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Running head: DOPE SICK: OPIOID EPIDEMIC 1

Dope Sick: Opioid Epidemic Influence on the Addicted, Society, Healthcare and Nurses

Megan Schleigh

King University
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DOPE SICK: OPIOID EPIDEMIC

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).

Significance of Opioid Addiction

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).

How Have Medical Providers Contributed to The Rise of Opiate Addiction?

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

American drugstore (Macy, 2018, p. 24).

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

“careless, naïve, and unsympathetic (Hagemeier, 2018).

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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What Were the Ethical Consequences of Their Actions?

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"

(Macy, 2018, p. 106).

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

into our country our own demise (Macy, 2018, p. 208).

Opioid Epidemic Influence on The Addicted and Their Family

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

sick" (Macy, 2018, p. 42).

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

interaction (98%) (Hagemeier, 2018).

Opioid Epidemic Influence on Society

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

health emergency (Hagemeier, 2018).

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

justice (Hagemeier, 2018).

Opioid Epidemic Influence on Hospitals

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

of an overdose patient treated and admitted rose to $20,500 (LaPointe, 2019).

Opioid Epidemic Influence on Nurses

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

interventions, play a critical role (ANA), 2018).

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

medication modalities, regional anesthetic interventions, surgery, psychological therapies,

rehabilitative/physical therapy, and complementary and alternative medicine (CAM). (ANA,

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

necessary investment (ANA, 2016).

My Personal Thoughts on The Opioid Epidemic

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

crisis. Retrieved from https://www.nursingworld.org/~4ae212/globalassets/docs/ana/ana_

nursings-role-in-opioid-crisis_2016.pdf

American Nurses Association [ANA]. (2018). The opioid epidemic: The evolving role of nursi

ng. Retrieved from https://www.ncsbn.org/2018_ANA_Opioid_Epidemic.pdf


Hagemeier, N. E. (2018). Introduction to the opioid epidemic: The economic burden on the healt

hcare system and impact on quality of life. Retrieved from https://www.ajmc.com/journals


/supplement/2018/combating-opioid-epidemic/intro-opioid-epidemic-economic-burden-

on-healthcare-system-impact-quality-of-life?p=1

LaPointe, J. (2019). Opioid overdose care totals $1.94B in annual hospital costs. Retrieved from

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ital-costs
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.com/journals-articles/article-collections/opioid-crisis

Macy, B. (2018). Dopesick. New York, NY: Little, Brown and Company.
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dical Research, 137(4), 636-638. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articl

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Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2017). Pain management and the opioid epidemic:

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Sederstorm, J. (2016). Opioid addiction treatment: Can managed care make an impact? Retriev

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ghr.nlm.nih.gov/condition/opioid-addiction#genes
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