The Public Health Approach to the Worsening Opioid Crisis in the United States Calls for Harm Reduction Strategies to Mitigate the Harm From Opioid Addiction and Overdose Deaths

2021 ◽  
Author(s):  
Yvon Yeo ◽  
Rosemary Johnson ◽  
Christine Heng
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
The United States ◽  
Public Health Approach ◽  
Opioid Crisis ◽  
Long Run ◽  
Reduction Strategies ◽  
Public Health Strategies ◽  
Overdose Deaths ◽  
The U.S

ABSTRACT The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid crisis is not improving but has become dire with the surge in fentanyl-related overdose deaths. Evidence-based strategies have to be implemented in the U.S. to control this epidemic before it destroys more lives. Other countries, including European countries and Canada, have invested more in harm reduction strategies than the U.S. even though they (especially Europe) do not face anywhere near the level of crisis as the U.S. In the long-run, upstream measures (tackling the social determinants of health) are more effective public health strategies to control the epidemic. In the meantime, however, harm reduction strategies have to be employed to mitigate the harm from addiction and overdose deaths.

Community Perceptions of Harm Reduction and Its Implications for Syringe Exchange Policy

2020 ◽  
Vol 50 (4) ◽  
pp. 507-523 ◽  
Author(s):  
Amanda Sharp ◽  
Joshua T. Barnett ◽  
Enya B. Vroom
Keyword(s):  
Harm Reduction ◽  
Community Education ◽  
The United States ◽  
Syringe Exchange ◽  
Policy Integration ◽  
Community Members ◽  
Exchange Program ◽  
Reduction Strategies ◽  
National Public Health ◽  
Overdose Deaths

In the United States, the rising prevalence of opioid addiction has led to an increase in opioid-related overdose deaths and transmission of infectious disease. This resulted in the declaration of a national public health emergency and the need for harm reduction strategies such as syringe exchange. Florida has seen increases in blood-borne diseases and fatal/nonfatal opioid overdoses, yet harm reduction policy integration has been historically limited. To inform policy change, this study explores the perspectives of community members in Manatee County, Florida, on harm reduction services. Six focus groups were conducted with findings centralized around three emergent themes related to the implementation of a syringe exchange program: (a) awareness and acceptability; (b) facilitating factors; and (c) perceived barriers. The results of this qualitative research helped to inform the successful adoption of a local syringe exchange ordinance. Recommendations for community education and engagement regarding harm reduction policy are discussed.

scholarly journals The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ying Han ◽  
Wei Yan ◽  
Yongbo Zheng ◽  
Muhammad Zahid Khan ◽  
Kai Yuan ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Severe Pain ◽  
Large Scale ◽  
Social Economic ◽  
The United States ◽  
Therapeutic Strategies ◽  
Public Health Threat ◽  
Reduction Strategies ◽  
Overdose Deaths

Abstract Fentanyl is a powerful opioid anesthetic and analgesic, the use of which has caused an increasing public health threat in the United States and elsewhere. Fentanyl was initially approved and used for the treatment of moderate to severe pain, especially cancer pain. However, recent years have seen a growing concern that fentanyl and its analogs are widely synthesized in laboratories and adulterated with illicit supplies of heroin, cocaine, methamphetamine, and counterfeit pills, contributing to the exponential growth in the number of drug-related overdose deaths. This review summarizes the recent epidemic and evolution of illicit fentanyl use, its pharmacological mechanisms and side effects, and the potential clinical management and prevention of fentanyl-related overdoses. Because social, economic, and health problems that are related to the use of fentanyl and its analogs are growing, there is an urgent need to implement large-scale safe and effective harm reduction strategies to prevent fentanyl-related overdoses.

scholarly journals Public health strategies to combat opioid epidemic in the United States: A systematic review

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
F Balidemaj
Keyword(s):  
Public Health ◽  
United States ◽  
Systematic Review ◽  
The United States ◽  
Opioid Abuse ◽  
Opioid Epidemic ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Opioid Crisis ◽  
Public Health Strategies

Abstract Background The opioid epidemic in the United States is a national public health crisis. Driven by an increase in availability of pharmaceutical opioids and by an increase in their consumption, specifically, for pain treatment, more so in the past twenty years, it has led to an economic cost of prescription opioid abuse, overdose, and dependence in the United States estimated to be 78.5 billion USD. The purpose of this systematic review was to identify and evaluate public health strategies that contribute towards combatting the opioid crisis. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a search was conducted of the PubMed database for articles in English language that analyzed the most effective ways to regulate health markets to decrease the opioid crisis in the United States. Results The initial search yielded 2397 titles, of which 15 full-text articles were ultimately selected for inclusion in this systematic review. The review identified four categories in overcoming this epidemic nationwide, including required improvement in patient utilization of and access to safe and effective treatment options for opioid abuse and overdose, addressing the stigma correlated with opioid use, considering appropriate use of abuse deterrent formulations (ADF) along with patient education, and improving prescribing practices via utilization of drug monitoring programs, CDC opioid prescribing guidelines and provider continuing education. Conclusions Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. While the methods with promising improvement of the situation have been identified, implementing them has shown to be a challenge. Continued application is needed, while considering possible new steps that could help reinforce their utilization further. Key messages Attempts to combat the opioid epidemic have been made, and the state and federal governments have only recently started to understand the magnitude of the seriousness of this public health crisis. The methods with promising improvement of the opioid crisis situation have been identified, however utilizing and implementing the existing public health strategies has shown to be a challenge.

scholarly journals Male-Female Disparities in Years of Potential Life Lost Attributable to COVID-19 in the United States: A State-by-State Analysis

2021 ◽  
Vol 11 (16) ◽  
pp. 7403
Author(s):  
Jay J. Xu ◽  
Jarvis T. Chen ◽  
Thomas R. Belin ◽  
Ronald S. Brookmeyer ◽  
Marc A. Suchard ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Attributable Mortality ◽  
Mortality Burden ◽  
Rate Ratios ◽  
Public Health Strategies ◽  
Male To Female ◽  
Universal Pattern ◽  
The U.S

Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantified and contrasted years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios, both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality burden in terms of YPLL compared to death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of cultivating a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.

A Public Health Guide to Ending the Opioid Epidemic

2019 ◽  
Keyword(s):  
Public Health ◽  
Primary Prevention ◽  
Substance Misuse ◽  
Traditional Approach ◽  
The United States ◽  
Public Health Approach ◽  
Opioid Use ◽  
The Public ◽  
Opioid Crisis ◽  
The Impact

Few contributions to the field concerning the current opioid crisis in the United States focus sufficient attention on the public health aspects of the epidemic and share examples that practitioners can use to prevent opioid use disorder and the broader issues of substance misuse and addiction. A great deal of prior published work has concentrated on health care and clinical perspectives related to the crisis, including developing prescribing guidelines, enhancing prescription drug monitoring programs, scaling up access to overdose reversal medication, and making medication-assisted treatment more widely available nationwide. This book adds to and complements this prior work by addressing the central tenets of the public health approach to the opioid crisis. Topics include how to best support community-based, primary prevention of substance misuse and addiction in various settings with diverse populations and how to effectively address the cultural, social, and environmental aspects of health that are driving the epidemic. Chapters describe how governmental public health agencies play a significant role in responding to the epidemic, in both public health’s traditional approach to disease surveillance and control and contemporary approaches to health promotion that include building community resilience, addressing the impact of adverse childhood events, and mitigating the root causes of addiction community-wide. This volume can be used to explore what it means to address primary prevention of addiction and how public health practitioners have led efforts to promote “opioid stewardship” at the local, state, and federal levels.

At the Intersection of Harm Reduction and COVID-19: The Role of Anthropologists during and Post-Pandemic

2021 ◽  
Vol 80 (4) ◽  
pp. 272-281
Author(s):  
Shana Harris ◽  
Allison Schlosser
Keyword(s):  
Public Health ◽  
United States ◽  
Harm Reduction ◽  
United States Public Health ◽  
The United States ◽  
Opioid Use Disorder ◽  
Public Health Approach ◽  
People Who Use Drugs ◽  
Opioid Use ◽  
Policy Changes

Harm reduction is a public health approach that emphasizes reducing the negative effects of drug use rather than eliminating it. It has been practiced for decades; however, the COVID-19 pandemic poses new challenges for people who use drugs (PWUD) and harm reduction providers. In the United States, public health recommendations to curb the pandemic are complicating harm reduction efforts. Harm reduction programs are rethinking how they engage with PWUD to comply with these recommendations while also providing essential services. In this article, we draw on academic literature, news articles, and information distributed by harm reduction programs to discuss issues currently faced by PWUD and harm reduction providers across the country. This discussion focuses on policy changes and programming adaptations related to three harm reduction interventions—syringe services programs, overdose prevention, and medications for opioid use disorder—that have emerged or gained traction during the pandemic. We argue that anthropologists should play a key role in addressing the obstacles and opportunities for harm reduction in the United States during and post-pandemic. Ethnographic research can generate important knowledge of how pandemic-related service and policy changes are localized by providers and experienced by PWUD and uncover how race, class, and gender may shape access to and experiences with modified harm reduction services. Applied anthropologists also have an important role in collaborating with harm reduction programs to ensure that the voices of marginalized individuals are not ignored as policy and programming changes take place during and after the pandemic.

scholarly journals A Public Health Strategy for the Opioid Crisis

2018 ◽  
Vol 133 (1_suppl) ◽  
pp. 24S-34S ◽  
Author(s):  
Brendan Saloner ◽  
Emma E. McGinty ◽  
Leo Beletsky ◽  
Ricky Bluthenthal ◽  
Chris Beyrer ◽  
...  
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Addiction Treatment ◽  
The United States ◽  
Current Data ◽  
Structural Factors ◽  
Opioid Use ◽  
Public Health Perspective ◽  
Injury Death ◽  
Opioid Crisis

Drug overdose is now the leading cause of injury death in the United States. Most overdose fatalities involve opioids, which include prescription medication, heroin, and illicit fentanyl. Current data reveal that the overdose crisis affects all demographic groups and that overdose rates are now rising most rapidly among African Americans. We provide a public health perspective that can be used to mobilize a comprehensive local, state, and national response to the opioid crisis. We argue that framing the crisis from a public health perspective requires considering the interaction of multiple determinants, including structural factors (eg, poverty and racism), the inadequate management of pain, and poor access to addiction treatment and harm-reduction services (eg, syringe services). We propose a novel ecological framework for harmful opioid use that provides multiple recommendations to improve public health and clinical practice, including improved data collection to guide resource allocation, steps to increase safer prescribing, stigma-reduction campaigns, increased spending on harm reduction and treatment, criminal justice policy reform, and regulatory changes related to controlled substances. Focusing on these opportunities provides the greatest chance of making a measured and sustained impact on overdose and related harms.

The Opioid Crisis: How Counselors Can and Should Respond

2021 ◽  
Vol 43 (2) ◽  
pp. 112-124
Author(s):  
Kevin S. Doyle
Keyword(s):  
Public Health ◽  
The United States ◽  
Public Health Emergency ◽  
Scope Of Practice ◽  
Professional Activity ◽  
Specialty Area ◽  
Ethical Imperative ◽  
National Public Health ◽  
Overdose Deaths ◽  
Do So

Drug overdose deaths in the United States have reached unprecedented levels in recent years and continue to rise. Counselors are uniquely positioned to respond to this crisis but may be reluctant or not equipped to do so due to a variety of factors, including scope of practice concerns. Responding to this crisis, however, is a clinical necessity and an ethical imperative for all practicing counselors, regardless of specialty area. A review of proposed responses at the macro/systemic, professional, and personal levels is presented, with concrete examples within each level, to assist counselors in identifying and implementing professional activity, advocacy, and engagement to address the unprecedented national public health emergency. Specific considerations for advocacy and for clinical practice are proposed to further assist counselors and motivate action.

Commissioned Corps Deployments & Family Resiliency

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Janice Arceneaux ◽  
James Dickens ◽  
Wanza Bacon
Keyword(s):  
Public Health ◽  
Health And Safety ◽  
United States Public Health ◽  
Disease Outbreaks ◽  
The United States ◽  
Humanitarian Assistance ◽  
Family Resiliency ◽  
Public Health Emergencies ◽  
National Public Health ◽  
The U.S

Established in 1889, the United States Public Health Service Commissioned Corps (Corps) is one of the seven uniformed services and is part of the U.S. Department of Health and Human Services. The Corps is committed to protecting, promoting and advancing the health and safety of the nation with a history that dates back over two centuries, beginning as the U.S. Marine Hospital Service. Today, the Corps responds and serves in many areas impacted by natural disasters, disease outbreaks, terrorist attacks and public health emergencies. Corps officers have deployed to provide assistance during national public health emergencies (e.g., hurricanes, bombings, flooding and wild fires); to combat the Ebola epidemic in West Africa; and to provide humanitarian assistance in Latin America and the Caribbean. Corps deployments impact not only service members but also their families. This article offers a brief overview of the Corps and discusses how deployments impact families. Family resiliency and future implications for research and practice will also be examined.

scholarly journals Healthy People 2020 Objectives for Violence Prevention and the Role of Nursing

2014 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Simon ◽  
Kimberly Hurvitz
Keyword(s):  
Public Health ◽  
Violence Prevention ◽  
Partner Violence ◽  
Youth Violence ◽  
Public Health Problem ◽  
The United States ◽  
Healthy People ◽  
Public Health Approach ◽  
Prevention Strategies ◽  
Healthy People 2020

Violence, including child maltreatment, youth violence, intimate partner violence, and sexual violence, is a significant public health problem in the United States. A public health approach can help providers understand the health burden from violence, evaluate evidence for prevention strategies, and learn where to turn for information about planning and implementing prevention strategies for this preventable problem. For the past three decades, the U.S. Department of Health and Human Services has published “Healthy People” objectives for the next decade. The Healthy People 2020 initiative includes 13 measurable objectives related to violence prevention, one of which was selected as a Healthy People 2020 Leading Health Indicator. Progress to achieve these objectives can save thousands of lives, reduce the suffering of victims and their families, and decrease financial cost to the law enforcement and healthcare systems. The role that nurses can and do play in violence prevention is critical and extends beyond just caring for victims to also include preventing violence before it happens. This article summarizes the violence prevention objectives in Healthy People 2020 and the resources for prevention available to support nurses and others as they move prevention efforts forward in communities to stop violence before it starts.

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