Opiate Epidemic Discussion

Many healthcare professionals consider the use and abuse of opiates to be an

epidemic. According to the CDC, prescription opiates rates are not the same for all
states. Watch the following video and review the short PDF article. Then answer
the following questions in your discussion post.

1. What are some ways that healthcare professionals can decrease the risk of
drug abuse and addiction?

a. Review policies and procedures to identify who and how much medication
are being administered to patients, so that some kind of control is establish
so people will not have an easy time abusing the medication system to get
more drugs when they dont need to.
b. Create standards for ordering and prescribing controlled substances. This
should include maintaining a chain of custody and utilizing witnesses when
disposing of controlled substances. Be aware if a practitioner is always
taking a larger dose in syringes for patients or not getting a second witness
when disposing of controlled substances.
c. Establish education and training across multiple disciplines to educate
staff on controlled substance diversion. Staff need to understand the issue,
risks to patients and the hospital and hospital procedures to reduce
diversion. Train staff on what to do if they suspect a co-worker is diverting
controlled substances. Health care professionals have an ethical duty to
protect patients. Part of this responsibility is to report impaired staff
members so they get help and patients are protected.
d. Place camera surveillance in high-risk areas. This is a useful tool to monitor
access to controlled substances in the hospital.
e. When something does go wrong, have procedures ready to launch to
investigate potential cases of diversion and discrepancies in controlled
substance inventory. The DEA recommends that the hospital notify local law
enforcement immediately because missing controlled substances could be
hitting the streets in the community. In addition, the DEA requires that its
office be notified immediately of the theft or significant loss of a controlled
substance.
 f. Review staff practices that can help avoid the problem on the front end by
reducing the vast number of opioid prescriptions that are being written.
Clearly, it is important to treat a patients pain, but the more traditional
methods of escalating narcotic use are not always in the best interest of the
patient. Clinical protocols regarding pain management processes can be
expanded to a multimodal approach that includes opioid pain killers when
appropriate but may also include anti-inflammatories and muscle relaxants,

2. What are some ways that each state can help decrease drug abuse and
addiction?

a. Reduce overdose deaths by providing easy access to naloxone. Naloxone,

now available as a nasal spray, immediately blocks the deadly respiratory
suppression caused by heroin, methadone and narcotic pain pills (like
OxyContin, Percodan and Vicodin), and it should be made easily available to
first responders, families and those dependent on narcotics and their
friends.
b. Identify and crack down on prescribers who are providing large quantities
of narcotics in so-called pill mills. Use state prescription databases to
identify these prescribers, and distinguish them from doctors legitimately
practicing with populations of pain and cancer patients.
c. Employ TV, radio and social media to educate families about drug-abuse
prevention. This has been repeatedly shown to reduce the non-medical use
of narcotic pain pills
d. Establish and implement medical guidelines for the treatment of chronic
pain. This can be done through quality improvement techniques and
performance improvement strategies.
e. Make problem drug and alcohol use screening a standard of
care. Screening for this abuse should be a universal practice, used with
adult patients seen in primary care settings to identify and intervene early
before addiction sets in and overtakes an individual. Screening, brief
intervention and referral for treatment, or SBIRT, is a proven intervention
that is generally covered by insurers, including Medicaid and Medicare. This
 intervention has also been adapted for teenage detection and intervention
of drug and alcohol problems.
f. Increase the availability, affordability and access to drug treatment
programs. An estimated 80 to 90 percent of individuals who could benefit
from treatment are not getting it. Celebrities who can pay vast sums for
private treatment programs should not be the only ones able to enter them.
The Affordable Care Act requires as an essential service element coverage
and parity for mental health and substance use disorders, meaning that
insurance benefits for addiction must be equivalent to any other covered
general medical condition. The opportunity for proper reimbursement for
substance disorder treatment has never been better.
g. Educate doctors, patients and families about what good addiction
treatment must include. Medical providers, not just addiction specialists,
need to appreciate the underlying neuroscience of addiction and fashion
their treatment accordingly. Patients and families need to be far more
informed consumers in order to advocate for effective treatments.
h. Expose treatment centers not providing comprehensive treatment for
substance abuse as falling below standards of quality of care. 12-Step
recovery programs (like Alcoholics Anonymous and Narcotics Anonymous)
are important as a part of a comprehensive treatment program, but have
low rates of effectiveness alone. Treatment options must include
motivational enhancement, cognitive-behavioral treatments, relapse
prevention, family education and support, wellness efforts and medication
to help prevent relapse and maintain sobriety.
i. Promote and pay for the use of medication-assisted treatment. This means
that recovery efforts can include medication. The use of medication should
not be exhorted as a violation of sobriety. A number of medications now
exist for drug and alcohol addiction (tobacco too) that improve rates of
abstinence or reduce use, called harm reduction. These include
buprenorphine (Suboxone), methadone, naltrexone (including the 28-day
injectable Vivitrol) and naloxone. Let's give people in recovery as good a
chance as possible not be drawn into puritanical and outdated notions of
recovery.
j. Keep hope alive. People with substance use disorders can recover. That
takes good treatment, hard work, ongoing support and keeping hope alive.
 People with addictions do get on the path to recovery but it is hard to
predict when that will happen. For some it is early, even after one or two
rehabilitation programs. For others it may take five, 10 or 20
rehab programs, and the pain and suffering of too many relapses. Persons
affected, their families and clinical providers need to sustain hope that
recovery can happen during what can be a protracted and very dark time.
The darkest moments, the most deadly, are when hope evaporates, which is
when exile from family, friends and communities and suicide are more
likely.

3. What are some ways that communities can decrease drug abuse?

Effectively deal with peer pressure. The biggest reason teens start using drugs
is because their friends utilize peer pressure. No one likes to be left out, and
teens (and yes, some adults, too) find themselves doing things they normally
wouldnt do, just to fit in. In these cases, you need to either find a better group
of friends that wont pressure you into doing harmful things, or you need to
find a good way to say no. Teens should prepare a good excuse or plan ahead
of time, to keep from giving into tempting situations

Deal with life pressure. People today are overworked and overwhelmed, and
often feel like a good break or a reward is deserved. But in the end, drugs only
make life more stressful and many of us all too often fail to recognize this in
the moment. To prevent using drugs as a reward, find other ways to handle
stress and unwind. Take up exercising, read a good book, volunteer with the
needy, and create something. Anything positive and relaxing helps take the
mind off using drugs to relieve stress

Seek help for mental illness. Mental illness and substance abuse often go
hand-in-hand. Those with a mental illness may turn to drugs as a way to ease
the pain. Those suffering from some form of mental illness, such as anxiety,
depression or post-traumatic stress disorder should seek the help of a trained
professional for treatment before it leads to substance abuse.

Examine the risk factors. If youre aware of the biological, environmental and
physical risk factors you possess, youre more likely to overcome them. A
history of substance abuse in the family, living in a social setting that glorifies
drug abuse and/or family life that models drug abuse can be risk factors.
 Keep a well-balanced life. People take up drugs when something in their life is
not working, or when theyre unhappy about their lives or where their lives are
going. Look at lifes big picture, and have priorities in order.

4. Look at your state on the CDCs map. Why do you think there is such a
difference from state to state?
The reason the opiate epidemic is different in each state is because it depends on the
laws surrounding how the drug will be administered and how the medical facility
administer the medications. Also different states have different laws regarding whats
legal and wants not legal.

If possible, research and list statistics for your state on prescription opiate
use. Were you able to find any information on what your state is doing to
address this epidemic?

Yes, @ https://law.georgia.gov/7-how-georgia-addressing-crisis

The Governor moved the Prescription Drug Monitoring Program from the
Georgia Drugs and Narcotics Agency to the Department of Public Health.
The bill requires pharmacists to register and upload prescription
information every 24 hours opposed to the seven-day requirement when
they prescribe a certain level of controlled substance. Also, beginning July 1,
2018, it also requires prescribers to review information from the PDMP
before issuing a prescription to a patient for the first time and at least once
every 90 days thereafter, unless:

The prescription is for no more than a three-day supply and no more than 26 pills.
The patient is in a hospital or health care facility, including but not limited to a
nursing home, an intermediate care home, a personal care home, or a hospice
program, which provides patient care and prescriptions to be administered and
used by a patient on the premises.
The patient has had outpatient surgery at a hospital or ambulatory surgery center,
and the prescription is for no more than a 10-day supply of such substance and no
more than 40 pills.
The patient is terminally ill or under the supervised care of a hospice program; or
 The patient is receiving treatment for cancer

Finnefrock, M & Umhoefer, S. (2016). 6 Steps for Hospitals to Take to Prevent Prescription Drug Abuse,
Diversion. Retrieved from

https://www.hhnmag.com/articles/7199-steps-for-hospitals-to-prevent-drug-abuse

Winkel, B. (2009). Top 5 Ways to Prevent Substance Abuse. Retrieved from

https://www.treatmentsolutions.com/top-5-ways-to-prevent-substance-abuse/

Office of Attorney General Chris Carr. (2017). Opioid Abuse. Retrieved from

https://law.georgia.gov/opioid-abuse