Essay III

Mara Coper

Opioid Crisis in Winston-Salem, NC

Introduction

Opioid crisis encompasses action to the opiate drugs, and this overuses and misuse of these drugs with considerable social, economic, and medical consequences. In the U.S, opioids are being overused both from medical and non-medical prescriptions. This crisis began in the 1990s following over-prescription of opioids, and this resulted in opioids becoming the most prescribed medication class in the United States. Opioid over-prescription of was due to an increased population of individuals with chronic pain. Opioids were prescribed to manage the pain. Over the years, the use of opioids increased, both prescription and non-prescription (Guy Jr, Zhang, Bohm, Losby, Lewis, Young & Dowell, 2017). The opioid crisis affects all communities in the U.S. One of these communities is Winston-Salem, North Carolina. According to Briker (2008), Winston-Salem is a town in Forsyth County in North Carolina, and the city began as a result of the merger of Winston and Salem towns in 1913. The opioid crisis is a significant public health issue in Winston-Salem, and community action is needed to remedy the situation. Comment by Vicky Fest: Opiod crisis encompasses the overuse and misuse of opiates with considerable social, economic and medical consequences. Comment by Vicky Fest: resulting in opiods becoming the most prescribed medication in the country Comment by Vicky Fest: and opioids were prescribed to manage it. Comment by Vicky Fest: You can write Guy Jr. et al when there is more than 3 authors. It saves time on typing

Symptoms

The opioid crisis is a growing problem in Winston-Salem. The number of people reported using opioids, medically, and non-medically has increased over the years (Green, 2017). Opioids crisis affects mostly non-Hispanic whites aged 18 and above. The Alaska natives and native Americans experience a five-fold rate in opioid overuse and misuse, with native Americans having the maximum number of people. The age group with the most significant number of individuals using non-medical opioids are individuals in the age range of 18 and 25. Those aged above 26 are the highest users of prescription opioids. Also, this issue affects women more than men since women receive more medication prescriptions. In particular, the opioid crisis affects mostly young, non-Hispanic white females. Comment by Vicky Fest: Do you have numbers to show how the problems has increased over the years? Maybe input that here or in introduction Comment by Vicky Fest: You put here that the age group with the most significant number of users is 18-25 but then say those age 26 and above are the highest users. These sentences sort of cancel each other out.

Opioid affects the brain. Opioids attach to and activate opioid receptors in the brain parts which control pain and emotions. Attachment of opioids to these receptors blocks pain signals signaled from the brain and releases large volumes of dopamine, a “feel-good hormone,” producing a euphoric feeling. As the mind becomes used to these feelings, the brain wants more and more opioids to provide the same pain relief levels and euphoria. This leads to dependence and later addiction to opioids. This means that an individual cannot function without opiates, and this is what has produced the opioid crisis. Comment by Vicky Fest: You can omit this sentence since the next one talks about how opioids affects the brain

At an individual level, the symptoms of opioid overuse and misuse include dependence on opioids. An individual experiences physical and psychological withdraw symptoms upon not using opioids. Also, uncontrollable cravings and powerlessness to control the use of opiates even though they produce adverse effects indicate opioid addiction. Other symptoms include prioritization of acquisition and use of opioids over other activities such as school and work, weight loss, lack of hygiene, drowsiness, isolation from family and friends, engaging in risky behaviors, being nervous, losing interest in activities previously enjoyed, and experiencing financial hardships (Green, 2017). Comment by Vicky Fest: I would word this as “Individuals experience….”

At the community level, the indication of the opioid crisis includes increased healthcare and criminal justice costs related to opioid use (Birnbaum, White, Schiller, Waldman, Cleveland & Roland, 2011). The opioid crisis drives up healthcare costs in Winston-Salem, and these expenses include therapeutic and drug expenses, prevention and treatment fees as well as study costs. The criminal justice charges include expenses attributed to the opioid crisis, including police, correctional facilities, legal, and adjudication (Birnbaum et al., 2011). Therefore, increasing healthcare and criminal justice costs related to opioids, all point to the opioid crisis in Winston-Salem. Comment by Vicky Fest: Birnbaum et al, 2011

Diagnosis

The primary cause of the opioid crisis is the prescription of opioids to manage pain (Green, 2017). According to Mohamadi, Chan, Lian, Wright, Marin, Rodriguez, and Nazarian (2018), the opioid crisis was due to opioid over-prescription, which started in the 1990s, resulting in opioid over-prescription. This was because, during this period, more than 100 million people in the U.S were suffering from pain. Drug corporations and the federal government pushed for the expansion of painkilling opioid use. This increased opioid prescriptions by doctors to patients. Another cause of this crisis is the continued use of opioids beyond doctor prescriptions to lessen pain or bring about euphoric feelings. This marks the start of opioid addiction, leading to dependence and the resultant crisis. Also, the inexpensiveness of opioids is the cause of this crisis. When compared to alternative intervention for pain management such as physical therapy, opioids are relatively inexpensive (Green, 2017). Comment by Vicky Fest: Mohamadi et al Add quotes around the direct quote you are citing

Other than Winston-Salem, there are also other communities suffering from this crisis, including Lockbourne in Pickaway County, Ohio, and Kermit in Mingo County, West Virginia. Heroin has become an epidemic in Lockbourne, leaving many dead. In this community, three people each day die due to heroin use. Lockbourne is a ground zero for the opioid crisis, devastating not only the state but also the nation. Also, there is no denying of the over-prescription opioids in Kermit in West Virginia (Patrick, 2019). At some point, a pharmaceutical company distributed more than 10 million pills to Kermit, over a 10-month period (Patrick, 2019). The combination of a small population in this community, approximately 400 people, with opioid accumulation, worsens the opioid crisis in Kermit. Comment by Vicky Fest: Since you are focusing on Winston-salem in my opinion it doesn’t seem pertinent to give so many facts about other counties/cities if not in your state or county

These communities are attempting to address the opioid crisis through various strategies. One of the strategies is education programs for community members focusing on the administration of naloxone. Also, these communities are increasing access to naloxone and addiction services to individuals with opioid addiction (Palombi, Olivarez, Bennett & Hawthorne, 2019). Another strategy is education initiatives for community members on safe usage, storing, and discarding of prescription pills to ensure the reduction of opioid overdose among the community members. The provision of support for community members in the recovery process has been beneficial in helping the community members struggling with opioid withdrawal symptoms (Palombi et al., 2019).

Cure

Both pharmacological and psychosocial treatments eradicate or reduce the opioid crisis. One type of medication used in treating opioid disorder is opioid antagonists, including naloxone and naltrexone (Veilleux, Colvin, Anderson, York & Heinz, 2010). Naloxone is administered through injection and naltrexone administered orally. These medications block opioid receptors and thus making opioid ingestion ineffective. Another type of drug that has proven effective in opioid disorder treatment includes opioid agonists, including methadone, acetate, levomethadyl, and buprenorphine (Veilleux et al., 2010). Opioid agonists block opioid receptors and produce the same impacts as natural endogenous opiates. Alpha 2 adrenergic agents, including lofexidine and clonidine are non-opioid medications used to diminish opioid withdrawal symptoms (Veilleux et al., 2010). Comment by Vicky Fest: Veilleux et al

Various psychosocial treatment approaches, including biofeedback, psychotherapeutic counseling, cognitive behavioral therapy, and psychodynamic therapies, improve relapses and treatment retention (Veilleux et al., 2010). The psychosocial treatment, when used in combination with pharmacological approaches, leads to high rates of treatment compliance, completion, and lower opioid use rates, and lower chances of relapses. Dugosh, Abraham, Seymour, McLoyd, Chalk, and Festinger (2016) have supported the effectiveness of offering psychosocial therapy, combining with medications in treating opioid adduction to improve clinical outcomes. Comment by Vicky Fest: Dugosh et al

Precision Addiction Management has been suggested as an approach to the effectively compact opioid crisis (Blum, Gondré-Lewis, Baron, Thanos, Braverman, Neary, ... & Badgaiyan, 2018). The treatment goal with precision addiction management is enhancing target reward deficiency and the volume of brain reward functional connectivity. Apart from pharmacological and psychosocial approaches, communities can eradicate or reduce the occurrence of the opioid crisis by increasing access to treatment and recovery sustenance. Comment by Vicky Fest: Blum et al

Prevention

Prevention is better than cure. Preventing the opioid crisis would help avoid the chances of individuals being impacted in the future. One of the prevention strategies is prescription monitoring program utilization. These programs control the number of primary care providers prescribing opioids for patients and the number of drugstores providing opioids for the patients (Hahn, 2011). The programs limit opioid prescriptions. For example, the implementation of this program in 2010 in Florida led to a 50 percent reduction in opioid overuse and misuse by 2012 (Green, 2017).

Another strategy is ending the supply of unfitting prescriptions and illegal opioids (Hahn, 2011). This can be achieved through laws that cut access to illegal opioids. Increase training in overdose recognition and treatment is another strategy for prevention. Training patients, members of the family, and first responders in overdose recognition and administration of naloxone would help in the prevention of this crisis (Green, 2017). They are encouraging opioid manufacturers to utilize opioid abuse-deterrent formulations. Opioid formulations having abuse-deterrent properties would prevent opioid addiction and thus preventing opioid crisis (Hahn, 2011).

Also, reducing inappropriate opioid prescriptions would prevent this crisis from happening in the future. When opioids are prescribed appropriately, and after careful patient evaluation, together with appropriate patient education, opioid overuse and misuses leading to the opioid crisis can be prevented (Green, 2017). Guidelines for opioid prescriptions for chronic pain would promote appropriate opioid prescriptions by primary care providers and therefore preventing the opioid crisis from occurring (Green, 2017). Additionally, an inappropriate opioid prescription can be prevented through educating primary care providers and patients on sage opioid prescription and appropriate opioid use.

Conclusion

The opioid crisis is a huge public health issue, and thus, addressing this problem is a priority for communities. Various communities, including Winston-Salem, are affected by this issue. Recognizing the symptoms of this public health issue is at the center of addressing it. Both pharmacological and psychosocial approaches are used in treating this issue. However, prevention is better than cure. Using various prevention strategies ranging from utilization of prescription monitoring programs to reducing inappropriate opioid prescriptions would prevent the occurrence of this issue in the future.

References