RESEARCH ESSAY

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Student’s Name

Professor Armes

ENGL 1320

17 Nov 2019

The Ethical Dilemma of the Opioid Epidemic

A silent killer in the United States is a drug that many people can be prescribed in a

doctor’s office, with addicting effects similar to illegal drugs such as heroin. Originally sold as

nonaddictive painkillers, opioids such as Oxycontin were prescribed heavily upon their first

release in the American medical market. In fact, researcher Robbie Wright states that the sale of

opioid prescriptions has quadrupled in the United States in the past ten years (Wright 527). With

opioid sales on the rise in both the black market and in physicians’ offices, the problem of how

to combat the opioid crisis becomes increasingly more prominent. The continued mass sales of

opioid prescriptions in the US has created lifelong addictions in many citizens; therefore, the

opioid prescriptions must be more heavily regulated and proper addiction resources should be

provided for all people suffering from an opioid addiction.

The majority of opioid addictions begin in professional settings such as a physician’s

office, with a study showing “from 1999 to 2015, more than 183,000 people died as a result of

overdoses of prescription opioids” (Zierk 185). While many factors have contributed to this high

casualty number as it is today, one of the main contributors researcher Robbie Wright argues is

the pharmaceutical industry. When Oxycontin was first introduced on the drug market back in

1995, pharmaceutical companies advertised the drug as a “nonaddictive painkiller designed to

treat any and all types of pain” (Wright 527). It was advertisements like these that helped

perpetuate OxyContin, and many drugs like it, as one of the bestselling intensive pain

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medications sold on the market in the 1990’s up until present day, which then introduced a mass

addiction epidemic to the drug and many others. The aftermath, which reached the height that it

did for reasons that include lack of industry regulation and insight from ethics guidelines (Zierk

213), is a nationwide problem of opioid addiction, with numbers still increasing today. While

advertisements for opioids like OxyContin are not as common in present day, the effects of the

first wave of these advertisements overall helped ensure the success of the drug in the medical

industry.

An important factor to take into consideration when looking at the opioid epidemic as a

whole is the performance of the pharmacists and physicians that are in charge of formulating and

prescribing these opioid medications; is the education and training they receive enough to

prepare them for the possible consequences of these prescriptions? In a research study by

researchers Lily Rowan Mahon et al. looked into students at the University of Minnesota’s

pharmaceutical school and initiated a series of surveys about substance abuse and opioid

addictions. After the surveys concluded, the researchers found that there were “considerable

knowledge gaps in addiction basics, overdose risk factors, and opioid overdose first-aid

procedures” (Mahon et al., 7). The researchers concluded that some of the solutions to help

prevent this lack of knowledge would be to have stronger focuses on opioid abuse and training

with opioids for students in their classes. While this study was only focused on one university in

particular, it does increase questions about the training the students receive before they gain their

diploma and certifications and whether or not it is sufficient enough for handling future opioid

treatments. If extra classes and trainings were enforced, it would overall help prevent and

decrease the percentage of opioid addiction rates in the United States through doctors both

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gaining a refresher on and enforcing alternative treatments for chronic pain as well as giving

proper doses of opioid medications.

A noticeable statistic when looking at the rate of opioid addictions across the United

States is the increased number of addiction rates in rural communities compared to urban

communities, despite rural communities typically having lower population levels. While factors

such as low income levels per capita can play into effect on why this is the case, one of the main

reasons of why these addiction rates are higher is because of the lack of treatment centers for

these areas. The primary opioid treatment drug, Methadone, is an extremely expensive drug that

is usually only provided to opioid treatment centers in more urban areas. Not only is the drug

high in price, but it is also difficult to acquire for people that live further away, which usually

translates into more rural areas. In the article “Improving Rural Access to Opioid Treatment

Programs,” Researcher Quentin Johnson et al. states that “Methadone regulation requires new

patients to be present in person for administration five or six days a week” (Johnson et al., ). This

regulation makes it especially difficult on people who do not live in close proximity to an opioid

treatment facility, as many other factors such as family responsibilities and work may prevent

people from being able to commute. These factors could also be contributed to higher funding in

urban areas as compared to rural areas, with local governments typically having a higher amount

of money in city governments than local governments in the country.

While it has been statistically proven that urban areas have a higher average of opioid

overdose deaths than urban areas, there is still a staggering number of opioid overdose deaths in

urban areas. Despite urban areas being more densely populated than rural areas, urban areas also

see a parallel to rural areas in terms of location and commuting. Because urban areas tend to be

large in size, some areas of these cities may not be close to an opioid treatment facility,

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especially in areas with a higher low income population. Researchers Zan M. Dodson, Eun-Hye

Enki Yoo, Christian Martin-Gill, and Ronald Roth explored the dilemma of inner city opioid

clinics in Pittsburg, Pennsylvania and how the clinics tend to cluster in certain areas as compared

to others. The areas that these clinics tend to cluster more towards tend to be more wealthy,

higher income areas as opposed to lower income areas, which shows a discriminatory approach

to providing access to certain kinds of health care for different demographics. Dodson et al.

discusses this in the article, and states that in the future government officials and health care

companies need to build clinics “accounting for demographic and economic factors, distance and

time to treatment (physical accessibility), and ways to improve accessibility to immediate

treatment that is not reliant on existing hospital and EMS systems” (Dodson et al., 1195).

Providing the proper care and resources to people who currently are without these resources

would be one of the steps needed to help combat the opioid epidemic. Critics of this solution

could argue that the overall process would be too expensive and cause a city’s budget to be in

debt, however, through proper funding, this solution would be one of the fastest ways to expedite

the opioid epidemic.

As excessive prescriptions of opioid medications and the zoning of treatment facilities

both affect the numbers of people addicted to opioids and prevent the problem from being

solved, there are numerous outcomes that appear as the epidemic persists. Typically opioid

addictions begin in the physicians’ office, where one prescription for pain relief can possibly

lead to a lifelong addiction. However, when these patients that are addicted are no longer

prescribed these opioid medications, they often times turn to different means; the black market.

In fact, researcher Klara A. Zierk states that there is a “rising number of acute overdoses due to

both illegally obtained opiates and opioids and legally prescribed drugs” (Zierk 187). The

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opioids suggested in this excerpt from the black market ranges from opioids like OxyContin that

can be prescribed by a physician to, Zierk states, harder drugs such as heroin and cocaine, all

having devastating effects on the person taking them (Zierk 186). While there is still a large

percentage of people addicted to prescribed opioids and opiates, the black market is typically the

next step for people addicted to opioids. The percentage of people that went from a prescribed

opioid addiction to an addiction to drugs such as heroin and cocaine was reported on in a study,

with injection drug users interviewed in 2008 and 2009 found that “86 percent had used opioid

pain relievers non-medically prior to using heroin” (Zierk 186). These results help show the

increasing problem of the reckless prescribing of opioids, as they can lead to more problems later

on, as well as possibly lead to the introduction of illegally obtained drugs. Some preventions to

this return to previous solutions listed above; by physicians prescribing appropriate dosage

amounts or using alternative treatments, the patients’ likelihood of becoming addicted to these

medications will most likely decrease.

There is a long list of ways to improve the opioid epidemic and decrease the numbers of

people being addicted, but it overall is a gradual process that will take years to fix. Wright states

that “the first step is to pass a distinguished, detailed approach to enforcing registration

requirements for manufacturers and distributors” (Wright 547). This solution stems from the

abundant amounts of opioids being prescribed from the pharmaceutical industry and calls for

stricter regulations and enforcements when producing and prescribing these drugs. If these

policies are eventually passed, it would help prevent more people from being addicted and help

decrease the amount of new people being addicted each year. However, policy implementation

could go even deeper and more specific than just setting regulations for pharmaceutical

companies. Re-education practices or requiring extra classes on opioid abuse for both studying,

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new, and practicing physicians could help bring proper training and/or refresh learned material.

Another way to help prevent future opioid addictions is by “expanding the use of practice

guidelines could help strengthen physician awareness of proper opioid prescribing doses” (Zierk

213). Zierk explains that the general ethics guidelines help promote safer, and more ethically

appealing methods and practices towards treatment for chronic pain (Zierk 213). Providing

alternative practices for chronic pain relief that do not use addicting drugs would help put an end

to the overall issue of improper opioid prescribing doses.

Although the cause of the opioid epidemic mainly lies in the hands of pharmaceutical

companies and doctors, the solutions lie in both the causers and the people affected. While it is

common to state some possible solutions to prevent people from becoming addicted, little

attention is given to people that have already become addicted. Opioid addiction can completely

uproot someone’s life, leaving them vulnerable and unable to continue through life. For someone

that is already suffering from an opioid addiction, support from others with an opioid addiction

may help give a sense of hopefulness to the victim that they can overcome the addiction. In an

article written by Michael Fraser and Marcus Plescia, it is now required that states have

“prescription drug monitoring programs that allow health care providers to view prescription

histories and better clinical options to treat addiction, support evidence-based recovery programs,

and increase attention to opioid use and addiction from a community perspective” (Fraser et al.,

216). The article also reiterates that one of the largest problems within the opioid epidemic is that

peope are “relying too heavily on clinicians and the health care system to prevent opioid misuse

and not enough on community-driven public health approaches to addressing the root causes of

addiction” (Fraser et al., 216). Overall, one of the main solutions to decreasing opioid addiction

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levels is by helping the people already addicted through support systems and community-driven

tactics.

The opioid epidemic is a serious problem both globally and nationally, with the rates of

addiction growing exponentially each year. In order to combat this epidemic, appropriate

measures need to be taken such as providing better funding so that people from lower income

areas can have access to opioid treatment programs, increasing the levels of opioid treatment

education for students in pharmaceutical and doctoral programs at universities, and increasing

overall awareness of the destructive nature opioid medications can possibly have on a person’s

life. These methods, while still likely to help reduce the rates of opioid addiction both directly

and indirectly, will take time in order to eventually see results because of factors such as the

lengthy process of policy implementation and board overview over classes at universities.

Unfortunately, if these steps are not taken, future rates of opioid addiction will continue to

exponentially rise year after year, creating more . However, if these precautions are taken in the

future, it is likely that the percentage of opioid addiction in the United States will greatly

decrease, providing a brighter future for Americans as a whole.

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Works Cited

Dodson, Zan M., et al. “Spatial Methods to Enhance Public Health Surveillance and Resource

Deployment in the Opioid Epidemic.” American Journal of Public Health, vol.

108, no. 9, 2018, pp. 1191–1196., doi:10.2105/ajph.2018.304524.

Fraser, Michael, and Marcus Plescia. “The Opioid Epidemic’s Prevention Problem.” American

Journal of Public Health, vol. 109, no. 2, Feb. 2019, pp. 215–217. EBSCOhost,

doi:10.2105/AJPH.2018.304859.

Johnson, Quentin, et al. “Improving Rural Access to Opioid Treatment Programs.” The Journal

of Law, Medicine & Ethics, vol. 46, no. 2, 2018, pp. 437–439.,

doi:10.1177/1073110518782951.

Mahon, Lily Rowan, et al. Harm Reduction Journal, 16 Nov. 2018,

web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=4&sid=9001c71d-a22e-

4749-a0f0-b0b6afd0c9b9%40sessionmgr4006.

Wright, Robbie. “The Opioid Epidemic: Returning to the Basics.” Mercer Law Review, vol. 70,

no. 2, Winter 2019, pp. 525–547. EBSCOhost, search.ebscohost.com/login.aspx?

direct=true&db=a9h&AN=135458576&scope=site.

Zierk, Klara A. “THE REAL ANTIDOTE: A CRITICAL REVIEW OF U.S. AND CANADIAN

DRUG TREATMENT COURTS AND A CALL FOR PUBLIC HEALTH

PREVENTION TOOLS AS A SOLUTION TO THE OPIOID EPIDEMIC.”

Indiana International & Comparative Law Review, 13 Mar. 2019,

web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=6&sid=7aaea66d-9ef2-

4a91-b13d-c9f082fffd16%40sessionmgr101.