scholarly journals Addressing the Opioid Epidemic: Recommended Solutions from Physicians

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Jessica Cataldo ◽  
Sandra Collins ◽  
Richard C Mckinnies ◽  
Jane Nichols ◽  
Thomas A Shaw
Keyword(s):  
United States ◽  
Active Role ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Multifaceted Approach ◽  
Improve Treatment ◽  
Opioid Crisis ◽  
A Current

The purpose of this study was to assess physicians’ accounts related to the current opioid epidemic and to identify solutions that they feel would be most successful in addressing opioid misuse and overuse. A survey was administered a group of physicians obtained from a nationwide database. Nearly all physicians surveyed believed there was a current opioid crisis in the United States and that physicians should take an active role in addressing opioid use in patients. Four key themes emerged regarding solutions to the opioid crisis: i) policy change, ii) improve treatment, iii) education, and iv) alternative treatment. The diversity of responses highlighted the need for a multifaceted approach to address opioid misuse and abuse.

scholarly journals A cross-sectional study of opioid involvement in non-poisoning suicide – risks and prevention opportunities

2020 ◽  
Author(s):  
Maryann Mason ◽  
Suzanne McLone ◽  
Tami Bartell ◽  
Sarah Welch ◽  
Karen Sheehan ◽  
...  
Keyword(s):  
United States ◽  
Suicide Prevention ◽  
The United States ◽  
Cross Sectional Study ◽  
Close Monitoring ◽  
Opioid Epidemic ◽  
Sectional Study ◽  
Opioid Use ◽  
Chi Square ◽  
Cross Sectional

Abstract Background The current opioid epidemic has drawn attention to drug overdose deaths including unintentional and suicide poisoning deaths which peaked in the United States in 2017. Concurrent with the opioid epidemic, the number and rate of suicides in the United States has increased. At the same time, the proportion of suicide deaths across cause of death has shifted and the proportion of suicides by poisoning (including overdose) has decreased. On the face of it, it would appear that the opioid epidemic has not intersected with suicide as signaled by the decline in suicide deaths due to poisoning. However, opioid use and misuse is associated with suicidal ideation and attempts and therefore it is plausible that opioids may play a role in suicide deaths by causes other than poisoning. Objective This study examines opioid involvement (as measured by the presence of opioids but below the lethality threshold) in suicides by causes other than poisoning, Methods A cross-sectional study utilizing Illinois National Violent Death Reporting System data including all suicides toxicology screened for opioids. Chi-square tests were used to compare decedent and incident circumstance characteristics by opioid toxicology screen status. Results Of 1007 non-poisoning suicides screened for opioids, 83.6% (842) were opioid negative and 16.4% (165) were opioid positive. Over half (52.7%) of decedents positive for opioids died by firearm. White race, age 75 and over, and widowed or unknown marital status were associated with opioid positivity. Opioid positivity is linked to testing positive for other substances. One quarter of decedents testing positive for opioids had a history of substance abuse. Twenty eight percent of opioid positive decedents suffered from physical health problems. Conclusion Suicide decedents who are opioid positive and who die from causes other than poisoning have distinct characteristics which suggest an array of suicide prevention efforts – for example -- including information on risk of suicide for opiate users in firearm sales, including suicide prevention counseling in health care settings in which opiates and/or benzodiazepines are therapeutically prescribed, and close monitoring of pain symptoms among patients experiencing chronic pain. ​

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 The Opioid Crisis Viewed Through the Lens of a Black and White Camera

2020 ◽  
Vol 5 (9) ◽  
Keyword(s):  
United States ◽  
Racial Disparities ◽  
Health Care Disparities ◽  
Cognitive Biases ◽  
Historical Review ◽  
The United States ◽  
Regulatory Control ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Access To Treatment

The United States’ opioid epidemic is a national public health emergency. As opioid use has not been shielded from health care disparities furthered by economic, gender, race, and sex biases, discrepancies in the rates of abuse and access to treatment exist among non-white minorities. This narrative literature review is an evaluation of the literature centered on minority racial disparities in opioid use, abuse, and care in the United States. Racial disparities in prescribing opioid-containing compounds are staggering among non-white individuals. A historical review of opioid regulatory control is offered as an explanation for the cognitive biases demonstrated by clinicians. Governmental regulation is among the polyfactorial roots of racial inequity in the opioid epidemic. Literature describing physician bias and portrayals of racial and sexual disparities in opioid abuse disorders are presented. As part of the national response to this evident disparity, addressing these issues will be an important factor in curbing this epidemic and tools to assist in mitigating these obstacles are presented.

Surveillance, Evaluation, and Research and the Opioid Epidemic

2019 ◽  
Author(s):  
Yngvild Olsen ◽  
Joshua M. Sharfstein
Keyword(s):  
United States ◽  
Life Expectancy ◽  
The United States ◽  
Opioid Epidemic ◽  
Opioid Crisis

How well is the United States tracking the opioid epidemic? Not well. For a threat that has cost tens of thousands of lives and reduced US life expectancy, the opioid crisis is not sufficiently monitored. Federal reports with data on the number of...

Implications of the Opioid Crisis for the American Disability Community

2020 ◽  
Vol 34 (4) ◽  
pp. 265-274
Author(s):  
Mykal J. Leslie ◽  
Kathleen Sheppard-Jones ◽  
Malachy L. Bishop
Keyword(s):  
United States ◽  
Rehabilitation Counseling ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Research Education ◽  
Opioid Crisis ◽  
Increased Risk ◽  
The Relationship

PurposeThe profession of rehabilitation counseling has long been responsive to emerging disabilities. To date, however, the profession's attention and response to the ongoing opioid crisis in the United States has been incommensurate with the scope and detriment of opioids and opioid use disorder (OUD) on Americans with disabilities. The opioid crisis, including the overuse, abuse, and overdose rates associated with prescription and illegal opioids, affects people of all ages and backgrounds. However, people with disabilities are at increased risk for developing OUDs, and they experience greater barriers to OUD treatment than people without disabilities.MethodThis article describes the origins and development of this crisis, the relationship between disability and increased risk for OUD, and the barriers to treatment that exist. We then evaluate the role of rehabilitation counseling, including the need for further action in advocacy, research, education, and policy.Results and ConclusionsThroughout this article, we encourage a more urgent and concerted response than seems to be the case presently.

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Electronic Reporting ◽  
Number Of Patients ◽  
Overdose Deaths

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

Physician Autonomy and the Opioid Crisis

2018 ◽  
Vol 46 (2) ◽  
pp. 203-219 ◽  
Author(s):  
Nathan Guevremont ◽  
Mark Barnes ◽  
Claudia E. Haupt
Keyword(s):  
Public Health ◽  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Health Crisis ◽  
Physician Autonomy ◽  
Public Health Crisis ◽  
Opioid Crisis ◽  
Physician Relationship ◽  
Regulatory Regimes

The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

scholarly journals Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study

2020 ◽  
Author(s):  
Joshua A Barocas ◽  
Golnaz Eftekhari Yazdi ◽  
Alexandra Savinkina ◽  
Shayla Nolen ◽  
Caroline Savitzky ◽  
...  
Keyword(s):  
United States ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Population Level ◽  
Risk Groups ◽  
The United States ◽  
Published Data ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Behavior Profiles

Abstract Background The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes. Methods We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030. Results The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030. Conclusions The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.

The opioid epidemic

2017 ◽  
Vol 52 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Nitin Chopra ◽  
Lauren H Marasa
Keyword(s):  
United States ◽  
Treatment Options ◽  
The United States ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Significant Family History ◽  
History Of ◽  
Number Of Treatment

Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.

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