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Dope Sick: Opioid Epidemic Influence on the Addicted, Society, Healthcare and Nurses
Megan Schleigh
King University
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Dope Sick: Opioid Epidemic Influence on the Addicted, Society, Healthcare and Nurses
Introduction
Opioids are a class of drugs that act in the nervous system to produce feelings of pleasure
and pain relief (U.S. National Library of Medicine [NLM], 2017). Opioids have a high potential
for causing addiction in some people, even when the medications are prescribed appropriately
and taken as directed (NLM, 2017). Opioid addiction is characterized by a powerful, compulsive
urge to use opioid drugs when they are not needed (NLM, 2017).
Americans, representing 4.4 percent of the world's population, consume roughly 30% of
its opioids (Macy, 2018, p. 186). Many prescription opioids are misused or diverted to others
(NLM, 2017). Individuals who become addicted may prioritize getting and using these drugs
over other activities in their lives, often negatively impacting their professional and personal
relationships (NLM, 2017). The opioid epidemic's toll is felt across the life span and in every
sociodemographic group (Phillips, Ford, & Bonnie, 2017). A Case and Deaton study showed
that 56% of Americans now knew someone who abused, was addicted to, or died from an
overdose of opioids (Macy, 2018, p. 16). Opioid addiction is a long-lasting, chronic disease, that
can cause major health, social, and economic problems (NLM, 2017).
Current national trends indicate that each year more people die of overdoses, the majority
of which involve opioid drugs (Phillips, Ford, & Bonnie, 2017). Drug overdose has already taken
the lives of 300,000 Americans over the past fifteen years, and experts now predict that 300,000
more would die in only the next five years (Macy, 2018, p. 5). It is now the leading cause of
death for Americans under the age of fifty, killing more people than guns or car accidents, at a
rate higher than the HIV epidemic at its peak (Macy, 2018, p. 5). It is estimated that each day 90
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Americans die prematurely from an overdose that involves an opioid (Phillips, Ford, & Bonnie,
2017).
Opiate addiction started during the Civil War era. During the Civil War, morphine was sold
widely from drugstore counters, no prescription necessary; not only for veterans, but also for
women with menstrual cramps and babies with hiccups (Macy, 2018, p. 11). In 1897, heroin was
created by Dr. Dresser, who praised heroin, and stated that it was a safe family drug, suitable for
baby colic, colds, influenza, joint pain, and other ailments (Macy, 2018, p. 24). Dr. Dresser
stated that unlike Codeine, heroin was not addictive and that it was a sure cure for alcoholism
and morphine abuse (Macy, 2018, p.24). Like Codeine, heroin was made readily available at any
In 1953, Dr. Wood created the hypodermic needle, swearing that whereas smoking or
swallowing morphine caused addiction, shooting it up would not (Macy, 2018, p. 22). During the
Civil War, it became standard practice to leave behind morphine and hypodermic needles, with
instructions to use as needed (Macy, 2018, p. 22). An estimated hundred thousand veterans
became addicted (Macy, 2018, p. 22). By the 1920's, it was dawning on officials that addiction
was skyrocketing as drug-related admissions to hospitals were steadily rising (Macy, 2018, p.
25).
In 1996, Perdue Pharma developed the most popular opioid in history, OxyContin
(Phillips, Ford, & Bonnie, 2017). OxyContin is believed to be the drug that initiated the current
opioid misuse epidemic (Phillips, Ford, & Bonnie, 2017). Perdue Pharma stated that OxyContin
was supposed to provide steady relief three times as long as previous formulations and would not
be abused as it did not provide a euphoric high (Macy, 2018, p. 19). Dr. J. David Haddox stated
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that the risk of addiction with the new formulation was 0.5%, if taken as prescribed (Macy, 2018,
p. 20).
The introduction of OxyContin coincided with the moment in medical history when
doctors, hospitals, and accreditation boards were adopting the notion of pain as the "fifth vital
sign" (Macy, 2018, p. 27). This new idea gave greater importance to controlling pain, making
pain as important as other vital signs (Macy, 2018, p. 27). Hospitals incentivized doctors and
nurses to treat pain liberally or risk losing reimbursements (Macy, 2018, p. 27).
A 2000 New York Times article explained that pain had been grossly undertreated for too
long, stating that many health care workers still erroneously believe that adequate pain relief can
leave patients addicted to the drugs (Macy, 2018, p. 28). Purdue Pharma's David Haddox stated
that prescribing OxyContin for pain was the moral, responsible, and compassionate thing to do
(Macy, 2018, p. 27). Healthcare providers unwilling to prescribe opioids were considered
“opiophobic” and initiatives promoting stricter controls on opioid prescribing were described as
Dr. Alexander and Dr. Kolodny believe the opioid problem stems from physicians being
too quick to prescribe opioids for pain management (Sederstorm, 2016). In 1991, prescriptions
written in the United States for opioids were around 76 million; at peak in 2011, there were 219
million prescriptions written, an increase of nearly 300% (Hagemeier, 2018). It is now known
that Perdue Pharm aggressively promoted and hand-picked the physicians to market to that were
most susceptible to their market (Macy, 2018, p. 32). Industry wide, pharmaceutical companies
spent $4.04 billion in direct marketing to doctors in 2000, up 64% from 1996 by bribing doctors
into selling their product with a variety of incentives (p. 32). It wasn't until 2016 that the FDA
regulated and strongly encouraged that doctors severely limit the use of opioids (p. 271).
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Dr. Alexander believes that physicians underestimated the addictive potential of these
drugs and at great cost to patients and their loved ones (Sederstorm, 2016). Dr. John Burton
remembers telling his residents that "A patient can't get hooked on 14-days-worth of opioid pills"
and states that he was absolutely wrong (Macy, 2018, p. 29). A farmer in Lee County told his
doctor that OxyContin had stolen everything from him. He stated, "Nothing's more powerful than
the morphine molecule, and once it has its hook on you, nothing matters more. Not love. Not
family. Not sex. Not shelter. The only relationship that matters is between you and the drug"
The gateway theory of the movement of prescription opioid users to heroin is predicated
on the fact that opioid medications produce the same neuro-pharmacologic effects as heroin, so
the substances are natural substitutes (Phillips, Ford, & Bonnie, 2017). In one study, about 80
percent of current heroin users reported that they began with prescription opioids (Phillips, Ford,
& Bonnie, 2017). Ashlyn Kessler, a previous drug mule, states that it's unreal how many people
follow the same pattern: Oxys-Roxys-Heroin, because heroin is cheaper, stronger, and usually
much easier to get than prescription opioids (Macy, 2018, p. 155). Dr. Van Zee states that he had
no idea that the OxyContin epidemic would become a heroin epidemic and that we had invited
Opioid use disorders have devastating physical, mental and socioeconomic consequences
(Mannelli, 2013). A study by Griffin et al found that patients with opioid addiction had worse
physical and mental quality of life compared to the general population (Hagemeier, 2018).
Opioid users often have other problems arise, such as infection, including cellulitis, endocarditis,
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and HIV/AIDS (Hagemeier, 2018). To feed their addictions, many users recruit new customers,
who eventually recruit new users (Macy, 2018, p. 10). The cycle too often ends in jail, prison, or
premature death (Macy, 2018, p. 10). Debbie Honaker, a previous drug addict stated that “at the
end of your journey, you're not going after drugs to get high, you're going to keep from getting
Opioid addiction substantially affects the quality of life of family members, including
financial security, mental health, social networks, and productivity (Mannelli, 2013). A study
found that family members experienced a moderate to severe burden on finances (100%),
disruption of family routine (99%), disruption of family leisure (99%), and disruption of family
Dr. Anna Lembke, an addiction-medicine specialist states that "drug epidemics unfold
like a vector phenomenon, where you have one individual who seeds that community and then
the spread begins" (Macy, 2018, p. 128). As the sales of opioids rose during the first decade of
the new millennium, so did the rates of opioid misuse and abuse (Hagemeier, 2018). By 2016,
11.5 million Americans were misusing prescription opioids, 2.1 million had opioid use disorder
(OUD), and more than 42,000 died from overdosing on opioids (Hagemeier, 2018). In October
2017, the US Department of Health and Human Services declared the opioid crisis a public
The rapid rise in opioid related deaths is the most devastating aspect of the opioid
epidemic (Hagemeier, 2018). Prescription opioid related deaths have tripled since 1999; opioid
overdose is now responsible for 115 daily deaths of Americans on average, which is roughly 1
death every 13 minutes (Hagemeier, 2018). According to the Council of Economic Advisers,
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there was an estimated economic burden of $504 billion in 2015 (Hagemeier, 2018). Costs that
contribute to the burden to society include those related to healthcare, workplace, and criminal
Hospitals are at the frontline of the crisis, caring for opioid overdose patients and making
treatment and admission decisions for them (LaPointe, 2019). While providing high-quality
substance abuse and addiction care is always at the top of each provider’s mind, hospital budgets
are also feeling the strain from the opioid epidemic according to the recent analysis (LaPointe,
2019). Every day, more than 1000 people are treated in EDs for misusing prescription opioids
(Hagemeier, 2018).
In 2014, opioid overdoses were responsible for 147,654 ED visits, with estimated direct
medical costs of $152.8 million (Hagemeier, 2018). Approximately $1.94 billion in annual
hospital costs were attributable to patients who experienced an opioid overdose between October
2017 and October 2018, the analysis of 647 healthcare facilities showed (LaPointe, 2019). The
average hospital cost of an overdose patient who was treated in the emergency department and
released was $504, but the average increased to $11,731 for patients treated and admitted
(LaPointe, 2019). Furthermore, about 40 percent of the opioid overdose patients admitted
experienced organ failure (LaPointe, 2019). Adding in costs for intensive care, the average cost
Registered Nurses (RNs), who are often the best equipped to assess a patient’s pain and
need for pharmacologic pain relief, are on the front lines of the opioid epidemic (American
Nurses Association [ANA], 2018). Advanced Practice Registered Nurses (APRNs), whose
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education prepare them to assume responsibility and accountability for assessment, diagnosis,
and management of patient problems, including the use and prescription of pharmacologic
Because RNs practice in a variety of direct care, care coordination, leadership, and
executive roles, they are often in a key position to help patients and their families understand the
risks and benefits of pain treatment options (ANA, 2018). As educators and patient advocates,
nurses are in a unique position to help patients with non-opioid pain management including other
2018).
Drug overdose is a leading cause of injury death in the United States, and as nurses, we
have a responsibility to get involved and educate patients and the public about the current opioid
epidemic (Lippincott, n. d.). ANA recognizes the significance of this public health crisis and is
committed to helping nursing stand as a leading provider in the fight against opioid dependence,
overdose, and death (ANA, 2016). Taking steps to ensure that health care professionals who
prescribe opioids are properly trained and educated in opioid prescribing is a critical and
According to the American Psychiatric Association, fear of stigma can lead patients to
forego getting treatment, leading to poor health outcomes (AHA, n. d.). It is known that
healthcare provider’s own subconscious prejudices, or bias, can affect the way we treat patients
(Tello, 2017). To fight these prejudices, we need to recognize, name, and understand these
attitudes and actions (Tello, 2017). We need to practice and model tolerance, respect, open-
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mindedness, and peace for each other (Tello, 2017). What they need now more than ever, is our
support. George Vaillant, Psychiatrist at Harvard Medical School, states that "if you want to treat
an illness that has no easy cure, first of all treat it with hope" (Macy, 2018, p. 269).
The opioid crisis has brought too much heartache to this country (Woods, 2017). As
nurses, we must recognize we are integral to assessing and managing pain appropriately, be able
to identify patients who need addiction therapy and help them gain access to those resources, and
we must be a voice for responsible prescribing (Woods, 2017). Together with the
interdisciplinary team, we can help to alleviate the opioid crisis; we owe it to our patients
(Woods, 2017).
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References
American Hospital Association [AHA]. (n. d.). Addressing stigma. Retrieved from https://www.
aha.org/bibliographylink-page/2018-09-28-addressing-stigma
American Nurses Association [ANA]. (2016). Nursing’s role in addressing nation’s opioid
nursings-role-in-opioid-crisis_2016.pdf
American Nurses Association [ANA]. (2018). The opioid epidemic: The evolving role of nursi
on-healthcare-system-impact-quality-of-life?p=1
LaPointe, J. (2019). Opioid overdose care totals $1.94B in annual hospital costs. Retrieved from
https://revcycleintelligence.com/news/opioid-overdose-care-totals-1.94b-in-annual-hospit
ital-costs
Lippincott. (n. d.). Nursing and the opioid epidemic. Retrieved from https://www.nursingcenter
.com/journals-articles/article-collections/opioid-crisis
Macy, B. (2018). Dopesick. New York, NY: Little, Brown and Company.
Mannelli, P. (2013). The burden of caring: Drug users & their families. The Indian Journal of Me
es/PMC3724243/
National Institute on Drug Abuse [NIDA]. (2019). Opioid overdose crisis. Retrieved from https
://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
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Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2017). Pain management and the opioid epidemic:
Balancing societal and individual benefits and risks of prescription opioid use- Consensus
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-can-managed-care-make-impact
Tello, M. (2017). Racism and discrimination in health care: Providers and patients. Retrieved
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U.S. National Library of Medicine [NLM]. (2017). Opioid addiction. Retrieved from https://
ghr.nlm.nih.gov/condition/opioid-addiction#genes
Woods, A. D. (2017). Using the art and science of nursing to fight the opioid crisis. (2017).
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