To analyze current policies aimed at addressing the opioid crisis, describe examples of the crisis, and suggest a few options to help solve the problem to the community. A stakeholder group of people in the community, including local policymakers, leaders, and concerned citizens. The United States of America is experiencing a severe crisis of opioid abuse. In 2019 alone, opioids took the lives of 50,000 Americans, and the economic burden from the problem is about $78.5 billion a year (National Institute on Drug Abuse, 2021). This issue concerns many stakeholders, from society and medical staff to individual policymakers and representatives of various structures like the Center for Disease Control and Prevention (CDC) or the National Institute on Drug Abuse (NIDA). Although different structures and organizations are making many efforts to stop the crisis, communities can also significantly contribute to solving the problem. Everyone present here can learn and do more than now, and then together community will save more lives. Today, I will present a description and analysis of policies against the opioid crisis, consider examples of the crisis, and propose several measures and actions that communities can take in this fight.
It is important to say that there are several main directions for political action in the fight against the opioid crisis. Key actors such as the U.S. Department of Health and Human Services (HHS) and National Institutes of Health (NIH) prioritize the following:
Improved access to treatment, prevention, and recovery services;
Promote the availability and use of drugs that prevent overdoses;
Healthcare surveillance for transparent reporting and collection of data to better understand the situation;
Support research in understanding pain and safe methods of its management;
Promoting different pain reduction methods (Collins, 2017; NIDA, 2021).
Most organizations involved in the fight against the crisis are focused on the mentioned goals. Organizations include Substance Abuse and Mental Health Services Administration (SAMHSA), CDC, Food and Drug Administration (FDA), and other entities. Some organizations add their own goals; for instance, the Healthcare Fraud Prevention Partnership (HFPP) also seeks to identify and stop fraud and other dishonest opioid activities (Healthcare Fraud Prevention Partnership, 2017). Programs in the States, in turn, monitor drug prescriptions and the work of pain management specialists (CDC, 2019). Thus, all measures aim to reduce the chances of opioid abuse and maintain the nation’s health.
The analysis aims to understand and evaluate policy effectiveness to provide informed advice for new policy decisions and actions. Analyzing the existing medical policy, it is worth paying attention to its successes. Some successes include:
State programs in Ohio, Kentucky, Florida, New York, Tennessee, and other states, have helped reduce opioid abuse and mortality rates (CDC, 2019);
SAMHSA provides professional training grants and Medication-Assisted Treatment (MAT) for vulnerable populations;
The CDC conducts and supports studies that bring new knowledge on risk factors and other influential aspects and offer solutions.
However, it is worth noting that the problem continues to exist. In particular, policies may have unintended consequences of using drugs other than opioids due to insufficient attention to the causes of abuse (Lee et al., 2021). Therefore, the fight against opioids should be comprehensive and include measures to improve social conditions and community support.
Let us consider some examples of the manifestation of the opioid crisis, which may be significant for policies to combat it. Examples:
The opioid crisis began in the late 20th century when pharmaceutical companies convinced society that opioid-based painkillers would not be addictive and were prescribed in large quantities (NIDA, 2021);
About 21-29% of patients with prescriptions for opioids due to chronic pain misuse them, and 4-6% of abusers later abuse heroin (NIDA, 2021).
8-12% of those taking prescribed opioids suffer from opioid use disorders (NIDA, 2021);
Risk factors for developing opioid addiction include improper or prolonged drug use, poverty, unemployment, personal or family history of misuse, risk behavior, contact with high-risk individuals, stress, and other causes (Mayo Clinic Staff, 2018).
Understanding the risks, causes, and influencers for the opioid crisis, one can suggest several measures that communities can take. Proposed measures include:
Collaboration within the community to raise awareness about the dangers of opioids, policies to combat the crisis, the possibilities of intervention, and the provision of assistance for overdoses;
Creating an organization or public coalition that can help people with addiction, particularly through referral to treatment, providing drugs that prevent overdoses, and other measures;
The creation of support groups in various areas help those who suffer from addiction, help those who suffer from chronic pain and similar issues connected with risk factors.
The evaluation criteria for proposed policy options include:
Community awareness of the dangers of opioids, laws related to the crisis, and people’s ability to take action and provide assistance;
Help members of the community that suffer from opioid use disorders;
Availability of overdose prevention drugs and treatment to those members of the community who need them;
Activities of support groups aimed at mitigating risk factors and social support.
In summary, it is essential to note that the opioid crisis poses a significant danger to Americans. It began after erroneous information that opioid-based drugs are not addictive spread. However, the use of such drugs carries a high risk of developing addiction and other disorders associated with opioid use. Various organizations and public bodies have taken many actions to combat the crisis. Key measures are drug prescription control aimed at reducing opioid use, finding other pain management methods, and similar efforts. Societies can be critical participants in the struggle by providing information, helping those who suffer from addiction or severe pain, and taking other measures. Thus, everyone present here can take some actions and help save lives.
References
Centers for Disease Control and Prevention. (2019). State successes. CDC Website. Web.
In most patients, some types of drugs function better as expected, but the same cannot be said about other patients who experience advance side effects such as toxic effects, even with minimal doses. The reason for such adverse outcomes, in some patients, has been attributed to genetic. This essay defines pharmacogenomic testing, demonstrates how it would change prescription of opioid treatments and potential benefits to medical marijuana testing.
According to Kitzmiller et al., pharmacogenomics is the study of “how genetic factors relate to interindividual variability of drug response” (243). It has been established that significant minorities of the population have genetic variants referred to as polymorphisms, which influence their reactions to different drugs (Kitzmiller et al. 243). Studies in genetic and comprehension of drug variability have led to increased pharmacogenomic testing in the last decade. As such, several polymorphisms have been tested and results are currently available.
Specifically for opioids and pain management, researchers have demonstrated that people with elevated levels of phenotype activities may need increased doses of opioids compared to patients with low phenotype activities (Tennant and Hocum 3). Based on such results, the researchers noted that the most appropriate mechanism involved high-activity catechol-o methyltransferase (COMT) outcomes, which led to a decreased response of the neurotransmitter and, thus, low signal transduction when painful stimuli occurred, causing higher pain intensity (Tennant and Hocum 3). In addition, these studies have also established that people with such conditions also reflect reduced downstream opioid receptor density (Tennant and Hocum 3). When such patients suffer pain, it could be extremely severe and, therefore, higher doses of opioid are normally needed.
Medical marijuana is known to management chronic pain conditions such as spinal cord insult, fibromyalgia, and neuropathic pain among others (Stanz 1). In this regard, pharmacogenomic testing can significantly transforms prescription of medical marijuana to patients. For instance, in the recent years, a medical marijuana-testing laboratory has developed a technology to predict possible outcomes associated with “medical marijuana several strains through the use scientific data and reviews obtained from social networking Web site” (Stanz 1). Consequently, patients can personally choose medical marijuana based on ratings for “sleep aid, pain relief, nausea treatment and anxiety, appetite stimulation, and mood modification” (Stanz 1). These new technologies open more avenues for pharmacogenomic testing to enhance outcomes. Thus, medical marijuana with multiple applications can be effectively used based on pharmacogenomic testing results.
Obviously, pharmacogenomic testing will transform the practice of medicine and prescription. It has been noted that the use of pharmacogenomic testing is now extending to some widely prescribed medicine and other drugs used in primary care. It is imperative to note that the mass application of individualized medicine is not yet developed while expert committees have not given their opinions for most drugs, including medical marijuana.
With the information of patients’ genetic conditions, physicians could determine possible reactions of patients to specific drugs, including medicine marijuana. As such, they are most likely to lead to enhanced efficacy, reduced cases of advance outcomes related to drugs, and lower costs of treatment. Thus, potential impacts of pharmacogenomic testing are substantial because many drugs with adverse outcomes are subjected to chemical activities involving polymorphic enzymes. Adverse, unexpected reactions of drugs remain risky to public health. Hence, morbidity and mortality associated with adverse drug reactions, including medical marijuana can be curbed through pharmacogenomic testing.
References
Kitzmiller, Joseph P. David K. Groen, Mitch A. Phelps and Wolfgang Sadee. “Pharmacogenomic testing: Relevance in medical practice.” Cleveland Clinic Journal of Medicine 78.4 (2011): 243–257. Print.
The United States is facing a serious social problem in the name of the opioid epidemic. It is a challenge that impacts millions of people, especially teenage children. A significant population of young American people is at risk. The good news is that the opioid problem and other related addictions are preventable if the right preventive models are employed. Throughout this course, different preventive models and their effectiveness have been explored. Specifically, primary, secondary, and tertiary intervention methods have been emphasized as the best approaches to dealing with social concerns at a broad level. Based on what I have learned, I strongly believe combining the three prevention models would be effective in my school or community.
The prevention models work perfectly well since they target different behaviors and groups. As a result, the strategy or programs ensures that everyone in the community is served. The primary prevention level majorly aims to create awareness about the social problem and how to avoid it (Capuzzi & Stauffer, 2014). In the case of the opioid pandemic, the primary stage educates the masses on the causes and effects of misusing opioid drugs. Although the target population is young people, other members of society can also benefit from the knowledge. Thus, the goal of primary prevention is to control the problem before it harms people by creating awareness.
On the contrary, secondary prevention targets individuals at risk through exposure to social problems. Although the approach educates the targeted people, the main purpose is to enhance change in behaviors (Capuzzi & Stauffer, 2014). For instance, secondary prevention helps in educating those youths who are experimenting with drugs. Thus, it enables the affected individuals to abandon the behavior before it gets to the addiction level. Lastly, the tertiary prevention approach focuses on treating the affected individuals (Capuzzi & Stauffer, 2014). An excellent example is young people already addicted to drugs like opioids. The aim is to lessen the impact of the addiction and help the persons recover from the problem. Therefore, the prevention model would be effective in my school or community since it caters to everyone, including people not yet affected and those already struggling with addiction.
Reference
Capuzzi, D., & Stauffer, M. D. (2014). Foundations of addictions counseling (3rd ed.). Pearson.
The widespread opioid epidemic has forced many to endure significant pain and suffering. Numerous individuals have passed away; the epidemic has damaged countless families and communities irreparably. Since the problem is intricate and nuanced, it will require various approaches that concentrate on different facets of the epidemic. A multi-pronged approach will be required to fully address this issue, favoring such treatment options as behavioral therapies and pharmaceutical methods.
Efficient Approaches
Increasing access to addiction treatment is one approach that is frequently mentioned. The inability to obtain inexpensive healthcare is one of the main barriers to treating drug addiction. Only a small portion of the estimated 20.3 million Americans with substance use problems received treatment, according to data from 2018, with financial difficulties being the leading cause (Hanson et al., 2020, p. 675). Addressing this may entail expanding the number of treatments that have been shown effective, such as medication-assisted therapy, behavioral therapy, and peer support initiatives (Hanson et al., 2020). Additionally, it might be necessary to raise the standard and accessibility of care, especially in remote and underserved areas. This includes educating more medical professionals in addiction treatment, offering financial incentives to motivate them to practice in these fields, and raising funding for initiatives and services. The benefits of lower costs and better outcomes can be enjoyed by society by ensuring access to comprehensive care.
On the other hand, the over-prescription of opioid medicines, which plays a significant role in the emergence of addiction, must also be addressed. Implementing prescription drug monitoring programs, educating healthcare professionals more, and tackling illegal distribution and prescription drug addiction are some ways to achieve this. In order to lessen the reliance on opioid medicines, non-opioid pain management options, including physical therapy, massage, and chiropractic care, should be made more widely accessible.
The Use of Resources
Considering the scope of the opioid epidemic, it is crucial to think about how to make the greatest use of available resources. As a sizeable number of them do not receive treatment because of a lack of funding, it will take a deliberate and methodical strategy to stop the opioid crisis. Resources must be distributed in a way that considers all facets of the issue, from prevention and treatment to recovery and support. Thus, the most effective approaches should be prioritized for funding. For this, it is necessary to have a thorough awareness of the problem and the flexibility to modify and improve as circumstances dictate.
As it stands, both pharmacological and drug-free methods are among the most effective approaches. Behavioral therapies are one especially beneficial strategy; they target numerous drugs and employ various techniques to assist people in achieving their goals. A standout among these treatments is cognitive behavioral therapy (Hanson et al., 2020). In addition, pharmacological treatments such as methadone, naloxone and naltrexone, buprenorphine, and disulfiram have been used to treat opioid addiction, with methadone being particularly effective in treating this particular substance abuse disorder (Hanson et al., 2020). These treatments are based on the properties of the drug to which the patients are addicted and aim to suppress the effects of narcotic drugs. It can be seen that behavioral therapies and pharmacological approaches are the ones that merit priority for funding and resource allocation.
Conclusion
In conclusion, addressing the opioid crisis requires a holistic strategy incorporating pharmaceutical and behavioral treatments. Resources must be distributed in a way that considers all facets of the issue, from prevention and treatment to recovery and support, while behavioral therapies and pharmaceutical treatments need to be prioritized due to their proven impact. For this, it is necessary to have a thorough awareness of the problem and the flexibility to modify and improve as circumstances dictate. It is possible to overcome substance misuse and addiction and have a better, more rewarding life with the correct combination of therapy and support.
References
Hanson, G. R., Venturelli, P. J., & Fleckenstein, A. E. (2020). Drugs & Society. Jones & Bartlett Learning.
The misuse of prescription opioids is a widespread issue that has a considerable effect on the United States healthcare sector. House Bill 167, introduced in Ohio, has the potential to address the opioid crisis in the state by restricting the prescription of opioids by care providers. The bill has brought forward by a complex environment, including patients’ and providers’ attitudes to opioids, increased health care costs, and related legislative action on national and state levels.
The bill will have significant consequences for both care providers and consumers, such as improved patient safety, increased cost of care, and limited access to effective pain management. Compared to similar legislation in Canada, the bill has several weaknesses that could impair its effectiveness. The present paper analyses the bill, its context, and potential effects while also proposing amendments that would make the law more effective in addressing the problem of prescription opioid misuse.
Introduction
Healthcare in the United States is greatly influenced by the legislative environment of the country. Prevalent healthcare issues, such as access to care, prescription medications, and the cost of services, are often affected by bills on the state and national levels. The present paper will explore and discuss the bill to restrict the prescription of opioid medicines in Ohio, reflecting on the bill’s environment, passage, and consequences.
Bill Number and Title
The number of the bill to be addressed in the paper is HB 167. It is a house bill with a short title “Address Opioid Prescribing and Addiction Treatment”. An extended title of the bill is “To amend sections 4723.52, 4730.56, 4731.83, and 5119.363, to amend, to adopt a new section number as indicated in parentheses, section 3715.08 (3719.064), and to enact sections 3719.063 and 4729.283 of the Revised Code regarding naltrexone and medication-assisted treatment” (“House Bill 167,” 2018, para. 1). The bill serves to improve the mechanisms of opioid prescription and addiction treatment in the state of Ohio to reduce the incidence of overdose deaths and other adverse effects of opioid prescriptions.
Legislative Issue
The bill addresses the legislative issue of opioid prescribing and addiction treatment in the United States. Opioids are often prescribed to people with chronic pain, as well as other conditions that require superior pain management approaches. The prevalence of opioid use in the country is rather high, which influences the incidence of medication addiction and overdose. Therefore, the bill aims to restrict the use of opioids by patients to reduce the adverse effects of opioid medications.
Effect on Advanced Practice Nursing
The bill will have a significant impact on advanced practice nursing, as it will regulate the prescription of opioid medicines to patients. Hudspeth (2016) states that nurse practitioners are required to follow state and national guidelines when prescribing medications. Moreover, nurses also have a responsibility to ensure that the treatment is safe and effective. Therefore, the legislation will affect the treatment options available to advanced practice nurses and their decision-making with regards to treatment.
Sociocultural Environment
The socio-cultural environment of the bill includes people’s lifestyles and attitudes towards medications. In today’s world, many people rely on medications to live a fulfilling life, especially if the condition affects their daily functioning. Pain can have a critical effect on the quality of life of an individual, especially in the case of chronic or long-term pain that cannot be managed with over-the-counter medications. For instance, Schaller, Dejonghe, Haastert, and Froboese (2015) found that chronic low-back pain is associated with depression, anxiety, stress, and reduced mobility, and thus impairs the respondents’ quality of life.
This means that pain prevents people from living an active, healthy lifestyle, which is among the key determinants of happiness in the contemporary sociocultural environment. Therefore, pain management is necessary for people to remain physically active and have a high quality of life. While the bill seeks to regulate the prescription of opioids, it could also assist patients and care providers in adopting new options for pain management.
Ethical Environment
The ethical environment of the bill is comprised of the notions of quality of life, patient safety, and treatment efficacy. On the one hand, nurses and physicians alike have a professional responsibility to treat patients. When a condition cannot be treated or when treatment is a long-term process, care providers should focus on enhancing patients’ quality of life by managing the symptoms, including pain (Rothstein, 2017). Opioids are an effective means of controlling and relieving pain, and thus opioid prescriptions help to fulfill care providers’ responsibility to prescribe adequate pain management medications.
On the other hand, care providers are also responsible for ensuring and promoting patient safety. Opioid misuse is connected with a variety of patient safety threats, including overdose and addiction. Keyes, Cerdá, Brady, Havens, and Galea (2014) state that the number of deaths from unintentional overdose of opioids has increased dramatically since the 1990s: “Unintentional overdose deaths from opioid pain relievers have quadrupled since 1999 and by 2007 outnumbered those involving heroin and cocaine combined” (p. 52).
Therefore, while opioids are useful and help improve patients’ quality of life, there are also significant risks associated with prescribing these medications. The two sides of the issue present a moral dilemma for care providers and legislators, thus shaping the ethical environment of the proposed bill.
Economic Environment
The misuse of opioids has a significant impact on the United States economy. Lipman and Webster (2015) state that abuse of opioids contributes to the country’s healthcare expenditures, as the annual health care costs of opioid abusers are over eight times higher than for people who only take opioids as directed. The authors report that “in 2007, prescription opioid abuse cost $55.7 billion, which included $25 billion in health care costs, $25.6 billion in workplace costs, and $5.1 billion in criminal justice costs” (Lipman & Webster, 2015, p. 893). Therefore, regulating the prescription of opioids would help to alleviate the burden of opioid misuse on the economy.
Another factor constituting the economic environment of the bill is that people of low socioeconomic status are at a higher risk of opioid misuse. According to a study by Keyes et al. (2014), economically disadvantaged populations have a much higher incidence of overdosing on prescription opioids. This increases the health gap between people of different socioeconomic status. Also, the higher prevalence of opioid misuse in disadvantaged populations enhances the economic burden of the problem, as people with low income are more likely to rely on government-sponsored health insurance schemes.
Political and Legislative Environment
The problem of opioid use in the United States has received national attention and is often referred to as the opioid crisis. Multiple states have been trying to improve drug prescription monitoring programs in response to the issue (Barlas, 2017). The 21st Century Cures Act passed towards the end of 2016, provided $1 billion in grants to help states regulate opioid use and misuse. Similar legislation called the enate’s Opioid Crisis Response Act of 2018 (OCRA) funded federal agencies to run programs for opioid misuse prevention, treatment, and recovery (Sotomayor, 2018).
The act also includes directions to reduce the number of opioid pills sold to patients and prioritize research and development of effective, non-addictive pain management medications (Sotomayor, 2018). Overall, the political and legislative environment of the bill involves actions from state and federal authorities aimed at combatting opioid misuse and addiction to prescription opioids.
Passage of the Bill
Sponsors
The primary sponsor of HB 167 is Representative Jay Edwards in Ohio House District 94, who introduced the legislation in 2017 and defended it during Committee hearings. He is supported by Representative Larry Householder in Ohio House District 72. None of the Ohio legislators opposed the bill, and it received a favorable passage in the House with 16 positive votes and no negative votes (“House Bill 167,” 2018). The bill was discussed in three separate House Committee hearings, on May 17, 2017, June 20, 2018, and June 27, 2018. No opponents of the bill presented during the Committee hearings.
Stakeholders
The principal stakeholders of the bill are patients and care providers, and their interests are usually represented by professional associations. For example, the Ohio Academy of Family Physicians (OAFP, 2017) outlined some of the care providers’ concerns with the new piece of legislation in a letter to Ohio Representatives and Senators. The organization stated that House Bill 167 is deeply flawed, as it singles out primary care physicians, does not address barriers to office-based opioid treatment, and proposes mandatory continuing medical education.
Also, the OAFP (2017) presented some of the patients’ concerns, arguing that recommending treatments that are not covered by insurance (e.g., physical therapy, massage, and non-narcotic medications) will increase out-of-pocket health care expenditures and that many people will not be able to afford them. The letter sent by the organization to Ohio Representatives and Senators served to inform them of the gaps in the bill and to affect future legislative action.
A different position on the issue was expressed by the Ohio Pharmacists Association. Antonio Ciaccia, the Director of Government & Public Affairs at the Ohio Pharmacists Association, presented at the second Committee Hearing on June 20, 2018. In their statement, Ciaccia (2018) states that the legislation is fair to patients, as it provides them with opportunities to receive Vivitrol, which is long-lasting injectable naltrexone, in place of opioids. Ciaccia (2018) also commented that the legislation would be useful in addressing the opioid crisis and assisting people who are at risk of opioid misuse, thus benefiting many patients. The statement was recorded as part of the Committee Hearing and will be used as evidence during the future stages of the bill’s passage.
Timeline
The bill was successfully passed out of the House Health Committee, and the amended version of the bill (substitute) was referred to the House on July 2, 2018. Next, the bill will likely be scheduled for a Second Hearing in the House, where a vote will take place, and any amendments to the bill will also be reviewed. The Third Hearing will only follow if the bill passes the Second Hearing and is scheduled. If the bill passes the Hird Hearing, it will be referred to the Senate, and the process will be repeated. After that, conference action will be taken to vote on the bill, and an affirmative vote would mean that the bill is sent to the Governor, where it can either be signed into law or vetoed.
The complex legislative process that takes place in the United States makes it rather difficult to predict timelines accurately. In an optimistic scenario, the bill passes every stage of the process successfully within 1-2 months and is signed into action by Governor by the end of 2019. However, if there are any further amendments to the bill or if the Governor vetoes the bill and the Chambers will act to override the veto, each step of the process might take up to 3 or 4 months. In this scenario, the bill will be signed into action no earlier than 2021. Thus, the timeline to achieve the goals is December 2019 in the optimistic scenario and March-April 2021 in the pessimistic scenario.
Consequences for Providers
Short-Term Consequences
After the bill is signed into action, it will have several negative implications for providers. Firstly, it will prohibit primary care physicians and general dentists from prescribing opioids for over three days (Molnar, 2017). Physicians and dentists who have completed training in opioid addiction and fit several other conditions will be able to prescribe opioids for a period of up to seven days. Secondly, in the treatment of chronic pain, physicians will no longer be able to exceed the dosage of 50 MED. Thirdly, physicians will be required to offer naltrexone before prescribing opioids to patients (Molnar, 2017).
Therefore, the bill will restrict the prescription of opioids by primary care physicians, although the State Medical Board will be able to impose restrictions on prescriptions of opioids by other medical professionals.
Long-Term Consequences
In the long term, the bill will reduce the prescriptions of opioids to patients and will increase naltrexone prescriptions. As a result, the bill will promote patient safety and reduce the health care costs associated with opioid misuse. Another positive outcome of the bill for providers is that it will most likely stimulate researchers to develop new drugs that are comparable to opioids in their pain management properties but are not addictive. It is also possible that the bill will have some negative consequences, including the increased demand for services. For example, patients who used to receive prescriptions for longer periods will now have to come in for additional appointments to prolong their prescriptions.
Consequences for Consumers
Short-Term Consequences
The first consequence of the bill for consumers will be the limited access to prescription opioids. This will likely harm people who rely on opioids for pain management, as they will need to come in for additional appointments to receive their medication. Another probable negative consequence is the increase in out-of-pocket costs, as physicians will be required to recommend other treatments instead of prescribing opioids (OAFP, 2017). The positive short-term consequences will include increased decision-making autonomy and improved access to naltrexone, as the bill ensures a stable supply of naltrexone as part of its key provisions.
Long-Term Consequences
The primary long-term consequence of the bill for consumers has increased patient safety. The patients’ likeliness of developing an addiction to opioids or overdosing on the medicine will reduce dramatically as a result of the bill. Moreover, patients who are addicted to opioids will receive better access to addiction treatment programs, which will improve their quality of life and health. One negative long-term consequence of the bill is that the alternative treatment methods will not be as effective in pain management as opioids, and thus patients might experience an exacerbation of symptoms over time.
This Issue in Canada
Canada is one of a few countries that have been able to address the misuse of prescription opioids successfully. The Canadian government took three key steps to address the rising use and prescribing of opioids. Firstly, the government passed a law making overdose-reversal drug naloxone available without a prescription (Wood, 2018). This helped to reduce the number of deaths from prescription opioid overdosing, thus resolving one of the most critical issues associated with the opioid prescription. The HB 167 does not stipulate the prevention of overdosing using naloxone, and the medication is still considered a prescription drug in most states.
The second step taken by the Canadian government facilitated the patients’ use of supervised injection facilities, which also helped to reduce overdose deaths (Wood, 2018). HB 167 does not consider opioid use by drug addicts and focuses only on regulating the process of prescribing these drugs, which may impair its effectiveness in addressing the misuse of opioids. The government of Canada also issued evidence-based guidelines for the treatment of opioid addiction and enabled care providers to refer people to short-term inpatient programs instead of continued addiction treatment (Wood, 2018).
This is also a shortcoming of the HB 167, as the bill does not stipulate the use of free, short-term detoxification programs. One similarity between the approach used in Canada and HB 167 is that both aim to improve care providers’ awareness of opioid addiction treatment. This proved to be an effective way of ensuring that people with opioid addiction receive adequate treatment and reducing the incidence of overdose deaths.
Refinement or Change
To refine the bill, it is critical to address the costs of alternative treatments and the treatment of opioid addiction, as these are the two main weaknesses of the bill identified in the analysis. While restricting providers from prescribing opioids could be effective in reducing addiction and overdosing rates in the long-term, it is also critical to ensure that people have access to safe and effective alternatives.
Therefore, for patients who might receive opioids prescriptions, alternative pain management strategies should be covered by insurance or government-sponsored schemes. In treating opioid addiction, the legislators should also consider introducing some of the programs used in Canada, such as allowing the sale of naloxone without a prescription and referring patients for short-term detoxification programs without mandatory further addiction treatment. These provisions would help to decrease the number of deaths from opioids, as well as opioid addiction rates.
Conclusion
All in all, the proposed bill will have a significant impact on patient safety, cost of care, and the misuse of opioids. It could also be potentially useful in reducing deaths and hospitalizations related to prescription opioid overdosing, thus alleviating the economic burden imposed by opioid abuse on the healthcare sector. The progression of the bill appears to be smooth so far, and the bill may be signed into action before 2020. Nevertheless, legislators should also consider refining HB 167 to address the increase in out-of-pocket costs and create new options for treating patients with opioid addiction. These changes would help the bill to achieve its goals while also addressing the main concerns of patients and care providers.
References
Barlas, S. (2017). US and States ramp up response to opioid crisis: Regulatory, legislative, and legal tools brought to bear. Pharmacy and Therapeutics, 42(9), 569-592.
Ciaccia, A. (2018). Testimony for HB 167. Web.
House Bill 167. (2018). Web.
Hudspeth, R. S. (2016). Safe opioid prescribing for adults by nurse practitioners: Part 2. Implementing and managing treatment. The Journal for Nurse Practitioners, 12(4), 213-220.
Keyes, K. M., Cerdá, M., Brady, J. E., Havens, J. R., & Galea, S. (2014). Understanding the rural-urban differences in nonmedical prescription opioid use and abuse in the United States. American Journal of Public Health, 104(2), 52-59.
Lipman, A., & Webster, L. (2015). The economic impact of opioid use in the management of chronic nonmalignant pain. Journal of Managed Care & Specialty Pharmacy, 21(10), 891-899.
Molnar, E. (2017). H.B. 167 bill analysis. Web.
Ohio Academy of Family Physicians (OAFP). (2017). A letter to Ohio Representatives and Senators. Web.
Rothstein, M. A. (2017). Ethical responsibilities of physicians in the opioid crisis. The Journal of Law, Medicine & Ethics, 45(4), 682-687.
Schaller, A., Dejonghe, L., Haastert, B., & Froboese, I. (2015). Physical activity and health-related quality of life in chronic low back pain patients: A cross-sectional study. BMC Musculoskeletal Disorders, 16(1), 62-69.
The article “Public opinion and public policy: Heroin and other opioids” by Cook and Brownstein (2017) examines the extent to which public opinion is expressed in drug policy. Namely, the authors target Virginia as the state where the situation is critical. Recently, opioids containing painkillers dispensed in the pharmaceutical sphere by prescription were considered a universal and safe panacea for people suffering from chronic pain caused by various serious illnesses such as cancer. However, the safety of this drug proved to be not so safe since many Americans have to face opiate addiction caused by easy access to drugs that cause physical dependence. In addition to dependence, tablets with pain medication can also cause their consumers to have different side effects that negatively impact their physical and mental health, not to mention the fact that they can lead to a fatal overdose. The main question is whether public opinion supports treatment over arrest or not. The authors conclude that Virginians agree with the mentioned initiative and that public support may affect policymaking.
The quality of evidence provided in this article is appropriate. The authors use correct references to the sources used throughout the work. It should be stressed that the majority of sources is recent, while all of them are relevant to the identified topic. Therefore, a reader may proceed with exploring the theme of public opinion and opioid abuse by accessing the mentioned sources. The content of the article is well-organized and corresponds to the key issue. For example, Cook and Brownstein (2017) clearly outline the sample, measures, and methodology they use. After that, they provide findings and discussion sections accompanied by policy implications. The writing style is clear and elaborate. The authors apply such words and phrases that are easy to understand, so that both average readers and experts feel comfortable while reading it. As for the authors’ potential bias, it is possible to state that they do not stick to one or another opinion, listing objective facts and explanations. The article meets the standards regarding scholarly writing as it is written in an academic manner, includes relevant sources and a proper structure, presents the reference list designed according to APA, and contributes to the current evidence in the given field.
There are two potential ways of this article perception. It seems that policymakers and Virginians as well as Americans from other states compose the target audience. The first group of people may perceive it as an attempt to collect their opinions and document them to improve the existing policy regarding drug abusers. At the same time, the article intends to show people how the problem of heroin and other opioids may be resolved taking into account the attitudes of public. This reflects the fact that the scholars care about public opinion and implement it in research with the aim of improving the existing conditions. From the point of policymakers, the article may be used as guidance to be developed and advanced to eliminate this problem.
To make this article more relevant for an international audience, it seems important to involve some statistics and policies of other countries that also face the same problem. Such a continuation of the research is likely to reveal some new ideas on how to consider public opinion in policymaking and treat people abusing heroin and other opioids. The above suggestion is significant as it would allow comparing global data on the given topic and come up with the best solution.
Reference
Cook, A. K., & Brownstein, H. H. (2017). Public opinion and public policy: Heroin and other opioids. Criminal Justice Policy Review, 1(1), 1-23. Web.
The present opioid misuse and overdose crisis has emerged as one of the most devastating and lethal problems the world has ever faced. Although the pharmaceutical companies in the 1990s reassured the medical community that patients would not become addicted to the medications, healthcare practitioners began to overprescribe them (Assistant Secretary of Public Affairs, n.d.).
Strategies to Mitigate Opioid Crisis in Georgia
However, according to the Assistant Secretary of Public Affairs (n.d.), the high prescription rates later led to increased misuse of non-prescription and prescription opioids before the medical community understood that the medications were addictive. As a result of the adverse impacts of these drugs, there have been immense concerns about the issue. Thus, Georgia can prevent the opioid crisis by formulating state prescription laws and limiting the flow of illicit opioids.
Georgia should enact numerous regulatory and legal strategies to address opioid abuse, drug misuse, and overdose. Specifically, there is a need to formulate and enforce prescription drug practices to guide the prescription and dispensation of opioids and laws to allow health practitioners to assess a client before prescribing opioids (Centers for Disease Control and Prevention, 2018). All Georgian policymakers should make it mandatory to have state legal agencies that facilitate the doctors and help them prevent selling opioids to a single consumer in different centers. Hence, the most basic plan to prevent and mitigate the opioid crisis in Georgia is to enact laws to prevent opioid abuse, overdose, and misuse. Moreover, the state must limit the distribution and selling of illicit opioids to prevent the opioid crisis. Evidence shows that opioid-related deaths emerge from illicit opioids like illegally manufactured fentanyl or heroin (Homer & Wakeland, 2021).
Conclusion
In conclusion, Georgia should establish collaborative efforts across borders to gather and update data about the distribution and use of opioids. The plan is to massively invest in research to understand the current trends leading to abuse and curb any illegal manufacturing of opioids.
References
Assistant Secretary of Public Affairs (ASPA). (n.d.). What is the U.S. opioid epidemic? HHS.gov. Web.
Homer, J., & Wakeland, W. (2021). A dynamic model of the opioid drug epidemic with implications for policy. The American Journal of Drug and Alcohol Abuse, 47(1), 5-15.
Opioids fall in a class of drugs that have been used for centuries to manage pain and records show that their usage started in times of ancient Egypt. Research has led to the discovery of special receptors that these drugs work on in the brain and initial studies use morphine to demonstrate a ‘morphine receptor’ (Trescot et al., 2008). A variety of receptors for this class of drugs has since been discovered and new opioids have been discovered and synthetically manufactured.
The pharmacokinetic properties of these newer drugs have generated interest in a number of studies and recently the metabolism of most opioids has been clearly understood. A characteristic of most opioids that has led to their misuse and development of legislation to control their use is the potential addictive properties that they are associated with during their usage. Specific opioids in special dosage forms are also used for the treatment of opioid dependence.
New opioid dosage forms and treatment for opioid dependency have increasingly become part of medical treatments in the recent history with buprenorphine being an important drug for this function (Trescot et al., 2008). This research paper examines the pharmacology of opioids and their use in the treatment of opioid dependency, and specifically it looks at buprenorphine while comparing it with methadone.
Factors affecting oral bioavailability of buprenorphine
The bioavailability of a drug determines the dosage forms and how much of the unchanged form of the drug reaches the systemic circulation (Griessinger et al., 2005). Each route of administration has factors affecting the bioavailability, which are dependent on the body and drug characteristics.
The intravenous route of drug administration provides the highest bioavailability, which is set at 100%. On the other hand, oral administration and bioavailability are affected by the drug characteristics such as solubility, hydrophilic or lipophilic nature, and the receptors that a drug uses to get into the bloodstream (Griessinger et al., 2005).
Incomplete absorption of a drug while in the gastrointestinal system causes low bioavailability. Very hydrophilic drugs are unable to cross the lipid cell membrane, while highly lipophilic drugs are unable to cross the water layer that covers and surrounds the cells involved in absorption (Griessinger et al., 2005).
These elements are some of the factors affecting the oral bioavailability of buprenorphine. The receptor at the absorption site that the drug interacts with is also a significant determinant of the availability of the drug. Some receptors are involved in pumping the drug back to the gut lumen and when these are inhibited, the bioavailability increases (Griessinger et al., 2005).
The oral availability of buprenorphine is poor and it is affected by all the factors described above. However, the most important factor affecting the oral bioavailability of buprenorphine is the high metabolism by the liver and the intestines (Murphy et al., 2013). When buprenorphine is administered orally, the drug is metabolized in the liver and the gut by special enzymes, which leads to the reduction in the proportion of the drug that is available in the bloodstream.
The breakdown of a drug by gut enzymes and processes in the liver has conveniently been referred to as the first pass effect (Griessinger et al., 2005). The main enzyme system responsible for the degradation of the drugs in the liver is the cytochrome P450 (CYP), which is also responsible for the breakdown of buprenorphine. Murphy et al., (2013) posit, “Buprenorphine is converted in the liver primarily by cytochrome P450 (CYP) 3A4 to an active metabolite (nor-buprenorphine with weak intrinsic activity” (p. 316).
The breakdown of buprenorphine by the hepatic enzymes causes a reduction in the bioavailability, hence the efficacy of the drug. One way that can be used to increase the concentration of the drug that reaches the systemic circulation is increasing the dosage that is administered via the oral route. However, an increase in the dosage will mean more side effects as the metabolites affect other receptors.
Therefore, the increase in dosage is not a desirable way of overcoming the first pass effect. Another way in which the first pass effect affects buprenorphine in the liver is the process of glucuronidation that takes place here. According to Murphy et al., (2013), buprenorphine and its metabolite -norbuprenorphine, undergo glucuronidation in the liver and the process reduces its availability.
Various methods have been used to overcome the first pass effect that the drug undergoes when administered through the oral route. Buprenorphine is currently unavailable in oral formulations and the current formulations include the sublingual route and transdermal patches (Murphy et al., 2013).
According to Murphy et al., (2013), methods that can be used to reduce the drug first pass effect include the use of sublingual route, the transdermal routes, and the rectal suppositories. When drugs are administered through the oral route, the absorbed drug and its metabolites are absorbed to the portal system where the drug is taken to the liver and further transformation takes place.
The use of the sublingual route of administration avoids the portal system that takes blood to the liver, and the CYP enzymes break down less of the drug. Once the sublingual formulation is administered, it goes directly to the systemic circulation, hence avoiding the first pass effect (Murphy et al., 2013). According to Trescot et al. (2008), buprenorphine has high lipid solubility and due to this characteristic, the sublingual bioavailability is high.
This method is one of the ways in which researchers and pharmacists have been in a position to avoid the first pass effect. The use of transdermal patches is also common outside the US (Murphy et al., 2013). Transdermal patches are also effective in avoiding the portal system, hence reducing the first pass effect associated with liver metabolism by the Cytochrome P450 system (Murphy et al., 2013).
Drug-receptor relationships
Drug receptors are specific to a certain class of drugs and they are located in areas where the drug will have the desired effect. Opioid receptors have been located in the brain tissue and in other tissues in the body, and specific opioids have specific receptors that they bind.
The main opioid receptors are the “Mu (μ) receptor, the Kappa (κ) receptor (agonist ketocyclazocine), the Delta (δ) receptor (agonist delta-alanine-delta-leucine-enkephalin), and the Sigma (σ) receptors (agonist N-allylnormetazocine) (Trescot et al. 2008, p. 135). Different types of opioids exhibit the several drug-receptor relationships with different receptors being involved.
Opioids can be classified based on their drug-receptor relationships and this classification consists “agonists, antagonists, and partial agonists or antagonists” (Trescot et al., 2008, p. 134).
The affinity of these drugs at their respective receptors can be described as being the “strength of interaction between the drug and its receptor” (Trescot et al., 2008, p. 133). The efficacy of a drug is also considered when discussing the drug affinity and affinity can be described as “the strength of activity of a drug due to its drug-receptor interaction” (Trescot et al., 2008, p. 133).
According to Trescot et al. (2008), an agonist at a receptor is a drug that processes both affinity for the receptor and as a result, it has efficacy. On the other hand, an antagonist has affinity, but its efficacy is absent (Trescot et al., 2008). Drugs with affinity and partial efficacy can be described as being partial agonists at the particular receptor (Trescot et al., 2008).
Partial agonist: – Buprenorphine
Buprenorphine is classified as one of the opioids with low efficacy despite its high affinity, and thus it is a partial agonist (Trescot et al., 2008). This particular drug exhibits affinity at the Mu receptor where it binds by exhibiting its partial effect. It also possesses kappa receptor antagonism, which forms the basis of its use as an analgesic (Trescot et al., 2008).
The drug-receptor activity for this drug has also allowed its use in the management of opioid intoxication, as an abuse deterrent and a maintenance therapy for the detoxification and management of pain (Trescot et al., 2008). Its partial antagonistic effect at the kappa receptor is restricted to a certain level. This ceiling effect means that the drug is only useful up to a certain level and beyond this point, there is limited effect, but just the side effects that can be attributed to any other opioid (Trescot et al., 2008).
Partial agonist: – Oxycodone
Oxycodone is a partial kappa opioid receptor agonist (Murphy et al., 2013). This drug acts on the kappa receptor in different parts of the body to exert its effect and cause the desired effects.
Oxycodone is partial kappa opioid receptor and this aspect means that the drug is not as efficacious as other agonists, and thus it is available in combination form with other related drugs and classes of drugs to provide better efficacy (Murphy et al., 2013). The drugs that are combined with oxycodone to provide a better effect include acetaminophen and aspirin, which act in concert to produce pain relief (Murphy et al., 2013).
Opioid Antagonists: – Naloxone
Naloxone is “an opioid receptor antagonist and it acts at different opioid receptors, thus causing competitive antagonism” (Trescot et al., 2008, p. 139). Naloxone has a competitive antagonism at the delta, Mu, and kappa receptors and according to Trescot et al. (2008), this opioid antagonist has a “high affinity for the mu receptor, but it lacks any mu receptor efficacy” (p. 140).
The drug exerts its effects on both the central nervous system and any other peripheral tissue in the body and the pharmacologic uses are dependent on these actions on the receptors.
Naloxone is mainly used to reverse adverse opioid effects and it is useful in the maintenance of other treatments, deterrence to the use of opioids, and detoxification (Trescot et al., 2008). However, its main use is in the management of opioid toxicity due to its antagonistic nature at the opioid receptors.
Combination of the drug with other drugs such as buprenorphine is also used to prevent users from abusing the second drug when given intravenously (Trescot et al., 2008). Studies are also being conducted to establish whether the drug can be used to suppress tolerance to other drugs such as oxycodone (Trescot et al., 2008).
Opioid Antagonists: – Naltrexone
Naltrexone is also an opioid receptor antagonist and like naloxone, it acts at different opioid receptors by causing competitive antagonism (Trescot et al., 2008). Naltrexone also exhibits competitive antagonism at the delta, Mu, and kappa receptors and Trescot et al. (2008) state that like Naloxone, this opioid antagonist has a “high affinity for the mu receptor, it lacks any mu receptor efficacy” (p. 140).
The drug also exerts its effects on both the peripheral and central nervous system and many other tissues in the body with the receptors. The pharmacologic uses are similar to those of Naloxone and they are dependent on these actions on the receptors.
Naltrexone is mainly used to reverse adverse opioid effects and it is useful in the maintenance of other treatments, deterrence to the use of opioids and in detoxification (Trescot et al., 2008). Like Naloxone, the main use of Naltrexone is in the management of opioid toxicity due to its antagonistic nature at the opioid receptors.
Combination of the drug with other drugs such as buprenorphine is also done to prevent users from abusing the second drug when given through the intravenous route (Trescot et al., 2008). Studies are also being conducted on Naltrexone as with Naloxone to establish whether the drug can be used to suppress tolerance to other drugs such as oxycodone (Trescot et al., 2008).
Opioid Agonists-Antagonists: – Pentazocine
Opioid agonist-antagonists have poor efficacy at the mu receptor, but they have agonistic properties at the kappa receptors (Trescot et al., 2008). Pentazocine is a good example of partial agonist-antagonists and it exhibits all the characteristics that the group processes.
Partial agonist-antagonism means that the affinity of Pentazocine at the mu receptors is high with a corresponding low efficacy at the same receptor (Trescot et al., 2008). The drug is used as an analgesic like many opioids, but it also has a ceiling effect where increase in dosage will not lead to increase in analgesic properties, but only the toxicity of the drug (Trescot et al., 2008).
Respiratory depression
Reparatory depression is a major side effect property of opioids and it is exhibited by the reduction in the respiratory rate leading to the accumulation of carbon dioxide in the blood stream. Opioid activity on the mu receptors is the main known cause of respiratory depression in individuals using opioid drugs.
This side effect is potentially fatal and it varies with the tee of opioid that is used. It is also dependent on the personal characteristics of individuals and it is more pronounced in children as compared to adults. Buprenorphine and morphine are some of the opioids that exhibit this property of respiratory depression. However, these two opioids have different characteristics in their respiratory depression as discussed later in this paper.
Difference between buprenorphine and morphine
Morphine causes direct respiratory depression by acting on the mu receptors in the brain (Trescot et al., 2008). The drug binds to the receptor in the nucleus accumbens in the brain and the result of this activity is a decrease in response to carbon dioxide concentration rise in the bloodstream (Trescot et al., 2008).
When the reaction to high levels of carbon dioxide in blood is inhibited, the respiratory level decreases, which lead to the retention of more carbon dioxide in the blood. The result of accumulation of carbon dioxide in blood is a drop in the pH, thus resulting in respiratory acidosis. According to Trescot et al. (2008), the response curve shifts towards the right.
One known characteristic of morphine is that acidosis leads to increased delivery of the drug to the brain tissues (Trescot et al., 2008). As the blood carbon dioxide increases due to the depression of the nucleus accumbens and respiratory acidosis occurs, the amount of morphine that is delivered to the brain increases and this aspect further acts to cause profound respiratory depression that may be fatal (Trescot et al., 2008). Therefore, increase in morphine causes an increase in the respiratory depression and it can be said to be dose dependent.
Respiratory depression occurring from buprenorphine is not central, as it is evident with morphine. On the contrary, buprenorphine induces respiratory depression by acting on the mu receptors located in the lungs and not in the brain (Ohtani et al., 1997). As stated earlier, buprenorphine is a partial agonist, and thus the respiratory depression that it exhibits has a ceiling effect (Murphy et al., 2013).
The binding of this drug to the mu receptors is also stronger as compared to the binding by morphine, and thus the effects take longer and they may be prolonged (Murphy et al., 2013). The tight binding means that reversal using the opioid antagonists like naltrexone is harder as compared to other opioids.
Importance of the difference
The differences between the two drugs are significant in the application and daily use of the drugs in the management of pain and opioid toxicity. By exerting respiratory depression centrally, morphine can be used in limited doses, which must be monitored.
The toxicity that can come from this drug is also profound and it may be fatal. Higher doses of buprenorphine can be used as compared to the safest doses of morphine. Another implication is that the management of respiratory depression for buprenorphine may be hard using opioid antagonists such as naloxone as compared to the respiratory depression that is caused by morphine.
Dose-response curves
The dose response curves for the respiratory depression caused by morphine and buprenorphine are different. The respiratory depression in the curves can be represented by the decrease in ventilation rated after administration of the two drugs.
Graph showing the ventilation rate against the concentration of buprenorphine (source: Ohtani et al., 1997).
Transdermal dosage form of buprenorphine
Buprenorphine is available in the oral and transdermal route and a patch is applied to deliver constant drug doses for a period. The transdermal application of buprenorphine has several differences in the dosage, bioavailability, and efficacy to the use of the oral route.
The transdermal route is better tolerated compared to the oral route with fewer side effects being experienced due to the use of this path of drug administration (Pergolizzi et al., 2010). The common side effects at the area of application are the development of erythema and pruritus (Pergolizzi et al., 2010).
The transdermal route of application of methadone also lasts longer as compared to the use of the oral preparation. According to Pergolizzi et al., (2010), the patch acts as a depot for the drug, thus ensuring a constant supply of the same on the body’s demand.
The oral route requires frequent administration of the drug when used to manage pain and in the management of opioid toxicity. On the other hand, a transdermal patch has been used for over three days with researchers showing that it is still efficacious after the third day (Pergolizzi et al., 2010).
As earlier described, the first pass effect of a drug is important in the determination of its bioavailability. Through the application of buprenorphine orally, there is a considerable chance of the drug going through the first pass effect, which results in the reduction of the drug’s bioavailability.
The use of the transdermal patch allows the bypass of the liver and the gastrointestinal system, thus reducing the first pass effect (Pergolizzi et al., 2010). However, the transdermal route is a slower method of delivery of buprenorphine and it cannot be used to deliver the drug when it is needed more urgently. On the other hand, the sublingual and oral route, according to Pergolizzi et al. (2010), is a faster way of delivery of the drug.
Buprenorphine vs. methadone
Methadone is a synthetic diphenylheptane and it acts on the mu opioid receptor as an agonist (Trescot et al., 2008). This drug is unique with properties different from those exhibited by other opioids. The difference with other opioids will be compared in this section by using buprenorphine. The half-life of the two drugs, time of onset, and duration of effect and the dosing regimens will be used in the comparison.
Half-life
Trescot et al. (2008) posits that the half-life of a drug “is the time that it takes for its blood concentration to reduce by half” (p. 144). The plasma half-life of buprenorphine is 3-5 hours, which means that the drug plasma concentration reduces by half after 3 to 5 hours of administration.
The faster reduction in concentration of the drug when given through the sublingual route means frequent administration and this aspect underscores a setback in the management of intoxication since a more frequent dosage is required (Trescot et al., 2008). The transdermal patch also has the same half-life, but the availability is high and it provides a depot for the drug.
Methadone has a long half-life as compared to buprenorphine and this aspect can be attributed to the high lipid solubility (Trescot et al., 2008). High lipid solubility means that the drug is widely distributed in tissues, especially in fat tissue, which provides methadone with a very long elimination phase (Trescot et al., 2008).
Due to this aspect, the half-life is stated to be between 12 and 150 hours, and hence methadone may be administered once daily or longer than buprenorphine. A comparison of the two drugs shows that methadone has a longer half-life as compared to buprenorphine.
Time of onset/duration of effect
The time of onset of effects of a drug is the time that passes between the administration of a drug and the patient to experience its effects. In the case of buprenorphine, the onset of effects is three to four hours after administration through the sublingual route (Murphy et al., 2013).
This onset of action is slower as compared to other opioids and it is desired where the treatment of toxicity of opioids is to be treated (Murphy et al., 2013). The onset of action for buprenorphine, while using the transdermal route, is also slower as compared to the sublingual route. The duration of action of this drug is also long and it lasts for 12-150 hours
Methadone is similar to buprenorphine in the onset of action, and the process is even slower when given orally. However, the take taken for methadone to act is longer than that of buprenorphine and this case has been reported in some literature to be 4-5 days. This observation means that methadone can be administered in longer doses duration such as once daily and its effects can last longer (Murphy et al., 2013).
Dosing regimens used
The dosing regimen can be described as the formulation, route of administration, the dosage, and interval of administration of a drug (Murphy et al., 2013). Buprenorphine is available as a sublingual tablet, while methadone is available in most places as an oral liquid formulation (Murphy et al., 2013).
The onset of action for buprenorphine, as stated earlier, is slow and this characteristic is compatible with the slow onset of action that methadone has in its functioning. The buprenorphine tablets are dissolved under the tongue, while the liquid formulation of methadone is swallowed. Alternate day dosing for buprenorphine is also possible, while it is impossible for methadone.
Conclusion
Opioids have been used in the management of pain for a long time and a number of factors have contributed to their preference over other classes of drugs. This paper has described some of the receptors that opioids bind to exert their effects and the receptor-drug interaction has been described by giving examples. A number of opioids are also used in the management of opioid toxicity based on the receptor interactions that they display.
The paper focused on buprenorphine to examine some of the pharmacokinetic properties of opioids. Respiratory depression was stated as a major side effect of the opioids and there are established differences between respiratory depression provided by buprenorphine and that produced by morphine. A comparison between methadone and buprenorphine was also provided in the paper.
References
Griessinger, N., Sittl, R., & Likar, R. (2005). Transdermal buprenorphine in clinical practice-a post-marketing surveillance study in 13,179 patients. Current Medical Research Opinion, 21(1), 1147–1156.
Murphy, L., Fishman, P., McPherson, S., Dyck, D., & Roll, J. (2013). Determinants of buprenorphine treatment for opioid dependence. Journal of Substance Abuse Treatment 46(3), 315-319.
Ohtani, M., Kotaki, H., Nishitateno, K., Sawada, Y., & Iga, T. (1997). Kinetics of respiratory depression in rats induced by buprenorphine and its metabolite, norbuprenorphine. Journal of Pharmacology and Experimental Therapies, 281(1), 428–433.
Pergolizzi, J., Aloisi, A., Dahan, A., Filitz, J., Langford, R., Likar, R., Mercadante, S., Morlion, B., Raffa, R., Sabatowski, R., Sacerdote, P., Torres, L., & Weinbroum, A. (2010). Current Knowledge of Buprenorphine and Its Unique Pharmacological Profile. Pain Practice, 10(5), 428–450.
Trescot, A., Datta, S., Lee, M., & Hansen, H. (2008). Opioid Pharmacology. Pain Physician, 12(2), 133-153.
Medication abuse is one of the most common negative issues in the healthcare system. Unfortunately, the number of individuals suffering and dying from drug overdose is growing every year. In particular, the statistics in the US are alarming, which urges the government to take serious measures to prevent the spread of the crisis. The present paper aims to introduce the degree of the opioid crisis at the national level and in Los Angeles and to establish the most affected states and populations.
The Degree of the Crisis and the National Statistics
The opioid epidemic has reached a very high degree in the US. According to statistics, over two million citizens abuse their prescriptions (“Opioid crisis fast facts,” 2018). Recent data indicate that 6,2 billion hydrocodone pills were allocated at the national level in 2016. In the same year, over 63,600 cases of overdose deaths were recorded in the US (“Opioid crisis fast facts,” 2018). Out of these, 66.4% (42,249) of deaths are attributed to opioids. On average, 115 people in the country die every day (“Opioid crisis fast facts,” 2018). The situation is aggravated by the fact that physicians prescribe opioids at a high rate. Although the number of prescriptions has decreased since the 2012 peak of 282 million, it is still significant (“Opioid crisis fast facts,” 2018). Therefore, it is possible to conclude that the degree of the opioid crisis is dangerously high, and the strict supervision of prescriptions is necessary in order to alleviate the problem.
The States and Populations Most Affected
Not all of the US states are impacted by the opioid crisis equally. According to data provided by the Centers for Disease Control and Prevention, several states had the highest death rate of opioid overdose in 2016:
West Virginia (52.0 deaths per 100,000);
Ohio (39.1 per 100,000);
New Hampshire (39.0 per 100,000);
Pennsylvania (37.9 per 100,000);
Kentucky (33.5 per 100,000) (“Drug overdose death data,” 2017, para. 2).
Among the rest of the states, there are some in which death levels induced by drug overdose grow at a dangerous pace. Statistics indicate a significant rise in 26 states. Among them, there are New York, Kentucky, Oklahoma, Pennsylvania, Michigan, West Virginia, Indiana, Florida, Massachusetts, Wisconsin, Tennessee, North Carolina, South Carolina, Texas, Louisiana, Delaware, New Jersey, and Illinois (“Drug overdose death data,” 2017). Thus, currently, there are five states most influenced by the opioid crisis. However, there is a risk of other states reaching dangerous death rates.
Irrespective of the state they live in, people may be affected by the opioid crisis depending on some personal characteristics. According to Kneebone and Allard (2017), the most vulnerable group is represented by non-Hispanic whites and older but still working-age adults. Research also indicates that economically distressed populations are influenced more than financially stable ones (Kneebone & Allard, 2017). The reasons for the rise of the crisis are associated with the lack of effective opioid abuse programs or sufficient prescription restrictions.
Comparing the National Data to Los Angeles Data
Compared to the national statistics, Los Angeles data are less dramatic. Whereas the 2016 country death rate of an opioid overdose was 13.3 per 100,000 Americans, in Los Angeles, the rate was 3.2 per 100,000 (Faust, 2018). Experts consider the city’s ethnic diversity and racial heterogeneity to be the reason for such a statistical gap (Faust, 2018). Also, cultural diversity is believed to play an important role.
Conclusion
The opioid crisis poses a great threat to US society. The problem impacts some states and populations more severely than others, but there is no confidence that it will not reach out to more victims in currently low-rated regions. It is necessary to develop initiatives and implement interventions that would increase people’s awareness of the seriousness of the problem and encourage them not to engage in risky behaviors.
References
Drug overdose death data. (2017). Web.
Faust, M. (2018). The opioid epidemic isn’t hitting LA as hard as the rest of the country. Ethnic diversity might explain why. Southern California Public Radio. Web.
Kneebone, E., & Allard, S. W. (2017). A nation in overdose peril: Pinpointing the most impacted communities and the local gaps in care. Brookings. Web.
The United States, and the state of Arizona in particular, are currently experiencing a full fledged opioid crisis. According to recent statistics, as of now, around 1.7 million Americans are addicted to opioid medication with more than 130 people dying from opioid overdose every day. The origins of this public health disaster date back to the 1990s when opioid drugs were seen as an unexplored novelty – and a safe one at that. Pharmaceutical companies did a good job convincing those in the decision-making positions in the healthcare sector that opioid medication was not addictive, which later was proven to be untrue. In Arizona alone, within the time span from 2017 through 2019, 3,555 deaths were caused by opioids (Arizona Department of Health Services, 2019). What is even more alarming is that from 2013 through 2017, the opioid overdose rate had increased by 76%. The state will see even more deaths and reckless medication consequences if certain measures are not undertaken.
Idea for Addressing Solution
Legislative advocacy may be the only way to tackle the US opioid crisis. Since opioid overdose is often lethal, there is a need for clear and comprehensive standardized regulations that could be used by both health workers and patients. Apart from that, legislative advocacy creates a positive stir, draws attention to the issue, and ensures wide reaching publicity. A good solution might be improving opioid use disorder screening that would not only focus on preventing deaths but also on examining the reasons why individuals turn to excessive use (Saloner et al., 2018).
Research of the Issue
Evidence 1
Between 2017 and 2019, there have been 3,555 deaths and 25,969 suspected deaths caused by opioid overdose (Arizona Department of Health Services, 2019);
Evidence 2
At the same time, access to medication such as naloxone has increased significantly, making safe consumption nigh on impossible in the United States (Arizona Department of Health Services, 2019).
Stakeholder Support
Stakeholder(s) Supporting 1
Arizona Public Health Association as this organization has often attempted to raise awareness regarding the issue.
Stakeholder(s) Supporting 2
Arizona Nurses Association since nurses often play the role of health promoters and work closely with communities.
Stakeholder Opposition
Stakeholder(s) Opposed 1
Opioid drug producers could be apprehensive of the new legislation in fear of decreasing sales.
Stakeholder(s) Opposed 2
Some medical facilities that collaborate with producers could be afraid of losing an additional source of income. This opposition could be overcome by showcasing the proof that weaning patients off opioids is more cost-effective.
Financial Incentives/Costs
According to Florence, Zhou, Luo, and Xu, the yearly economic burden of opioid abuse is estimated at $78.5 billion. Over one third of this sum is substance abuse treatment costs. Around 25% of these expenses are on the public sector in health care; this also includes criminal justice costs.
Legislature: Information Needed and Process for Proposal
The steps for the presentation the proposal to the legislator
Booking a meeting with the chosen legislator;
Presenting the issue using the most recent statistics, outlining the impact if gone unnoticed, and describing possible solutions;
Answering questions to clarify details.
The process of the introduction of the idea as a bill to congress
Passing a bill to tackle the opioid crisis in Arizona would take the same steps as stated in the respective legislation:
Filing of the bill for introduction;
Introduction in open session;
Referral to standing committees;
First-house hearings;
Committee reports;
Consent calendar, otherwise debating the bill;
Second-house action;
Amending the bill if necessary;
Conference committee;
Sending the bill to the governor to accept or veto it.
Christian Principles and Nursing Advocacy
Christians have been long on the fence about how to classify addiction – as a sin or a sickness. It is readily imaginable how being dependent on a certain substances can be a sin. After all, a person chooses to build his or her life around something than God. Lately, however, both Evangelical and Catholic churches – the most prominent branches in the United States – have been supporting the view that addiction is a disease that a person barely has control over. Christianity teaches love and compassion, especially when it comes to those in the moments of dire need. It is important that opioid addicts seek healing in Christ – they should know that they have the support of both the community and God. Quoting the Gospel of Mark, “[…] your faith has healed you. Go in peace and be freed from your suffering.”
References
Arizona Department of Health Services. (2019). Opioid epidemic. Web.
Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016). The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Medical Care, 54(10), 901–906.
Saloner, B., McGinty, E. E., Beletsky, L., Bluthenthal, R., Beyrer, C., Botticelli, M., & Sherman, S. G. (2018). A public health strategy for the opioid crisis. Public Health Reports, 133(1_suppl), 24S-34S.