The Rise In Opioid Usage

The misuse of opioids in America is? a severe public health issue? prevalent at epidemic levels throughout our entire nation.1? The 2018 National Survey on Drug Use and Health determined 10.3 million Americans misused opioids, and there were 46,802 documented deaths caused by an opioid overdose within the year.2? Among these deaths were 35,363 Non-Hispanic Whites, 6,088 African Americans, and 4,370 Hispanics.3? Since 1999, the number of opioid overdose deaths has tripled with the highest number of overdoses occurring in Caucasian males.3? The National Institute of Health (NIH) estimates that around 191 million opioid prescriptions were written in 2017.2? Among those prescribed, about 21-29 percent misused the drugs and 8-12 percent became addicted.2? Every single day it is estimated that 128 people in America die from overdosing on opiods.2?

Opioid misuse and addiction levels are not equitable throughout America’s diverse population.3? The dominant underlying factors that contribute to this discrepancy are structural bias, social inequities, and discrimination.? These factors are rooted in issues that negatively impact public health, such as lack of access to healthcare and inadequate treatment options.? They also dictate the social and economic living conditions of individuals that can influence an increased probability of opioid addiction.

Society has built up structural bias to view opioid users as criminals, poor employees, and citizens that lack a moral compass.4? Many people also have the attitude opioid usage is a willful social choice and not an actual medical or psychological ailment someone has lost control over.4? These biased opinions towards? people with opioid use disorder (OUD) causes unfair treatment and harsh social stigmas that jeopardizes their health even further.? Opioid users who feel? stigmatized are less likely to seek treatment to help their addiction.4? If opioid users feel stigmatized and ashamed, there is also a higher probability that they will drop out of treatment.4? The harsh bias against opioid users causes? a misunderstanding towards addiction and a low desire to promote educational programs to help addicts.4? Structural bias limits the social support opioid users need to help fight their addiction and can increase the chances of overdosing.4

Another contributing factor that influences the opioid epidemic is social inequities.? For example, the lack of access to health care contributes to the opioid problem in America and is a common trend in rural communities.5? The remoteness? of a community can provide an opportunity to import and sell large amounts of cheap illegal opioids like heroin and fentanyl to overcompensate for a lack of medical treatment.6? To further compound the issue, opioid users that do not have access to health care are also unable to obtain prescriptions for drugs like Buprenorphine and Methadone to help treat withdrawal systems and beat addiction.5? Poor quality of health care is another social inequity that impacts the opioid crisis.? Citizens may lose their trust in poor quality medical facilities and prefer self treatment through the use of illegal opioids.? Insufficient medical treatment facilities and centers that are underfunded or understaffed may rely on overprescribing opioids as simple, but inappropriate means to solve their patient’s ailments, and in turn produce more opioid addicts in the community.7???

Discrimination and racism are both underlying factors that add to the opioid crisis in the United States.? The 2011 Healthcare Disparities Report confirmed that most racial/ ethnic minorities had not only less access, but also a worse quality of health care.6? Studies have shown that racial minorities are often in treatment centers for shorter amounts of time and have a lower chance of being treated with buprenorphine, one of the most effective treatment drugs for opioid addiction.8? The media releases opioid related stories about white individuals that include empathetic reasoning behind their usage, but tend to leave out explanations for usage among racial minority groups.? This builds a negative social stigma against minorities and opioid usage, making their usage seem like a self-control issue.6? Gender discrimination is also prevalent in the opioid epidemic.? Women are less likely to receive naloxone for overdose treatment, and also less likely to be given buprenorphine to help fight their addiction.8? Even though substance abuse disorders are more prevalent in males than females, women are less likely to receive proper overdose treatment and help with addiction.8

One way to address public health professionals’ challenges to overcoming the opioid epidemic in the United States? is through the use of a social ecological model.? The most significant changes that could? influence the largest number of people can be made by altering behaviors between organizational, community, and societal levels.? The misuse and overdose rates of opioids can be lowered by considering what issues lay fundamentally at each of these levels and reducing these risk factors.??

At an organizational level of the social ecological model, schools and health care organizations are two major factors that can help spread awareness and encourage effective treatment options for opioid users.? Schools can create more partnerships with educational programs like the Youth Opioid Prevention Campaign to help educate students about the crisis and encourage healthy behaviors.9? They can also help by implementing better education about the topic, like addressing how addictive opiates are, signs of users, and available treatment options.9 ? Training schools’ mental and physical health staff on drug screening and overdose treatments is an important prevention strategy as well.9? Health care organizations can be improved by treating opioid addiction as a medical problem instead of a social condition.10? Community health centers should continue to be developed to provide affordable care for opioid use prevention, treatment, and recovery.10? Private doctor clinics should seek to limit opioid prescriptions and instead use non-opioid alternatives to treat mental and physical pain to help decrease the amount of redistribution of opioids and limit the initial intake of opioids.1?

Many community influences can have an effect on the opioid crisis, such as public facilities and social capital.? Public facilities like hospitals and police stations can incorporate mandatory opioid specific training courses to help their staff better understand the epidemic, and how to properly treat overdose patients.11? Hospital administration should also monitor the amount of opioid prescriptions given to patients, and look to increase funding towards alternative care.11 ? Increased social capital has been directly linked to lower addiction rates in communities.12? Improving social networks in communities and encouraging the growth of churches, clubs, organizations, and volunteer associations can help the give the community the social support they need to prevent initial addiction habits.12? These social networks can benefit by partnering with organizations like the Drug Enforcement Administration (DEA)? and supporting community outreach programs for addicts, like providing meeting spaces and speakers for outreach programs like the Urban Survivor Union or Alcoholics Anonymous.12?

The social stigma of opioid users in societies and government policies should be altered as well.? Addiction is commonly seen as a social problem due to weak will power and low morals, instead of a mental or physical medical issue.4,13? Ideally, increasing education about opioids in the media and any educational setting can help turn the social stigma of opioids from harmful to protective.13? Improvements in government policies like making Prescription Drug Monitoring Programs mandatory for all states, and having them focus on implementing a stricter regulation of prescribed opioids would be beneficial.11? The expansion of Medicaid can also help provide healthcare to more individuals, and also help provide more access to prescriptions that can help opioid addiction.13? The DEA can help improve their policies towards the opioid epidemic like coordinating more efficiently with law enforcement agencies, better monitoring of drug cartels and underground drug sellers, and creating stricter legislation for pharmaceutical companies manufacturing opioids.14?

Cultural competence has the potential to significantly impact our nation’s opioid misuse and addiction problem.15? Public health workers could positively influence this issue by? improving patient data collection surrounding opioid usage.11? Substance abuse public health workers can also provide competency training to health care workers to help decrease negative social stigma towards opioid users and reduce prejudice and discrimination towards patients.15? This unbiased data and competency training could help eliminate the bias physicians have towards treating minorities with addiction, and ensure opioid users receive the same quality of care no matter their race or gender.11,15 ? If public health workers fail to incorporate cultural competence, they could be encouraging racism and discrimination that ensures minorities receive below standard treatment for overdoses and addiction.15? Ignoring cultural competence will decrease the trust the public has towards the healthcare industry, and discourage opioid users from seeking the medical help they need.15? This could potentially worsen the social stigma that opioid users are nothing but uncontrollable criminals, and in turn reduce funding and social support towards outlets that help diagnose, treat, and prevent opioid addiction.4,15

Reference List?

1. Azadfard M, Huecker MR, Learning JM. Opioid Addiction. National Center for Biotechnology Information Website. https://www.ncbi.nlm.nih.gov/books/NBK448203/#:~:text=Opioid%20use%20disorder%20and%20opioid,States%20are%20dependent%20on%20heroin. Updated August 14, 2020. Accessed September 24, 2020.

1. Opioid Crisis Statistics. U.S. Department of Health and Human Services Website. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html. Updated August 30, 2020. Accessed September 24, 2020.?

1. Opioid Overdose Deaths by Race/Ethnicity.? Kaiser Family Foundation Website. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-raceethnicity/?currentTimeframe=0&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Updated 2020. Accessed September 27, 2020.

1. Greenbaum Z. The Stigma that Undermines Care. American Psychological Association Website. https://www.apa.org/monitor/2019/06/cover-opioids-stigma. Published June, 2019. Accessed September 28, 2020.

1. Increasing Access to Medication-Assisted Treatment of Opioid Abuse in Rural Primary Care Practices. Agency for Healthcare Research and Quality Website. https://www.ahrq.gov/ncepcr/primary-care-research/opioids.html. Updated February, 2017. Accessed September 26, 2020.?

1. Santoro TN, Santoro JD. Racial Bias in the US Opioid Epidemic: A Review of the History of Systemic Bias and Implications for Care. Cureus. 2018;10(12): e3733 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384031/. Published December 4, 2018. Accessed September 25, 2020.?

1. Dasgupta N, Beletsky L, Ciccarone D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. American Public Health Association Website. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304187. Published January 10, 2018. Accessed September 27, 2020.

1. Volkow N. Access to Addiction Services Differs by Race and Gender. National Institute on Drug Abuse Website. https://www.drugabuse.gov/about-nida/noras-blog/2019/07/access-to-addiction-services-differs-by-race-gender.? Published July 16, 2019. Accessed September 27, 2020.?

1. Markiewicz J, Swanberg K, Weis M. Awareness, Education, and Collaboration: Promising School-based Opioid Prevention Approach. Substance Abuse and Mental Health Services Administration Website. https://www.esc-cc.org/Downloads/SAMHSA%20Opioid%20Brief.pdf Accessed September 29, 2020.?

1. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: US Department of Health and Human Services; 2016. https://www.ncbi.nlm.nih.gov/books/NBK424848/.? Accessed September 28, 2020.

1. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington, DC: US Department of Health and Human Services; 2018. https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf. Accessed September 28, 2020.?

1. Szalavitz M. Why Social Capital Could be the Key to Solving America’s Overdose Epidemic. The Guardian. August 16, 2017. https://www.theguardian.com/us-news/2017/aug/16/social-capital-us-opioid-epidemic-drugs-overdose. Accessed September 30, 2020.

1. Jalali MS, Botticelli M, Hwang RC, et al. The opioid crisis: a contextual, social-ecological framework. Health Research Policy and Systems. 2020;18(1): 87-89. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00596-8#citeas.? Accessed September 28, 2020.

1. DEA 360 Strategy. Drug Enforcement and Administration Website. https://www.dea.gov/divisions/360-strategy. Updated 2020. Accessed September 30, 2020.

Cultural Competency in Assessing and Treating Opioid Use Disorder. American Psychological Association Website. https://www.apa.org/advocacy/substance-use/opioids/resources/cultural-competency.pdf. Published 2018. Accessed September 30, 2020.