A Public Health Approach to Protecting Workers from Opioid Use Disorder and Overdose Related to Occupational Exposure, Injury, and Stress

2021 ◽  
pp. 104829112110310
Keyword(s):  
Public Health ◽  
Opioid Use Disorder ◽  
Public Health Approach ◽  
Workers Compensation ◽  
Care Providers ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Key Policy ◽  
The Impact

Opioid overdose mortality, in combination with increased deaths from alcohol and suicide, is having a profound impact on American workplaces, compromising occupational health and safety and increasing workers’ compensation and health insurance costs, absenteeism, and lost productivity. The President’s Council of Economic Advisers estimates that more than 1 million workers are out of the workforce due to the opioid crisis. The impact on workers is equally profound, including job loss, divorce and family disruption, and potentially imprisonment, injury, illness, and death. Pain from occupational injuries and illnesses and stress are important pathways to opioid use disorder. Effective workplace programs that incorporate the public health approach to prevention offer a significant opportunity to prevent and respond to the opioid crisis. To date, the nation’s efforts at combating the crisis have not included the necessary policy reforms to transform the workplace from a pathway to opioid misuse to a pathway to prevention, including education of workers, unions, employers, and health care providers and treatment and recovery of affected workers. Several key policy interventions are recommended to address this disconnect, including prevention of workplace injury, illness, and emotional distress; worker education and training; and replacement of stigmatizing, punitive workplace substance use programs with supportive programs. Increasing access to alternative pain treatment and preventing opioid misuse in workers’ compensation systems are other key policy recommendations.

Stigma and the Language of Addiction

2019 ◽  
pp. 33-44
Author(s):  
Michael Botticelli ◽  
Colleen L. Barry
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Substance Use ◽  
Public Attitudes ◽  
Opioid Use Disorder ◽  
Health Conditions ◽  
Public Health Approach ◽  
Opioid Use ◽  
Policy Changes ◽  
Opioid Crisis

Stigma influences attitudes toward individuals and groups, and these attitudes are expressed in how we as a nation have dealt with addiction in general and the opioid crisis in particular. Stigma is defined as a strong lack of respect for a person or a group of people or a bad opinion of them because they have done something or have traits of which society disapproves. Stigma creates misperceptions about how to end the opioid crisis and acts as a barrier for individuals with opioid use disorder to seek treatment and engage in recovery. Public attitudes toward addiction need to be changed to effectively end the epidemic, as does the language used to describe individuals who misuse drugs. Misperceptions and lack of understanding of addiction as a chronic disease have promoted the criminalization of individuals with substance use disorder rather than a public health approach. The case is made for policy changes that support new policy directions that stress parity in treatment for mental health and substance misuse with other “physical health” conditions as well as suggestions for better communications strategies to reduce stigma.

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.

scholarly journals The Opioid Epidemic: Challenge to Military Medicine and National Security

2020 ◽  
Vol 185 (5-6) ◽  
pp. e662-e667 ◽  
Author(s):  
Zygmunt F Dembek ◽  
Tesema Chekol ◽  
Aiguo Wu
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
National Security ◽  
Opioid Addiction ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Military Veteran ◽  
The Military

Abstract Introduction We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction. Materials and Methods A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis. Results Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as “street drugs” and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance. Conclusions Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans’ programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans’ health systems.

scholarly journals Assessing the impact of the Good Samaritan Law in the state of Connecticut: a system dynamics approach

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Nasim S. Sabounchi ◽  
Rebekah Heckmann ◽  
Gail D’Onofrio ◽  
Jennifer Walker ◽  
Robert Heimer
Keyword(s):  
Public Health ◽  
System Dynamics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Behavioral Changes ◽  
Opioid Use ◽  
Good Samaritan ◽  
Ed Visits ◽  
The Impact ◽  
Overdose Deaths

Abstract Background Although Good Samaritan laws (GSLs) have been widely adopted throughout the United States, their efficacy in individual states is often unknown. This paper offers an approach for assessing the impact of GSLs and insight for policy-makers and public health officials who wish to know whether they should expect to see outcomes from similar policy interventions. Methods Utilizing a system dynamics (SD) modeling approach, the research team conducted a policy evaluation to determine the impact of GSLs on opioid use disorder (OUD) in Connecticut and evaluated the GSL based upon the following health outcomes: (1) emergency department (ED) visits for overdose, (2) behavioral changes of bystanders, and (3) overdose deaths. Results The simulation model suggests that Connecticut’s GSL has not yet affected overdose deaths but has resulted in bystander behavioral changes, such as increased 911 calls for overdose. ED visits have increased as the number of opioid users has increased. Conclusions The simulation results indicate that the number of opioid-related deaths will continue to increase and that the GSL alone cannot effectively control the crisis. However, the SD approach that was used will allow policymakers to evaluate the effectiveness of the GSL over time using a simulation framework. This SD model demonstrates great potential by producing simulations that allow policymakers to assess multiple strategies for combating the opioid crisis and select optimal public health interventions.

scholarly journals The opioid crisis: a contextual, social-ecological framework

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mohammad S. Jalali ◽  
Michael Botticelli ◽  
Rachael C. Hwang ◽  
Howard K. Koh ◽  
R. Kathryn McHugh
Keyword(s):  
Interpersonal Relationships ◽  
Integrated Approach ◽  
Public Health Approach ◽  
Ecological Framework ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Social Ecological ◽  
Broad Public Health ◽  
Social Ecological Framework

AbstractThe prevalence of opioid use and misuse has provoked a staggering number of deaths over the past two and a half decades. Much attention has focused on individual risks according to various characteristics and experiences. However, broader social and contextual domains are also essential contributors to the opioid crisis such as interpersonal relationships and the conditions of the community and society that people live in. Despite efforts to tackle the issue, the rates of opioid misuse and non-fatal and fatal overdose remain high. Many call for a broad public health approach, but articulation of what such a strategy could entail has not been fully realised. In order to improve the awareness surrounding opioid misuse, we developed a social-ecological framework that helps conceptualise the multivariable risk factors of opioid misuse and facilitates reviewing them in individual, interpersonal, communal and societal levels. Our framework illustrates the multi-layer complexity of the opioid crisis that more completely captures the crisis as a multidimensional issue requiring a broader and integrated approach to prevention and treatment.

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 Opioid Use Disorder: Screening, Diagnosis, and Management

2021 ◽  
Vol 16 (2) ◽  
pp. 25-30
Author(s):  
Privia Randhawa ◽  
Seonaid Nolan
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
The Past ◽  
Opioid Crisis ◽  
Safe Opioid Prescribing

Over the past decade, the opioid crisis in Canada has been worsening. In 2019, over 3,800 people across Canada died due to an apparent opioid-related cause, which represents a 26% increase from just 3 years prior. Given North America’s ongoing opioid crisis, and the contribution opioid-prescribing practices have had to date, a critical need exists to ensure that health care providers are not only educated about safe opioid prescribing but also are knowledgeable about how to effectively screen for, diagnose, and treat an individual with opioid use disorder. RésuméAu cours des dix dernières années, la crise des opioïdes au Canada n’a cessé de s’aggraver. En 2019, plus de 3 800 personnes au Canada sont décédées d’une cause apparemment liée à la consommation d’opioïdes, ce qui représente une augmentation de 26 % par rapport à seulement trois ans auparavant. Étant donné la crise des opioïdes qui sévit actuellement en Amérique du Nord et la contribution des pratiques de prescription d’opioïdes qui ont eu cours jusqu’ici, un besoin critique est à combler pour veiller à ce que les fournisseurs de soins soient non seulement formés sur la prescription sécuritaire des opioïdes, mais aussi bien informés sur le dépistage, le diagnostic et le traitement efficace d’un trouble lié à la consommation d’opioïdes.

scholarly journals A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone

2016 ◽  
Vol 10 ◽  
pp. SART.S37030 ◽  
Author(s):  
Leen Naji ◽  
Brittany B. Dennis ◽  
Monica Bawor ◽  
Carolyn Plater ◽  
Guillaume Pare ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Addiction Treatment ◽  
Protective Factor ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Abuse ◽  
Care Providers ◽  
Opioid Use ◽  
Increased Risk ◽  
The Impact

Introduction Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free). Methods Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model. Results History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003). Conclusion This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (&gt;45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P &lt; 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

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