Opioid Epidemic: Policies, History, Proposed Change

Problem Overview - Magnitude, Scope and Population Affected

On October 16th, 2017, the United States Government stated that the American opioid epidemic was now a national health crisis (Department of Health and Human Services, 2019). According to the Center for Disease Control and Prevention (CDC), from 1999 to 2017, more than 700,000 individuals had died from a drug overdose, making it the number one form of preventable death in the United States (CDC, 2018). Of these 700,000 deaths, 400,000 of them could be directly connected to opioids, including both prescription and illicit drugs (CDC, 2018). Furthermore, since 2002, over eleven million individuals have misused the drug, dramatically increasing the rates of emergency room visits for nonmedical opioid use (Zee, 2017).

The opioid epidemic does not discriminate between age, race, or gender, as the death rates directly connected to opioid overdoses have increased among every demographic (Jones, et al., 2018). Specifically, though, males under 50, individuals recently released from prison, and those who have been prescribed opioids, are at the greatest risk of developing this disease (Zee, 2017). Approximately twenty-one percent of patients who had been prescribed opioids for the management of chronic pain developed an opioid addiction or dependency, and of these individuals, nearly five percent of them have transitioned from prescription opioids to heroin (Zee, 2017). Although this epidemic came as a shock to many, it has been boiling for years, beginning in the early 1990s and continuing through present day (Department of Health and Human Services, 2019). Through the collaboration of government officials, medical regulators, and pharmaceutical companies, programs and policies were set into place that created an environment ripe for the rampant outbreak of this devastating and deadly epidemic.

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Analysis of Policies and History

Despite the fact that addiction has always been a part of American society, the opioid epidemic was ultimately exacerbated through the perfect collision of two radical changes within American society. The first of these changes was the reintroduction, and rebranding of a pain medication known as Oxycodone (Jones et. al, 2018). Beginning in 1996, Purdue Pharma, a large pharmaceutical company, began to market their version of this drug, emphasizing its incredible ability to alleviate pain, with little to no side effects (Jones et. al, 2018). Renaming the drug OxyCotin, Purdue Pharma specifically marketed it as a non-addictive pain medication and began targeting doctors and pharmacists across the country (Zee, 2017). Purdue Pharma held hundreds of all expense paid trips for these individuals, incentivizing them to prescribe their drug in massive quantities. Despite numerous studies depicting its addictive qualities, Purdue Pharma continued to falsely market their product, actively exploiting the American population (Zee, 2017).

At the same time that Purdue Pharma was leading their campaign, the Joint Commission on the Accreditation of Healthcare Organization (JCAHO), introduced new standards for the prescription of pain medications (Baker, 2017). In 1996, due to a public out-cry for the rebranding of pain as a medical disorder, and not merely a symptom, JCAHO set forth a movement that would allow OxyCotin to be prescribed in a more liberal fashion (Baker, 2017). Due to this movement, the Food and Drug Administration (FDA) approved the drug as a “minimally addictive pain reliever”, allowing for a massive increase in the number and rate of prescription opioids doctors were allowed to prescribe (FDA, 2019). Despite being based off of faulty, and misleading information, the passage of OxyCotin as a non-addictive pain management drug, paved the path for it to become one of the largest health crises to ever plague American society (Baker, 2017).

In conjunction with the head on collision of these two major shifts in American culture, the opioid epidemic was only exacerbated through the already established criminalization of the United States' most vulnerable populations. For centuries, instead of viewing addiction as a disease, American society has categorized it as a crime, only aggravating the issue and ultimately, creating more harm (Human Rights Watch, 2019). Instead of funneling the country's resources towards education, and prevention, American politicians have deemed these individuals as less than, blaming them for a disease they had no control over (Human Rights Watch, 2019). Through the criminalization of addiction and mental health, the lack of access to basic medical care, and the global stigmatization of this disease, individuals who have been afflicted by this illness have been forced to the fringes of society, suffering both physically and mentally, unable to live a life they so rightly deserve.

Human Rights Violated

Through the indiscriminate, careless, and haphazard policies set into place by the United States government, pharmaceutical companies, and medical doctors, countless Americans have had their most basic human rights violated on a daily basis. Through the misclassification of drugs, and the criminalization of addiction, Americans are being aggressively exploited by their leaders, instead of supported. Directly violating the Universal Declaration of Human Rights, which was established to protect every human’s most basic rights, policy makers enacted regulations that dehumanized and harmed their very own citizens. Although a number of these human rights, declared as innate to all, have been aggressively violated, specifically Article 25 in the “Universal Declaration of Human Rights”, has been egregiously defied.

According to Article 25,

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family including…medical care and necessary social services, and the right to security in the event of…sickness, disability…or…lack of livelihood in circumstance beyond his control. (United Nations General Assembly, 1948)

Through the creation of this article, leaders wanted to ensure that all individuals, no matter their status, had access to the fundamental supports needed to live a prosperous and meaningful life. Unfortunately, this most basic right has been violated on a number of levels, for all Americans who have struggled with, and who are currently struggling with an opioid addiction. Not only did the United States government play a critical role in the development and rampant spread of this disease, they have only compounded the issue by criminalizing the disease and turning a blind eye. Instead of creating policies that would have funneled resources towards prevention and education, the government demonized these groups, making it incredibly difficult for any individual to gain access to the resources they need to free themselves from the chains of addiction.

Policy Development

Over the course of history, social policies and programs, that come to define modern society, are often determined by the historical and political context of that time. This statement rings particularly true for the policies, programs, and legal actions that have been enacted in direct response to the opioid epidemic that has ravaged American society. Due to the rapid, and unpredictable spread of this health crisis, American political and legal structures at first created rash, and harmful legislation that ultimately exacerbated this deadly situation. Recently though, the United States Congress passed a revolutionary law that actively combats this epidemic on the macro, mezzo, and micro-level.

On October 24th, 2018, the United States Congress passed H.R. 6, otherwise known as the “SUPPORT for Patients and Communities Act” (Walden, 2018). Through the enactment of this law, the United States government has finally begun to view the opioid epidemic through a humane, and supportive eye. Instead of criminalizing the Americans who suffer from this horrific disease, the government now is creating programs and policies that aid in recovery and prevention (Walden, 2018). Specifically, through reforming aspects of Medicare and Medicaid, and now viewing this epidemic as a public health crisis, the United States government is finally supporting its most vulnerable citizens instead of criminalizing them (Walden, 2018).

Through the passage of this law, community leaders, medical professionals, and government officials now have the ability to combat this epidemic on the macro, mezzo, and micro-level (Walden, 2018). With increased funding for treatment programs, education initiatives, as well as stricter guidelines on how prescription opioids can be prescribed, the United States government is not only supporting those already devasted by this disease, they are actively protecting those who may be vulnerable to developing an addiction in the future (Walden, 2018).

Proposed Change

Despite recent strides to eradicate the American opioid epidemic, there is still much work that needs to be done. Specifically, leaders must now work to eradicate the stigmas that plague those afflicted by addiction, and actively combat the criminalization of this deadly disease. In order to do this, it is now the duty of social workers, policy makers, and medical professionals to continue to rewrite policy and create an environment that supports, guides, and educates all members of society on the realities of addiction.

The “Support for Patients and Communities Act” is a revolutionary piece of legislation that is laying the groundwork for true American change. Unfortunately, many of the aspects that make up this piece of legislation will not reach their true potential before the American culture that surrounds addiction changes. This culture includes eliminating the criminalization of addiction, as well as the eradication of the stigma that follows those who are afflicted by this disease. Due to these two major barriers, many individuals either do not have access to the benefits put in place by this new piece of legislation or are too afraid to access them due to the judgements that may follow. Fortunately, there are areas within the United States that are actively combating these impediments, and tangible progress has been made.

One amendment, which is critical to the impact that the “SUPPORT for Patients and Communities Act” can have on the American population, is the use of drug courts to replace criminal courts for those individuals plagued by addiction (National Institute of Justice, 2012). These courts, through the use of an interdisciplinary team, aim to rehabilitate individuals instead of criminalize them (National Institute of Justice, 2012). Through the unification of social workers, treatment professionals, prosecutors, and law enforcement agencies, communities are coming together and pooling resources that allow for individuals to gain access to the supports they need. Instead of pushing these victims through the criminal justice system, these drug courts offer supports and guidance, in the hopes of leading these individuals towards recovery (National Institute of Justice, 2012).

The battle that is now being fought against the opioid epidemic is a complicated, long, and convoluted war. Luckily, American society is now moving in the right direction, and finally taking proactive, and humane steps towards treating these vulnerable individuals. In addition to the continued efforts to implement aspects of the “SUPPORT for Patients and Communities Act”, social workers, and community leaders must revive their unrelenting battle to destigmatize and humanize these individuals, educating the greater public on the realities of this disease.

References

1. Baker, D.W. (2017). The Joint Commission’s Pain Standards: Origins and Evolution. Retrieved from https://www.jointcommission.org/assets/1/6/Pain_Std_History_Web_Version_05122017.pdf.
2. Center for Disease Control (2018). Understanding the Epidemic | Drug Overdose | Injury Center. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.
3. Department of Health and Human Services (2019). What is the U.S. Opioid Epidemic? Retrieved from https://www.hhs.gov/opioids/about-the-epidemic/index.html.
4. Human Rights Watch (2019). Every 25 Seconds, Someone is Arrested for Drug Possession in the US. Retrieved from https://www.hrw.org/news/2016/10/12/us-disastrous-toll-criminalizing-drug-use.
5. Jones, M.R., Viswanath, O., Peck, J., Kaye, A.D., Gill, J.S., & Simopoulos, T.T (2018). A Brief
6. History of the Opioid Epidemic and Strategies for Pain Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993682/.
7. National Institute of Justice (2012). Overview of Drug Courts. Retrieved from https://nij.gov/topics/articles/overview-drug-courts.
8. United Nations General Assembly (1948). Universal Declaration of Human Rights. Retrieved from https://www.un.org/en/universal-declaration -human-rights/.
9. U.S. Food and Drug Administration (2019). Opioid Timeline. Retrieved from https://www.fda.gov/drugs/information-drug-class/timeline-selected-fda-activities-and-significant-events-addressing-opioid-misuse-and-abuse.
10. Walden, G. (2018). SUPPORT for Patients and Communities Act. Retrieved from https://www.congress/gov/bill/115th-congress/house-bill/6.
11. Zee, A.V. (2017). Trends in Opioid Use, Harms, and Treatment. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK458661/.