drug and turn it into this blockbuster product; a product that would bring in more than 1 billion in sales a year. Other drug companies very quickly saw how profitable this was and began to do exactly the same thing. This is an epidemic that was caused by greed”.

Crooked pharmaceutical companies like Purdue Pharma were one of the leading companies that pushed the prescription of opioids on so many doctors. Steven May, the former Purdue Pharma Sales Representative says “You know one of the things that bothered me about a situation was as they came out with a plan, you know, to help doctors document better, and we would go and provide them with these tools to better document the treatment of pain. But then what would happen when those same exact doctors would get in trouble for “overprescribing” using the documentation that they (Purdue Pharma) provided, they wiped their hands. No support for those doctors and some doctors lost licenses, doctors who committed suicide, and doctors who went to prison, lost everything. They were doing exactly what the company (Purdue Pharma) taught us to teach them to do”. The Purdue Pharma company has earned more than $35 billion from their opioid sales, and the family who owns the company has a net worth of over $13 billion (Addicted: America’s Opioid Crisis). So far, 48 states have filed one or more lawsuits against pharmaceutical companies on the grounds of their role in the opioid epidemic and the lives lost because of it (Addicted: America’s Opioid Crisis).

The second wave of the opioid epidemic started in 2010 when people started to realize the effects of overprescribing opioids for pain management (Understanding the Epidemic). Steps were being made to make access to opioids harder for people to lessen the addiction rates (History of the Opioid Epidemic). However, this good intention backfired quickly when opioid abusers turned to a cheaper and more sustainable drug: heroine (History of the Opioid Epidemic). Prescription opioids were much more expensive than heroin because the users either had to get them from a doctor or buy them from a seller illegally. This made the heroin a very appealing drug to young people who could not afford to keep buying prescription opioids. For many people, opioids were a gateway drug to heroin and other opioids (Prescription opioid use is a risk factor for heroin use).

The third and most recent wave of the opioid epidemic is the use of synthetic opioids like fentanyl and drugs that contain fentanyl in them (Understanding the Epidemic). It began in 2013 when a new string of opioids hid the illegal market that was fifty times more powerful than heroin (Addicted: America’s Opioid Crisis). This means that only a small amount of fentanyl can be taken without it being deadly. This also means that the amount of overdoses tends to be higher because people do not know how potent it is until it is too late (Synthetic Overdose Data). According to the Center for Disease Control and Prevention, there were more than 28,000 deaths in 2017 from fentanyl. It is the most lethal type of opioid that can be found in America today, and the use of this dangerous drug is only rising (Synthetic Overdose Data).

Opioids do not only affect the people who use the drug, but it also affects everyone around them. There are 2.2 million children who have been affected by the opioid epidemic; they are put into foster care and have to grow up without their parents because they died of an opioid overdose (The Ripple Effect). It is not uncommon for a baby to be born suffering from opioid withdrawal. It is every 15 minutes and Kevin Morse, a recovered addict, said: “When he (his son) was first born they actually had to give opium and they put it into his baby formula just to keep him from shaking, and that was very scary, but they just told me that it was withdrawal symptoms, but he was shaking.” When a pregnant woman is addicted to opioids, she might refuse prenatal care so that her doctor does not find out she is addicted (The Opioid Epidemic: Impact on Children and Families). People who are addicted to opioids usually have inferior nutrition, and this can hurt the baby and cause problems during and after birth (The Opioid Epidemic: Impact on Children and Families). According to Michael Maes, Molecular Biologist and Neuroscientist from Deakin University, “The number of pregnant women using narcotic pain medications rose five-fold from 2000-2009 and continues to rise. The increase has resulted in infants being born with a condition called Neonatal Abstinence Syndrome (NAS) that is linked to congenital disabilities and severe withdrawal symptoms demonstrated by the infant at birth”.

The opioid epidemic can affect everyone from all socioeconomic backgrounds and all ages. There are addicts in middle school, and there are addicts in their 60s who are struggling the same way (Opioids and Adolescents). Around 8 million children live in a household where at least one parent is an opioid user (The Opioid Epidemic: Impact on Children and Families). This creates a volatile living environment for a child and can cause them to suffer trauma and, in some cases, even become users themselves (The Opioid Epidemic: Impact on Children and Families). Stephanie Horton, a foster mother to Ben who was born addicted to heroin because his two parents can recall traumatic memories from his early childhood. Stephanies says “He would tell his preschool teacher that his “other daddy” would tie a rubber band around his arm and use a spoon and then he would be “asleep,” is what he would say, he would get sleepy, and Ben would say “I would try and wake up my dad, but I could not wake him up,” and he would say things like “I just wanted to be stronger, I want bigger muscles so when I shale him, he’ll wake up” (American Epidemic: The Nations Struggle With Opioid Addiction). Opioid users that are parents traumatize their children by subjecting them to their lifestyle and influencing them negatively.

Homelessness and addiction are almost always linked, and addiction usually leads to homelessness. Addictions destroy relationships with families and friends and can cause someone to lose their home and job (Substance Abuse and Homelessness). In 2008, when the opioid epidemic was in, it is the most dangerous state, substance abuse was named as the most significant cause of homelessness for single adults (Substance Abuse and Homelessness). In the first wave of the opioid epidemic, the majority of opioid users were obtaining the drug legally from a prescription. However, when doctors began to stop overprescribing opioids, addicts had to find a different dispenser, which would usually be illegal ( The Relationship Between Crime and Opioid Use). Either it was stealing opioids from people the users knew or buying them from dealers on the street ( The Relationship Between Crime and Opioid Use).

Opioids are a very addictive and potent drug that alters brain chemistry and gives the user a sense of euphoria and a sense of relief (Opioid Addiction). Frequent opioid causes you to become tolerant of the drug, which means that you need a higher dosage of the drug to get the full effect. When the dose is raised every time it is used, there is a point where it cannot be raised anymore, and the user overdoses (Opioid Addiction). When a user decided to go on a detox or try to get clean, they go through a phase called withdrawal. This happens because they have become dependent on opioids for everything. During withdrawal, the user can experience muscle cramping, diarrhea, and anxiety (Opioid Addiction).

The opioid epidemic is a human-made epidemic caused by pharmaceutical companies who want to make money. There is no real cure to the addiction caused by opioids and causes lifelong health problems. It is an everyday struggle for anyone who is dealing with or has dealt with this addiction. Sadly, the only way out for a majority of people is death. There have been many drug crises before the opioid epidemic, and there will be more after, our responsibility as a society it reveals the root causes and lends help to the people affected.

Problem Overview – Magnitude, Scope and Population Affected

On October 16th, 2017, the United States Government stated that the American opioid epidemic was now a national health crisis (Department of Health and Human Services, 2019). According to the Center for Disease Control and Prevention (CDC), from 1999 to 2017, more than 700,000 individuals had died from a drug overdose, making it the number one form of preventable death in the United States (CDC, 2018). Of these 700,000 deaths, 400,000 of them could be directly connected to opioids, including both prescription and illicit drugs (CDC, 2018). Furthermore, since 2002, over eleven million individuals have misused the drug, dramatically increasing the rates of emergency room visits for nonmedical opioid use (Zee, 2017).

The opioid epidemic does not discriminate between age, race, or gender, as the death rates directly connected to opioid overdoses have increased among every demographic (Jones, et al., 2018). Specifically, though, males under 50, individuals recently released from prison, and those who have been prescribed opioids, are at the greatest risk of developing this disease (Zee, 2017). Approximately twenty-one percent of patients who had been prescribed opioids for the management of chronic pain developed an opioid addiction or dependency, and of these individuals, nearly five percent of them have transitioned from prescription opioids to heroin (Zee, 2017). Although this epidemic came as a shock to many, it has been boiling for years, beginning in the early 1990s and continuing through present day (Department of Health and Human Services, 2019). Through the collaboration of government officials, medical regulators, and pharmaceutical companies, programs and policies were set into place that created an environment ripe for the rampant outbreak of this devastating and deadly epidemic.

Analysis of Policies and History

Despite the fact that addiction has always been a part of American society, the opioid epidemic was ultimately exacerbated through the perfect collision of two radical changes within American society. The first of these changes was the reintroduction, and rebranding of a pain medication known as Oxycodone (Jones et. al, 2018). Beginning in 1996, Purdue Pharma, a large pharmaceutical company, began to market their version of this drug, emphasizing its incredible ability to alleviate pain, with little to no side effects (Jones et. al, 2018). Renaming the drug OxyCotin, Purdue Pharma specifically marketed it as a non-addictive pain medication and began targeting doctors and pharmacists across the country (Zee, 2017). Purdue Pharma held hundreds of all expense paid trips for these individuals, incentivizing them to prescribe their drug in massive quantities. Despite numerous studies depicting its addictive qualities, Purdue Pharma continued to falsely market their product, actively exploiting the American population (Zee, 2017).

At the same time that Purdue Pharma was leading their campaign, the Joint Commission on the Accreditation of Healthcare Organization (JCAHO), introduced new standards for the prescription of pain medications (Baker, 2017). In 1996, due to a public out-cry for the rebranding of pain as a medical disorder, and not merely a symptom, JCAHO set forth a movement that would allow OxyCotin to be prescribed in a more liberal fashion (Baker, 2017). Due to this movement, the Food and Drug Administration (FDA) approved the drug as a “minimally addictive pain reliever”, allowing for a massive increase in the number and rate of prescription opioids doctors were allowed to prescribe (FDA, 2019). Despite being based off of faulty, and misleading information, the passage of OxyCotin as a non-addictive pain management drug, paved the path for it to become one of the largest health crises to ever plague American society (Baker, 2017).

In conjunction with the head on collision of these two major shifts in American culture, the opioid epidemic was only exacerbated through the already established criminalization of the United States’ most vulnerable populations. For centuries, instead of viewing addiction as a disease, American society has categorized it as a crime, only aggravating the issue and ultimately, creating more harm (Human Rights Watch, 2019). Instead of funneling the country’s resources towards education, and prevention, American politicians have deemed these individuals as less than, blaming them for a disease they had no control over (Human Rights Watch, 2019). Through the criminalization of addiction and mental health, the lack of access to basic medical care, and the global stigmatization of this disease, individuals who have been afflicted by this illness have been forced to the fringes of society, suffering both physically and mentally, unable to live a life they so rightly deserve.

Human Rights Violated

Through the indiscriminate, careless, and haphazard policies set into place by the United States government, pharmaceutical companies, and medical doctors, countless Americans have had their most basic human rights violated on a daily basis. Through the misclassification of drugs, and the criminalization of addiction, Americans are being aggressively exploited by their leaders, instead of supported. Directly violating the Universal Declaration of Human Rights, which was established to protect every human’s most basic rights, policy makers enacted regulations that dehumanized and harmed their very own citizens. Although a number of these human rights, declared as innate to all, have been aggressively violated, specifically Article 25 in the “Universal Declaration of Human Rights”, has been egregiously defied.

According to Article 25,

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family including…medical care and necessary social services, and the right to security in the event of…sickness, disability…or…lack of livelihood in circumstance beyond his control. (United Nations General Assembly, 1948)

Through the creation of this article, leaders wanted to ensure that all individuals, no matter their status, had access to the fundamental supports needed to live a prosperous and meaningful life. Unfortunately, this most basic right has been violated on a number of levels, for all Americans who have struggled with, and who are currently struggling with an opioid addiction. Not only did the United States government play a critical role in the development and rampant spread of this disease, they have only compounded the issue by criminalizing the disease and turning a blind eye. Instead of creating policies that would have funneled resources towards prevention and education, the government demonized these groups, making it incredibly difficult for any individual to gain access to the resources they need to free themselves from the chains of addiction.

Policy Development

Over the course of history, social policies and programs, that come to define modern society, are often determined by the historical and political context of that time. This statement rings particularly true for the policies, programs, and legal actions that have been enacted in direct response to the opioid epidemic that has ravaged American society. Due to the rapid, and unpredictable spread of this health crisis, American political and legal structures at first created rash, and harmful legislation that ultimately exacerbated this deadly situation. Recently though, the United States Congress passed a revolutionary law that actively combats this epidemic on the macro, mezzo, and micro-level.

On October 24th, 2018, the United States Congress passed H.R. 6, otherwise known as the “SUPPORT for Patients and Communities Act” (Walden, 2018). Through the enactment of this law, the United States government has finally begun to view the opioid epidemic through a humane, and supportive eye. Instead of criminalizing the Americans who suffer from this horrific disease, the government now is creating programs and policies that aid in recovery and prevention (Walden, 2018). Specifically, through reforming aspects of Medicare and Medicaid, and now viewing this epidemic as a public health crisis, the United States government is finally supporting its most vulnerable citizens instead of criminalizing them (Walden, 2018).

Through the passage of this law, community leaders, medical professionals, and government officials now have the ability to combat this epidemic on the macro, mezzo, and micro-level (Walden, 2018). With increased funding for treatment programs, education initiatives, as well as stricter guidelines on how prescription opioids can be prescribed, the United States government is not only supporting those already devasted by this disease, they are actively protecting those who may be vulnerable to developing an addiction in the future (Walden, 2018).

Proposed Change

Despite recent strides to eradicate the American opioid epidemic, there is still much work that needs to be done. Specifically, leaders must now work to eradicate the stigmas that plague those afflicted by addiction, and actively combat the criminalization of this deadly disease. In order to do this, it is now the duty of social workers, policy makers, and medical professionals to continue to rewrite policy and create an environment that supports, guides, and educates all members of society on the realities of addiction.

The “Support for Patients and Communities Act” is a revolutionary piece of legislation that is laying the groundwork for true American change. Unfortunately, many of the aspects that make up this piece of legislation will not reach their true potential before the American culture that surrounds addiction changes. This culture includes eliminating the criminalization of addiction, as well as the eradication of the stigma that follows those who are afflicted by this disease. Due to these two major barriers, many individuals either do not have access to the benefits put in place by this new piece of legislation or are too afraid to access them due to the judgements that may follow. Fortunately, there are areas within the United States that are actively combating these impediments, and tangible progress has been made.

One amendment, which is critical to the impact that the “SUPPORT for Patients and Communities Act” can have on the American population, is the use of drug courts to replace criminal courts for those individuals plagued by addiction (National Institute of Justice, 2012). These courts, through the use of an interdisciplinary team, aim to rehabilitate individuals instead of criminalize them (National Institute of Justice, 2012). Through the unification of social workers, treatment professionals, prosecutors, and law enforcement agencies, communities are coming together and pooling resources that allow for individuals to gain access to the supports they need. Instead of pushing these victims through the criminal justice system, these drug courts offer supports and guidance, in the hopes of leading these individuals towards recovery (National Institute of Justice, 2012).

The battle that is now being fought against the opioid epidemic is a complicated, long, and convoluted war. Luckily, American society is now moving in the right direction, and finally taking proactive, and humane steps towards treating these vulnerable individuals. In addition to the continued efforts to implement aspects of the “SUPPORT for Patients and Communities Act”, social workers, and community leaders must revive their unrelenting battle to destigmatize and humanize these individuals, educating the greater public on the realities of this disease.

References

1. Baker, D.W. (2017). The Joint Commission’s Pain Standards: Origins and Evolution. Retrieved from https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf.
2. Center for Disease Control (2018). Understanding the Epidemic | Drug Overdose | Injury Center. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.
3. Department of Health and Human Services (2019). What is the U.S. Opioid Epidemic? Retrieved from https://www.hhs.gov/opioids/about-the-epidemic/index.html.
4. Human Rights Watch (2019). Every 25 Seconds, Someone is Arrested for Drug Possession in the US. Retrieved from https://www.hrw.org/news/2016/10/12/us-disastrous-toll-criminalizing-drug-use.
5. Jones, M.R., Viswanath, O., Peck, J., Kaye, A.D., Gill, J.S., & Simopoulos, T.T (2018). A Brief
6. History of the Opioid Epidemic and Strategies for Pain Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993682/.
7. National Institute of Justice (2012). Overview of Drug Courts. Retrieved from https://nij.gov/topics/articles/overview-drug-courts.
8. United Nations General Assembly (1948). Universal Declaration of Human Rights. Retrieved from https://www.un.org/en/universal-declaration -human-rights/.
9. U.S. Food and Drug Administration (2019). Opioid Timeline. Retrieved from https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-opioid-misuse-and-abuse.
10. Walden, G. (2018). SUPPORT for Patients and Communities Act. Retrieved from https://www.congress/gov/bill/115th-congress/house-bill/6.
11. Zee, A.V. (2017). Trends in Opioid Use, Harms, and Treatment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458661/.

The Centers for Disease Control and Prevention is a government branch that is responsible for addressing epidemics and other health-related issues. The CDC has provided a collaboration of many real-life stories of people who have struggled with opioid addiction, including Christopher’s story. Christopher had an amazing life until he got in a very minor car accident when he was twenty years old. He experienced slight back pain and was prescribed opioids. Christopher quickly became addicted and he sought out any doctor that would prescribe him more opioids. He increased his pill intake from one to twenty-five a day, which completely flipped his life around. He no longer cared about work, he didn’t sleep, and he became very angry towards those that he loved. He was unable to receive help, and within two years of being prescribed opioids, he overdosed at the age of twenty-two. (“Real Stories”) Christopher’s death was a tragedy and emphasizes how fatal opioids can be.

The Addiction Center is an organization that helps patients find the help they need to recover from addiction. They define the Opioid Epidemic as a growing issue that refers to the increasing number of deaths and hospitalizations from opioids. (Smith “The Opioid Epidemic) This crisis is a devastating national issue; for there are over one hundred Americans across the country dying each day due to opioid overdose. Ann Schuchat, CDC acting director, stated, “This fast-moving epidemic does not distinguish age, sex, or state or county lines, and is still increasing in every region of the U.S.” (“Transcript for VitalSigns Teleconference: Opioid Overdoses Treated in Emergency Departments”) Schuchat refers to the Opioid crisis as an epidemic, which is a widespread occurrence of an infectious disease. This outbreak is spreading; there are more and more Americans are falling into this all-encompassing addiction. So far the Opioid crisis is not slowing down, if anything it is accelerating, and no one knows when it will end, or if it will end at all. Soon no one will be able to go untouched by the shattering effects that come from opioid addiction. Because this is such a widespread crisis, many people are passionate about this topic; such as healthcare professionals, writers, reporters researching this national crisis, and personal stories from individuals affected, or from family members of those affected that passed away.

Dangers of opioids

The Opioid Epidemic began in the late 90s when pharmaceutical companies began creating new ways to manage pain. (Smith “The Opioid Epidemic”) These companies promised good results and did not yet know the risks to these opioids which led many doctors to begin prescribing them in large amounts. George Lopez, a writer for VOX since 2014 and a former Cincinnati Newspaper writer, explains, no one knew what future problems opioids could cause so the US was soon flooded with opioid painkillers prescribed by healthcare professionals. Drug dealers then followed by selling heroin and illegal opioids that people could buy when their prescriptions ran out or when they wanted something stronger. ( Lopez “The Opioid Epidemic, Explained.”) Because of opioids’ strong addictive properties when someone becomes addicted they need for something stronger, which often leads to the use of many illegal drugs.

Opioid addictions are proven to lead to other serious addictions. Searching for a stronger high, most opioid addicts eventually move on to other drugs such as heroin and fentanyl. In a 2014 study, in Jama Psychiatry, 75% of heroin users started with pain killers. That’s not a coincidence. In a 2015 analysis, CDC researchers found that people who are addicted to painkillers are forty times more likely to become addicted to heroin. Heroin is illegal in the United States and is more potent, which makes it much more addicting; therefore, it is more likely for someone to overdose. (Lopez “The Opioid Epidemic, Explained.”) Brenda is a perfect example of this claim. At the age of twenty-five, Brenda was in a serious car accident that required her to see multiple doctors, one of whom prescribed her opioids. A single day after she filled her prescription, she doubled the amount she took and from then on, she never took her prescription responsibly. She went from going to many doctors to get more medication to selling it off the streets in her community. Eventually, Brenda became addicted to Heroin and it took a toll on her life. She reached the point she never thought her addiction would get to. Heroin destroyed her relationships with family and her friends. (“Real Stories.”) Basically, this isn’t just a painkiller Opioid Epidemic; it’s a full-on epidemic, involving legal and illegal drugs, and doesn’t seem to be slowing down any time soon.

Once on the path of addiction, it can be very difficult to get off it. After taking opioids for a few weeks, they become essential to feel even a little okay. When someone has stopped taking drugs abruptly, their body will seriously be affected which is called withdrawal. Symptoms of withdrawal include anxiety, goosebumps, restlessness, insomnia, yawning, body aches, sweating, vomiting, diarrhea, fever, shaking, faster-than-normal heartbeat, rapid breathing, high blood pressure, hallucinations, and seizures. Symptoms can appear as soon as twelve hours after the last dose is consumed. The severity of symptoms can vary depending on how long the individual has been using the drug, or whether they are quitting abruptly or taking other drugs to help them stop taking opioids. When someone stops taking opioids, they need to do so slowly over a long period of time and under the supervision of a healthcare professional. (“Symptoms of Opioid Withdrawal.”) Doctors need to be able to supervise their patients so that they are more aware of what their patients are actually doing with their prescriptions, and can assist them when they need to stop taking their medication.

Opioids can be a very useful tool in effectively controlling pain if used correctly. There are many people who are in a great deal of pain, whether fighting cancer or some other pain-causing illness or injury. Opioids can be very effective in controlling cancer patient’s pain, an article written on cancer pain states, “Not to aggressively attempt to manage pain in ‘malignant’ pain conditions, using any tools available, would be unethical and simply bad practice.” (Foley“The treatment of cancer pain.”) Cancer patients and many others are dealing with tremendous amounts of pain and it would be “unethical” to not do anything possible to control their pain. There are many people who use opioid painkillers to successfully manage pain without falling into addiction.

CDC data show opioid deaths dropped 4.6% overall during a 12-month period that encompassed 2017 and 2018. (“Provisional Drug Overdose Death Counts”) With proper resources and awareness about the risks of opioids, opioid deaths have dropped. Doctors are finding that opioid deaths decreased in the last years. Does this mean the opioid crisis is on the downfall? Will the rise in deaths drop? Unfortunately, this decrease in opioid deaths was paired with an 11.1% opioid death increase due to illicitly manufactured Fentanyl. (“Provisional Drug Overdose Death Counts”) Fentanyl is the strongest pain reliever developed so far, it is 80 to 100 times stronger than morphine and can only be prescribed in the emergency room. It was primarily developed for the treatment of cancer-related pain. But because it is such a strong drug, it is being made illegally and sold in many different ways. Drug dealers are combining it with many different drugs because it takes very little fentanyl to produce a high. This is dangerous because people taking these drugs may be taking much more than their bodies are used to without realizing it, therefore they are at the risk of overdose.

The Opioid Epidemic is not slowing down, those individuals who were given opioids painkillers for minor injuries were not warned of the dangers that opioids can lead to. If doctors and healthcare professionals had been made aware of the dangers and addictive properties of opioids, many opioid addictions and overdoses could have been prevented. Opioids can be effective in treating intense pain and chronic pain, especially in cancer patients. But without strict guidelines on who should be prescribed opioids the number of opioid prescriptions being filled skyrocketed along with the amount of opioid-related deaths. Because not only are people becoming addicted to prescription drugs, they then turn to other drugs to fill their addiction. With stricter guidelines on who should be prescribed opioids, the amount of patients with possibilities of becoming addicted could decrease.

Effects on America and individuals

Opioids have had and continue to have very many effects on America and individuals, ranging from different symptoms, leading to other drug addictions, and driving families and friends apart. The Overdose Lifeline Website was founded and executively produced by a woman whose son died of a heroin overdose, she has been given many awards for working with overdose patients. She wrote, Opioid Overdose has many symptoms and warning signs, these include but are not limited to: very pale face, clammy to touch, lips have a purple hue, vomiting, gurgling noises, unable to be awakened, or cannot speak, or their breathing slows or stops. (“Opioid Overdose: Know Your Options.”) Looking for warning signs and symptoms can save a life.

The United States is crumbling under the effects of Opioids. America is the world’s leading consumer of these drugs. Stanford Drug Policy expert Keith Humphreys stated: “Consider the amount of standard daily doses of opioids consumed in Japan. And then double it. And then double it again. And then double it again. And then double it again. And then double it a 5th time. That would make Japan Number 2 in the world, behind the United States.” In only ten years, our country is at risk the lose the entire population of Baltimore which is over six hundred thousand people. How did we get here? First of all, pharmaceutical companies market these drugs in a way that will help them make the most money possible, even though the evidence shows that the risks clearly outweigh the benefits. Second, doctors were under a lot of stress at the time to treat pain more seriously, quicker, and more effectively. Doctors weren’t sure how to treat complex pain because treatments required too many resources, so the easiest alternative would simply be to prescribe patients pills. This national crisis has obviously escalated rapidly from there.

CDC statistics show that on average 130 people in the United States die from opioid overdose each day. (“Understanding the Epidemic”) This number is way higher than it should be, this is way too many people dying early due to overdose every day, and the number is not going down, it is increasing every day. In 2017 the opioid-related deaths were 6 times higher than in 1999. (“Understanding the Epidemic”) The National Institute on Drug Abuse is a government-funded organization that does national research on drug abuse. In an article published by them, it states, The total “economic burden” of prescription opioid misuse in the United States alone is $78.5 billion a year. (“Opioid Overdose Crisis”) An economic burden is the amount of money that is required for medical costs, such as physician appointments, ER visits, outpatient visits, and hospital stays. Drug overdose is the leading cause of injury-related deaths; more deaths than car accidents, and homicides. In 2016, 64,000 people died, which is more than from guns, car crashes, HIV/AIDS, and deaths from the Vietnam and Iraq wars combined, and it is a growing issue/ it hasn’t slowed down. Only increased. (“Opioid Overdose: Know Your Options.”)

Among many patients, the effects of opioids are very positive. Unrelieved pain can have just as devastating effects. Unrelieved pain can decrease immune system function, delay the healing process, and decrease the effectiveness of healing. According to R Norman Harden, a healthcare expert from the Rehabilitation Institute of Chicago, trying to recover from an accident without medication is unwise. (“Chronic Pain and Opiates: A Call for Moderation.”) Though effective, the risks of addiction still exist. Opioids can only be given under strict guidelines and only for a set amount of time before physical dependence occurs.

Opioids can be a big help in people recovering from accidents, as they are in an extreme amount of pain. Opioids can also help to keep pain under control while healthcare professionals figure out what the source is or while they attempt to fix the problem. The moral of the story is that opioids can be good if they are used in moderation, the problem is that once physical dependence begins most patients cannot stop themselves from becoming addicted.

Alternate solutions/policies/recovery

MAT stands for medication-assisted treatment, this is a program that uses other medicines to fight cravings. Experts say it is “the gold standard” for opioid addiction treatment, but also be aware that it doesn’t work for everyone. (Lopez “The Opioid Epidemic, Explained.”) MAT is not available to many people because the government has set strong regulations and policies on how many prescriptions doctors can prescribe. Many people are fighting for all funds to go toward MAT because of how effective it has been in helping people overcome opioid addiction.

Opioids can be extremely beneficial when doctors follow the guidelines and prescribe medication in the right way. If this were to happen every time, patients would have more access to safe and effective chronic pain treatment. Doctors first need to determine when to prescribe patients with medication; timing is essential. It is vital that they explain the risks and benefits of the treatment before prescribing medication. Doctors next must decide the dosage, the duration of the prescription, and make sure that the patients have follow-up appointments scheduled. Lastly, they need to address how harmful addiction can be. Once these items have been addressed, the chances of successful treatment are high. (“CDC Guideline for Prescribing Opioids for Chronic Pain.”)

Even if readily available resources became accessible, the reality is that people will still choose to abuse opioids and fall into addiction. Steve’s story emphasizes the power of addiction. Steve was an amazing man and excelled in many aspects of his life. As an adult, he suffered from extreme back pain. That pain led to depression. Steve was prescribed opioids to help with the pain. The medication was the difference between night and day for Steve, but he quickly became addicted to his medication. After a while, Steve realized he had a problem and tried to turn it around by enlisting in rehab facilities, but the gravity of his addiction was too strong and he relapsed and died of an overdose at forty-three years old. (“Real Stories.”) Steve’s story demonstrates how difficult it can be to beat addiction, and even with the help, beating the odds is difficult. If funding was used appropriately for medications like MAT, doctors followed the guidelines presented from CDC, and patients considered other options, opioids would be prescribed correctly, patients could avoid addiction altogether, and fatalities would dramatically decrease.

Increasing readily available resources for those with opioid addiction is a very important part of fighting against the epidemic, but making the right kind of resources available could be the most important part. An article from the yale school of medicine states that admitting people to rehabilitation and expecting patients to retain abstinence-only adds to the problem. As this only heightens cravings and lowers tolerance to the drugs, which leaves a very high risk for overdose and death. ( Hamm“New Strategies for combating the opioid epidemic.”) But a more productive way to treat opioid addiction is with drugs such as Buprenorphine which fulfills cravings but does not have the intense addictive properties of opioids. Patients can eventually taper their dosages down and eventually stop taking it all together. This is a much more successful way of treating opioids because cravings are met so there is no need to take other drugs.

The Opioid Epidemic is affecting millions of Americans both directly and indirectly. If doctors continue to carelessly prescribe these painkillers, hundreds of thousands more people will lose their lives. Lembke, a Stanford addiction specialist, states, “If you see someone who continues to use despite their lives being totally destroyed- losing their jobs, losing loved ones, ending up in jail- nobody would choose that. Nobody anywhere would ever chose that life. So clearly it is beyond the individual’s control on some level.” (Lopez “The Opioid Epidemic, Explained.”) Until we understand this, policies and regulations will remain inadequate and this crisis will continue to spread. When doctors correctly prescribe medication and supervise their patients, patients understand they have alternate options for pain relief, and funding is correctly distributed is when people will be able to take control of their pain, use this medication to benefit their lives, and beat addiction.

Opioid Epidemic

Each day, more than one hundred people die in the United States from overdosing on a prescription drug, commonly known as opioids (“Opioid Overdose Crisis”). Opioids are a type of drug that is derived from the opium poppy plant, or that have been man made to match the same chemical structure of said plant. The ever-so-abundant abuse of these drugs has led to a national epidemic.

Using prescription drugs for purposes other than what they were prescribed for is known as substance abuse. The abuse can be attributed to using too much of the drug, taking a drug that is not prescribed to that person, or taking the drugs for the intention of getting “high” (Prescription Drug). When opioids are taken correctly, there is little to no side effects nor damage to the brain, however, when they are taken incorrectly, nerve damage to receptors in the brain can be damaged. One side effect of opioids, taken correctly or not, is the chemical feeling of euphoria in the brain while using. This euphoria also causes a feeling of dependence when it is not achieved, leading to addiction and substance abuse (“Prescription Opioids”).

This epidemic has come about because of the over prescription of these pain relievers. In past years, such as the late 1990s, doctors were not informed about the safety and risks these drugs posed. They promised that the drugs were safe and began to over prescribe them (Volkow). As of 2017, the opioid mortality rate has contributed to the third straight yearly decline in life expectancy in the United States, a number that hasn’t been seen since the 1960s (Felter).

As stated from the United States Defense Information System Agency, this epidemic has cost the US more than one trillion dollars since 2001, according to a new study, and may exceed another $500 million over the next three years (“Opioid Epidemic”). Although opioids are very effective in pain management, the alarming statistics of the epidemic proves that the government is not doing enough to regulate these opioids and changes must be made. Many examples of this can be found in sectors such as the American Economy, threats to National Security, and has taken a major toll on public health.

The opioid epidemic poses more problems than just addiction. Another large problem the US is facing that comes with opioids is a strain on our economy. A study from The National Institute on Drug Abuse has found that the effects of opioids has cost the US over $78.5 billion per year (“Opioid Overdose Crisis”).

This strain can be attributed to a loss in job earnings and productivity. Most work related injuries are prescribed opioids due to the frequent slip, trip, fall, hazards, and heavy workloads that are all common at workplaces (“Opioids and Work”). An article from the Centers For Disease Control explains that with these work related injuries also cause job insecurity, job loss, and highly demanding jobs with low control are also being prescribed prescription opioids (“Opioid Overdose Reversal”).

Another way that opioids put a strain on the economy is through medical health care. A report from the Defense Information Systems Agency, also known as DISA, has already cost the US over $215 billion over the last 18 years (“Opioid Epidemic”). These costs have come from hospital visits, emergency transportation, and a recovery drug to quickly stop an overdose. This recovery drug is commonly known as Naloxone and works by stopping opioids from sending signals to receptors in the brain (“Opioid Overdose Reversal”). Although this drug is life saving, it also attributes to the rising costs of the epidemic.

With the opioid epidemic, taxes are also affected which in turn, harms the economy. With deaths occurring at a younger age, local, state, and federal governments are all impacted because of lost tax revenue (“Opioid Overdose Crisis”). In an article from Adam Scavette, it is explained that the average age of death by overdose is only 41 years old. This then leads to a high percentage of lost productivity in the workforce (Scavatte).

These issues all lead to a strain on the US economy. The government however is not doing enough to stop this. It is projected that this epidemic is to cost an additional $500 billion to the US by the year 2020 (“Economic Toll”). If the government were to set more regulations on the administration on the overdose reversal drug, as well as increasing taxes on opioids itself, these simple solutions would make a large impact on reducing the strain to the economy. In New York alone, the attorney general granted $1.2 million to supply its officers with the drug, Naloxone (Scavatte). This is a major contribution to the massive amount of debt caused by the epidemic and solutions must be made to stop this.

Another reason that the government should be doing more to regulate opioids is because the epidemic poses a threat to national security. There are many factors that contribute to this such as the concern for the quality of life and many issues with homeland security. Homeland security is a part of the federal government and is responsible for securing the US from any and all threats we may face. However, despite their best efforts opioids are still a large and growing problem in the US.

One part of this security concern is that the quality of life must be evaluated. A study from The American Public Health Association concludes that policies implemented to stop prescription opioids have a high chance of increasing the use of heroin and will reduce the quality of life for this group (Pitt). In this study, it was also projected that with stopping opioid use, that heroin use would increase so much that the death toll of heroin overdose would outweigh the harms of prescription opioids (Pitt). This goes to show that although opioids are a rising problem, there is not yet a solution that will result in a lesser number of deaths and is becoming an even larger threat to national security.

Another threat opioids relate to US security is the Customs and Border Protection, also known as the CBP, has seen a rising number in opioids crossing the border. From a fact sheet produced by the Department of Homeland Security, it is shown that over the past two years, the CBP has found an 810% increase in opioids being sent through the mail and only a small portion has been stopped from reaching American communities (“Confronting”). The same statistic sheet from the Department of Homeland Security also states that international mail is screened for radiological material and packages that are considered high-risk are to then be screened by a canine, officer, or by x-ray (“Confronting”). Although international packages are being screened, there is no screening done to domestic packages nor are inconspicuous packages advancely screened, raising a large concern to the safety in the US.

Another way that this epidemic relates to security is the alarming fact that Homeland Security is seizing more opioids than ever before. Some of these statistics can be found on a fact sheet from the Department of Homeland Security stating that the CBP and ICE, the Immigrating and Customs Enforcement, has managed to collect over 5,000 pounds of opioids, the equivalent of over 1.2 billion fatal doses, and enough to kill each and every American four times (“Confronting”). This raises the concern about how much of this drug is not being seized. Although many pounds of these drugs are being found, many millions more are still going unnoticed.

Opioids raise a huge threat to the safety and security of the United States. This can be shown in many different ways including but not limited to; opioids sent in the mail foreignly and also domestically, the amount of opioids being seized, and the overall quality of life for Americans. In an article on the Department of Homeland’s official website, by John Davis, it says that “even with that close scrutiny, it’s hard to find something measured in milligrams in the tons of mail that come through every day” and that “agents and officers at the border and ports of entry check as many shipments as possible, it’s simply not practical to check every shipment” (Davis). Considering this to be true, the government should set more regulations to aid the search of packages and transportation with the intention of finding and confiscating more opioids. Another way the government can aid is to spend more money on Homeland Security so that they can have special teams dedicated to searching for opioids in a team greater than the 57 members that it has now for the entire nation (“Confronting”).

Another sector that goes to show the government is not doing enough to regulate opioids, are the impacts that they have on public health. Many factors support this such as increasing rates of HIV and neonatal abstinence. As of now the government is only giving minimal support and funding to aid the public health concern.

A large portion of this public health issue can be shown through the increasing rates of blood-borne illnesses due to shared needles. The Council on Foriegn Relations article on The U.S. Opioid Epidemic explains how with these shared syringes lead to raising rates of Hepatitis C and HIV (Felter). From AVERT, Global Information and Education on HIV and AIDS, tells that water used to clean injecting equipment, reusing containers to dissolve opioids, or reusing filters can, too, transmit HIV (“Sharing Needles”).

An additional way that opioids add to the risk of public health is the risk of babies being born with dependency. As the Council on Foreign Relations tells, “Mothers may pass on opioid dependence to their children if they are abusers while pregnant or breastfeeding” (Felter). The National Institute on Drug Abuse also states that if using opioids while pregnant, there is a high risk for the mother to have a miscarrige or to have a child with a low birth rate (“Prescription Opioids”).

To add to the public health concern, opioids have additional issues facing newborn babies. An issue that is to be faced is called Neonatal abstinence when a newborn baby has withdrawal symptoms from drugs that were being exposed while the baby was still developing. As the Council on Foreign Relations reports, “ Incidences of neonatal abstinence syndrome quadrupled in the last 12 years” (Felter). With this statistic, it can be shown that nothing is being done to help mothers in need while pregnant. The National Institute on Drug Abuse states that, “Methadone and buprenorphine are two medicines to treat opioid-dependent pregnant women” and these must be taken together while the mother is pregnant, which many mothers can not afford (“Prescription Opioids”).

These issues with opioids and public health are a major concern for American society. Although there are resources to dispose of used needles and programs that can assist with providing clean needles, there is still a large risk of blood-borne illnesses that can be spread with them. At AVERT, it is explained that “abusers that practice with needles may consider joining a methadone or buprenorphine programme to reduce your risk of HIV”, a liquid form instead of injection (“Sharing Needles”). Although this may be an option, it is not readily available for most people. Along with this, the statistics of Neonatal abstinence show that even though there are drugs that can help mothers quit, there are not always accessible to them, as many can’t afford it. The government should be putting more money into these resources so that the statistics of blood-borne illnesses and neonatal abstinence can decrease.

Although the government does have few support programs, access to them may not always be easy. The government has allowed New York to spend $1.2 billion for the opioid crisis (Scavatte), however, this amount only adds to and does not stop the projected costs for this epidemic. The government has created some relief programs to supply users with clean needles and water but does not stop the act from happening.

The government is not doing enough to regulate opioids. There are numerous statistics and reports that conclude that more government intervention needs to be made in an effort to stop this epidemic. It is shown that the government is willing to spend money for rescue drugs, creating specialized teams, and providing clean needles for users, all of these resources contribute to the debt that this epidemic is causing. The opioid epidemic is wreaking havoc on the United States’ economy, national security, and public health; and without the intervention of the government, this epidemic will never stop.

Works Cited

1. “Confronting the Opioid Crisis .” Official Website of the Department of Homeland Security, 30 Apr. 2019, www.dhs.gov/publication/confronting-opioid-crisis.
2. Davis, John. “Fighting the Opioid Scourge.” Fighting the Opioid Scourge | U.S. Customs and Border Protection U.S. Customs and Border Protection – Fighting the Opioid Scourge, www.cbp.gov/frontline/fighting-opioid-scourge.
3. “Economic Toll of Opioid Crisis in U.S. Exceeded $1 Trillion Since 2001.” Economic Toll of Opioid Crisis in U.S. Exceeded $1 Trillion Since 2001, Altarum, 6 Dec. 2018, altarum.org/news/economic-toll-opioid-crisis-us-exceeded-1-trillion-2001.
4. Felter, Claire. “The U.S. Opioid Epidemic.” Council on Foreign Relations, Council on Foreign Relations, 17 Sept. 2019, www.cfr.org/backgrounder/us-opioid-epidemic.
5. National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 22 Jan. 2019, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#two.
6. National Institute on Drug Abuse. “Opioid Overdose Reversal with Naloxone (Narcan, Evzio).” NIDA, 4 Oct. 2018, www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio.
7. National Institute on Drug Abuse. “Prescription Opioids.” NIDA, June 2019, www.drugabuse.gov/publications/drugfacts/prescription-opioids.
8. “Opioid Epidemic.” DISA Global Solutions, 9 July 2019, disa.com/drug-alcohol-testing/opioid-epidemic.
9. “Opioids and Work.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 Oct. 2018, www.cdc.gov/niosh/docs/2019-101/work.html.
10. Pitt, Allison L. ,Keith Humphreys, and Margaret L. Brandeau, 2018:
11. Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic American Journal of Public Health 108, 1394_1400, https://doi.org/10.2105/AJPH.2018.304590
12. Prescription Drug Abuse. ProQuest, Ann Arbor, 2019. sirsissuesresearcher, https://explore.proquest.com/sirsissuesresearcher/document/2257693204?accountid=193381.
13. Scavatte, Adam. “Exploring the Economic Effects of the Opioid Epidemic.” Federal Reserve Bank of Philadelphia Research Department, 2019.
14. “Sharing Needles to Inject Drugs, and HIV.” Avert, 20 Aug. 2019, www.avert.org/hiv-transmission-prevention/injecting-drugs.
15. Volkow, Nora D. “Prescription Drug Abuse.” NIDA Archives, 22 Sept. 2010, archives.drugabuse.gov/testimonies/2010/prescription-drug-abuse.

Summary

This paper’s intention is to deliberate the United States Opioid epidemic that has been going on for quite an extensive amount of years. This paper will also discuss the suggested recommendations to put in place targeting Overtown, Florida. This paper will explain why Overtown, Florida needs the enhancement of the policy, along with various opportunities for growth and bettering of public health throughout South Florida. Opioids are oral medications that have been commonly misused even when prescribed for the reduction of physical pain. Addiction begins when someone becomes dependent and puts themselves at risk for a drug-induced overdose. In the year 2017, pharmaceutical companies began medical and prescription limitations on filling opioids. This limitation was made to ensure that only a week supply would be given out per person. In the year 2016, 63,632 drug-induced overdoses were recorded and 42,249 had been linked to opioids. (CDC, 2018).

President Donald Trump acted amongst these troubling and dark times. At this time, there became a stance on public health emergency. The following methods were concluded in efforts to aid the United States Opioid Epidemic: “reimburse State Medicaid programs to cover substance abuse and treatment facilities, expand funding and access to existing and new, integrated medication-assisted treatments, instruct doctors in proper practices in pain management, widely increase access to naloxone, finally, waive existing federal provisions inhibiting effective responses” (Hodge, Wetter, Noe 2017). The United States Opioid Epidemic helped millions of Americans reinvent the way most would look at treatment for substance abuse.

Tackling the United States Opioid Epidemic is such an important topic to this day. Millions of Americans are losing control of their life and their life itself as the year 2019 comes to an end. The loss of millions of lives is rooted from scarcity in treatment options, lack of education on substance abuse, and pending support from the United States Government. The United States Opioid Epidemic is getting worse as time goes on because there is plenty of prosperity from political saying than losses. For example, the Needle Exchange Program gives out Narcan products to Americans. These organizations strong advocacy morals can be the line between life and death for millions of Americans. The United States Opioid Epidemic can better with the expansion and availability of Narcan, more public interest from schools and non-profit organizations, treatment centers accepting more insurance plans, social workers advocating for addicts, and an overall expansion on public education about the United States Opioid Epidemic.

Current Situation

The United States Opioid Epidemic is an ongoing battle that millions of Americans are still putting up their fights with. On June 1924, The Anti-Heroin Act was set forth as a Federal Law that banned the import and use of heroin and diamorphine. In 1970. The Controlled Substances Act of 1970 came to be. This Act was a federal policy that banned the import, making, use, and selling of stimulants, hallucinogens, narcotics, anabolic steroids, and depressants. In the year 2007, Perdue Pharma released a brand-new drug labeled as OxyContin. Perdue Pharma endorsed that when OxyContin was taken, the effects would be safer than that of Opioids. Perdue Pharma was eventually sued and charged with misleading the Americans for falsification of medical information. In the year 2010, the numbers of OxyContin use rose to 598,00. The most alarming fact of this dark statistic would be that the ages of users would range between twelve years old to forty-nine years old (Manchikanti, et al. 2012). In 2016, the United States Opioid Epidemic hit its boiling point. Roughly 64,000 Americans passed away from drug-induced overdoses. While in Florida, that same year, the consumption of heroin causing 952 fatalities, fentanyl causing 1,390 fatalities, oxycodone causing 723 fatalities, and hydrocodone causing 245 fatalities” (Florida Medical Examiners Commission Drug Report, 2016). In the year 2017, President Donald Trump authorized an executive order in correspondence to the United States Opioid Epidemic. President Donald Trump began the “President’s Commission on Combating Drug Addiction and Opioid Crisis. “The members of the Commission include Governor Chris Christie, Governor Charlie Baker, Governor Roy Cooper, Congressman Patrick Kennedy, Professor Bertha Madras, and Florida Attorney General Pam Bondi.” (House of Representative’s Final Bill Analysis, 2018).

On May 3, 2017, Governor Rick Scott signed the Executive Order 17-146 which focused on the United States Opioid Epidemic becoming a Florida Public Health Emergency. Executive Order 17-146 changed and renewed Florida first responders such as EMS and police to carry Narcan readily available on them. February 19, 2018, Florida’s Public Health Emergency was prolonged by Governor Rick Scott for sixty days. On October 26, 2017, President Donald Trump announced a nationwide public health emergency. Along with the announcement, President Donald Trump provided a five-point strategy to combat the opioid epidemic. The five-point strategy was stated as follows: access to prevention and treatment, targeting availability of Narcan, educating the public of the opioid crisis, provide support for research on addiction, and advance practice for pain management (NIH, 2017). On November 1, 2017, The President’s Commission on Combating Drug Addiction and Opioid Crisis made its final report and final recommendations. Their final report included: “reduce administrative burdens on funding towards the opioid epidemic, develop training for opioid prescribers, screening for mental health risk within patients, enhance the use of prescription drug programs and the way they monitor, and treat opioid addiction and recovery while researching” (NIH, 2017).

Proposed Changes

CS/CS/HB 21: “Controlled Substances” has been authorized to address the United States Opioid Epidemic. CS/CS/HB 21 sets forth health care practitioners must complete a board-approved, two hour continuing education course. All Florida Health Care Practitioners registered with the United States Drug Enforcement Agency must have completed the course by January 31, 2019. All Florida Health Care Practitioners must complete this mandated continuing education course when renewing their medical license (Controlled Substances Act of 2018). The continuing education course addresses the following: “up-to-date standards on prescribing controlled substances, alternatives to the current standards on controlled substance prescribing; and information on the risks of opioid addiction following all stages of treatment in the management of acute pain” (Controlled Substances Act of 2018). The course is mandated to be given by professional association of physicians that is legally accredited by the Florida Medical Association or the Florida Osteopathic Medical Association. The continuing education medical course can be completed in a long-distance format and must be included for the biennial renewal of a health care practitioner’s license. The Department of Health does not have the right to renew the individual’s license of a prescriber who fails to complete the mandated prerequisite (Controlled Substances Act of 2018).

CS/CS/HB 21 enacts the Department of Health to establish regulations and guidelines for prescriptions of controlled substances. These laws and regulations must contain the following: patient evaluation, creating and maintaining treatment plans, obtainment of patient consent and agreement, reviews conducted periodically, patient consultations, review of patient’s medical records, and medical compliance regarding controlled substances regulations (Controlled Substances Act of 2018). CS/CS/HB 21 limits the prescription amount of Schedule II opioids to a three-day period per patient. However, this amount may be modified to a week supply if a physician deems it medically necessary. If this is medically necessary, the documents and prescription bottle must indicate so prior to patient hand-off. Prescription limitations do not apply if the patient is treating cancer, terminal illness, or medical paint that may be associated with palliative care, or a severe injury with an Injury Severity Score of 9 or higher. If a physician prescribes a Schedule II opioid for a severe injury, CS/CS/HB 21 requires the physician to also prescribe an emergency opioid antagonist (Controlled Substances Act of 2018).

CS/CS/HB 21 began new regulations regarding medical reporting. By law, when opioids listed in Schedule II, III, and IV are given out, the controlled substances must be reported back to the Prescription Drug Monitoring Program (PDMP). CS/CS/HB 21 elaborates to include non-opioid controlled substances that is contained in Schedule V. CS/CS/HB 21 mandates the dispenser to document the following: patient’s phone number, indication whether the prescription is an initial dosage or a refill, amount of number of refills, name of person during hand-off, and government-issued Identification during hand-off (Controlled Substances Act of 2018).

CS/CS/HB 21 establishes regulations that pharmacies must follow during prescription hand-off. CS/CS/HB 21 requires patient consultations and a review of the PDMP to acquire patient history. This is mandated for patients sixteen years and older ages. The only case where a pharmacy does not need to report the hand-off is if there is a technical issue during hand-off. Although, the pharmacy must still report why the consultation of PDMP was not done and the prescription limit remains at a three-day dosage. Any pharmaceutical company that fails to comply is subject to a minor citation. However, offense occurs more than once, the dispenser will be subject to disciplinary action (Controlled Substances Act of 2018).

Effects of Proposed Changes

Continuing education courses for health care practitioners will help and educate not only those working in the field, but also current and future patients. By health care practitioner staying up-to-date on skills, medicine, and developments, they are more likely to be a valued worker to their company, as well as a confident worker for their patients to answer any minor or burning questions that they might have over medications. With the epidemic that has been going on for years, a patient might walk into pick up their prescription feeling very nervous during pick up. By having continuing education courses for pharmaceutical companies, breaking the ice and addressing medical concerns might be easier and smoother. Education starts by the curriculum of continuing education and flows between the confident dispenser and relieved patient. Lastly, continuing education will also provide ethical frameworks, instill a sense of accountability, and establish moral behaviors and decision -making.

Political Implications

CS/CS/HB 21 was put forth by Health Services Committee, Health Quality Subcommittee and Representative Boyd. CS/CS/HB 21 was a very successful proposition from the get-go as The Health Quality Subcommittee voted 15 YEAS and 0 NAYS, the House of Representatives voted 99 YEAS and 0 NAYS, and finally, the Senate voted 37 YEAS and 0 NAYS. On March 8, 2018, Governor Rick Scott signed for CS/CS/HB 21 and became effective on July 1, 2018. CS/CS/HB 21 many medical teams such as dentists, podiatrists, optometrists, physicians, physician assistants, pharmacists, and pharmacy technicians (Controlled Substances Act of 2018).

Pharmacies, medical providers, and physicians do not benefit from CS/CS/HB 21. As previously mentioned, pharmaceutical companies are notoriously infamous for honoring and marketing their products, even if their products do not benefit human lives. In the years 2000 and 2003, the FDA indicated that OxyContin labels contained misinformation, therefore misleading millions of Americans (FDA, 2018). Pharmacies and medical providers also do not benefit from CS/CS/HB 21 because having to complete a two-hour training course towards their licensure renewal puts more work to the staff members’ training and educational process. Physicians do not benefit from CS/CS/HB 21 because the legal penalty for overprescribing opioids rose in the year from a third-degree felony to a second-degree felony. If a physician is caught overprescribing controlled substances, they may be subject to disciplinary action.

Police officers and law enforcement benefits from CS/CS/HB 21. By common word of mouth, law enforcement’s mission is stated as, “to serve and protect”. By interfering with opioid-related crimes, law enforcement puts a stop to trends from an individual level, to a group-level, to possibly a community level. By serving their communities, law enforcement saves thousands of lives not only statewide but nationwide as well. Law enforcement has the power to charge drug dealers in federal court. Sometimes these scandals become news-worthy. By spreading awareness that smuggling opioids is a serious crime, this could reduce the numbers of incidents and save potential lives by reminding the public to seek help if they or a loved one are at risk for substance abuse through drug-dealing or through personal use.

Fiscal Implications

There are no fiscal impacts on the State Government revenues. However, there are fiscal impacts on the costs. CS/CS/HB 21 assumes $27,035,532 in nonrecurring funds from the Federal Grants Trust Fund to the Department of Children and Families (DCF), in costs correlating to the second year of the State-Targeted Response of the Opioid Crisis Grant. The purposes of these costs are prevention and treatment to cease opioid related overdoses. Another cost would be $14,626,911 in recurring funds from the General Revenue Fund to DCF towards community-based services. These community-based services include outreach, treatment, and recovery specialties. Social services might also include: aftercare services, outpatient services, case management, medicated-assisted therapies such as Narcan. As mentioned previously, $5,000,000 in returning funds from the General Revenue Fund to DOH is also provided for the costs of emergency opioid antagonists for distribution to emergency responders. $6,000,000 in recurring funds is provided from the General Revenue Fund to the Office of State Court Administrator for medicated-assisted therapy for those at risk for becoming involved in drug-related crimes or are mandated by the court. $873,089 is provided in recurring funds and $117,700 is provided in nonrecurring funds from the General Revenue Fund to DOH for innovations to PDMP (House of Representatives’ Final Bill Analysis, 2018).

There are also fiscal impacts for pain management clinics and criminal justice systems. Pain Management Clinics DOH savings are associated with decreases in the unlicensed-activity examinations occurring throughout pain management clinics. Standard costs of examination are roughly $2,100. In the last biennium, the Department of Health studied six examinations, which led up to a cost of about $12,600. Administrative spending is associated with allotting the credentials of exemption, are below spending relating unlicensed activity examinations. This results in saving expenditures (House of Representatives’ Final Bill Analysis, 2018). The Criminal Justice System’s fiscal implications would be that CS/CS/HB 21 has a positive impact on prison beds since CS/CS/HB 21 enacted that opioid-related crimes rose from a third-degree felony to a second-degree felony (House of Representatives’ Final Bill Analysis, 2018).

Recommended Action

On July 1, 2018, the CS/CS/HB 21: Controlled Substances Statute took effect. I support the passing and enacting of CS/CS/HB 21. After some consideration, I concluded that what we need is more public education amongst Overtown, Florida. This would be possible through various social workers speaking at major social services facilities such as Camillus House, Banyan Health Systems, Kristi House, and Miami-Dade Public Schools. I believe Florida International University would have great pull to make these connections happen. For example, Professor Boren and other social work professors at Florida International University could invite graduate students to prepare portions of speeches alongside of them at townhall meetings or local speaking events held in Camillus House and Touching Miami with Love. Additionally, since Law Enforcement also cares about this topic, we could invite them to share their experiences and current polices that have been put into place. This could very well target Overtown for now, but if more communities and people of power care and become involved, we could turn these meetings of public education, into an Opioid Awareness Day for Miami-Dade County. Lastly, I would recommend a lot of broadcasting tools such as Florida International University email alerts, Camillus House email alerts, Instagram and Facebook alerts on social media pages created for the prevention and awareness of opioid usage. I believe that spreading more awareness of CS/CS/HB 21 and resources to stop the opioid epidemic should not be a one-day or a couple of months duration. This should be a complete advocacy topic that social workers, law enforcement, teachers, and even health care practitioners can speak up in order to create more awareness and decrease the numbers of those who have lost or are at risk for losing their lives due to lack of education and substance abuse addiction. In conclusion… Calling all Social Worker Professors at Florida International University, could you help me, and millions of Americans start a movement on public education? Overtown and many other vulnerable communities like Allapattah, Miami Gardens, Downtown, etc. could use Professionals like us that really care about our community. If you are interested, please follow me on LinkedIn and let us start a conversation on how we can make community change happen. Let’s work on making an official “Opioids Awareness Day” in 2020!

References

1. CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov.
2. Controlled Substances Act, Fla. Stat. § § 456.0301 (2018). Retrieved from https://www.flsenate.gov/Session/Bill/2018/21/?Tab=Analyses
3. Florida Medical Examiners Commission Drug Report 2016. (2017). Florida Medical Examiners Commission Drug Report. Retrieved from https://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-in-Deceased-Persons/2016-Annual-Drug-Report.aspx
4. Hodge, J. G., Wetter, S. A., & Noe, S.A. (2017). Emerging legal responses to curb the opioid epidemic. Journal of law, medicine & ethics, 45(3), 460-63. Retrieved from https://doi.org/10.1177/1073110517737557
5. Manchikanti, L., Helm, 2. N., Fellows, B., Janata, J. W., Pampati, V., Grider, J. S., & Boswell, M. V. (2012, July). Opioid epidemic in the United States. Retrieved November 24, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/22786464
6. NIH (2017). Evidence on Strategies for Addressing the Opioid Epidemic. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458653/.
7. The Florida Senate. CS/CS/HB 21 — Controlled Substances Bill Summary; Retrieved from https://www.flsenate.gov/Committees/BillSummaries/2018/html/1799
8. Timeline of selected FDA activities and significant events addressing opioid misuse and abuse. (2018). Retrieved from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm338566.htm

From when President Eisenhower gave his ‘Domino Effect’ speech in 1954, to the fall of Saigon in 1975, the U.S. military had been inserted into Vietnam in order to fight off the communist forces at war with South Vietnam. Although the Vietnam conflict was never considered a real war, nearly 60,000 U.S. soldiers were killed in battle. America’s involvement went on for more than 20 years and oversaw leadership from: Dwight. D Eisenhower, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, and Gerald Ford. With many of the United States soldiers being draftees, there was a growing concern of a drug epidemic taking place overseas. However, it was Nixon and his team who led the public to believe that after the conflict was over the U.S. would have a growing problem of addicted soldiers coming home. Citizens over in the states were filled with concern for their hometowns to be filled with junkies. Although many Vietnam soldiers were painted to be hardcore drug abusers in early 1970 by Nixon and other forms of media, there were many misconceptions which still resonate today about: drugs of choice for young American soldiers, rehabilitation methods, and addiction.

One of the biggest issues to affect the misconception of addiction is how the public reacted to the Saigon heroin epidemic. President Nguyễn Văn Thiệu, of the South Vietnamese government, issued out a special task force to combat the flow of heroin to soldiers. The Director of the Bureau of Narcotics and Dangerous Drugs, John Ingersoll, informed the U.S. government of the heroin circulation between U.S. troops. Ingersoll quoted a military commander saying, “Tens of thousands of soldiers are going back as walking time bombs”, which only added to public fear of drug corrupted soldiers finding their way home. The U.S. government was in need for a solution to the crisis. America attempted to prevent the drug epidemic by removing supplies and treating the addicted. However, even though there were nearly 60,000 addicted soldiers, only 10 rehabilitation centers were provided by the Army. The largest of these facilities could only hold around 30 soldiers. Because of the lack of rehabilitation methods provided by the U.S. government, America turned to punishment methods for heroin addicted soldiers. One high ranking officer commented on punishment after the rehabilitation program by saying: “You can only do it once. The next time its jail or a bad conduct discharge that stays with you the rest of your life. Let’s face it. I would have never been on the stuff if they hadn’t sent me over here”. By incarcerating and punishing Vietnam troops, American society began to believe that addiction was only for the lazy, undisciplined, and criminal. Many were persuaded by the idea that addiction could be cured by pure willpower and punishment. By completely curbing the idea of a slow rehabilitative addiction process, the United States’ soldiers were ostracized because of false preconceived notations.

In fact, drug abuse and addiction has very little to do with self-discipline. Overcoming the chemical craving in one’s brain has more to do with a shift in environment rather than pure willpower. When studying soldier behavior after the war, Lee Robins found that approximately 95 percent of soldiers who used heroin in Vietnam, expel their addiction nearly on arrival home. Robins discovered that addiction could suddenly disappear if there was a sudden change of environment, therefore debunking previous ideas about how addiction takes place in the brain. However, the American people were still not fully aware of this study, and continued to turn drug abusers into outcasts. Another contributing factor to the country’s widespread fear of drug abuse, was the fallacy that all drugs used in Vietnam were inherently equal. This is to say that a soldier who used marijuana or alcohol would immediately be categorized as a junkie. Even though only around 28 percent of U.S. soldiers had used hard drugs, many more were viewed as addicts because of their use of marijuana. This only contributed to the constant ostracizing of young soldiers, and the mass delusion that all drugs were inherently for the mentally unstable.

Even though around 9 in 10 soldiers overcame their addictions after entering the United States, there were still many veterans struggling with their disorder. American society had out casted these young struggling soldiers, which led to many ending up: homeless, unemployed, and still struggling with drug abuse. As of 2008, nearly 47 percent of homeless veterans are from the Vietnam era, and close to 76 percent struggle with drug and alcohol abuse. Rehabilitation programs were not as available as one might think during the post-Vietnam era. The United States government today still fails to support the homeless population today. The Department of Veterans’ Affairs only managed provided 8,000 beds, despite the population of homeless veteran’s being close to 200,000. Although our country is currently taking action to better support homeless veterans, America still faces a large problem caused by misconstrued information on addiction. Many American citizens are currently incarcerated for non-violent drug offenses. As of April 6, 2019, 45.5 percent of inmates are imprisoned on drug related charges. Rather than focusing on the rehabilitation methods for those inmates, America’s legal system has taken a more disciplinary approach. The federal inmate population at the end of 1976 was 23,566, and at the end of 1986 it was 36,042. These mass amount of drug charge arrests took place right after the Vietnam War ended. This particular timeline showcases how a negative outlook on addiction can impact the lives of millions.

To this day American society still struggles to cope with the realities and facts about drug abuse. Because Nixon and the American people blackballed soldiers struggling with addiction, fallacies about drug cravings and rehab still resonate today. Proper measures to prevent and contain this epidemic were not taken. Due to the troubled past America has had with introducing new ideas, Lee Robins’ research was never popularized or introduced to the American public.