Determining a social problem to zero in on is no easy task. Currently, the news is focusing in healthcare, women’s rights, gay rights, and police brutality. These issues hit home for several individuals, but none match the reach of the topic of this paper. Over the past few years, there has been an increasing amount of reporting on this one particular hot topic. This topic was dealt with in private or denied altogether for years, but this alone does not separate it from the other hot button issues of today’s news. What separates it from the others lies in the following sentence. It is an issue that eludes social class, economic status, race, and even gender. Therefore, it touches more than just one group of individuals. What is the hot topic? It is opioid addiction.
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The National Institute on Drug Abuse describes opioids as derivatives of the opium poppy plant, but it does not make this an exclusive character. Not all opioids are made the same. Some are made in a laboratory from synthetic material designed to mimic the benefits of the natural form. Opioids are often utilized for their ability to ease pain and other symptoms of discomfort. The feeling opioids gives to those who use it, per the website for the National Institute on Drug Abuse, is likened to a relaxed high. This results in opioids being used to treat other conditions as well. When looking for the common names for some of these drugs, you are going to see Fentanyl- the drug that is rumored to have killed Michael Jackson, Hydrocodone- also known as Vicodin, and Morphine- the best drip pain medicine you will get at your local ER (just kidding). The point is that this class of drugs is common used in the medical field. If you are injured and in moderate pain, then it is likely you were prescribed one of these. If you are undergoing surgery, then it is likely you were prescribed one of these to manage the pain afterwards. The question becomes then where did this medication cross the line from being a regular pain reliever to the death sentence we have come to know it as? Glad you asked.
Explaining the Social Problem
Cicero and Ellis (2017) referenced that past focus on answering why opioid abuse has grown was limited to interviews. For their article, they wanted to review peer-led research to get to the bottom of the issue. Three of the common motivations Cicero and Ellis (2017) found was to cope with life stressors, to self-medicate psychological issues, and pain management. What they noted was each of those areas produced a cycle of need, or dependency. For those with life stressors, the opioid provided a break from the stressors of life. This goes back to feeling a relaxed high described by the National Institute of Drug Abuse. For those with psychological issues, opioids appeared to relieve their anxiety and free them from the constraints of their minds. Basically, it helped them to be normal participants in society. For those with pain management needs, the opioids provided a type of double-whammy. It relieved their pain, which is the desire. Problem was they were dependent upon them. Trying to lessen the opioid use proved to be just as problematic thanks to withdrawal symptoms. To reduce the withdrawal symptoms, they returned to opioids.
The Effects of Opioid Addiction
Opioid addiction is not a black problem, a Hispanic problem, or a poor-man’s problem. No, it crept into the houses of the rich and the poor equally. Though many can argue it more specifically crept into the houses of white America at an alarming rate, the reach of the problem is not easily contained to racially motivated agendas. The Center for Disease Control estimates that, on average, 115 Americans die ever day from an opioid overdose (CDC, 2017). This number is not broken down by race, indicating the desire to make this everyone’s problems in America. This number is not broken down by class or sex or any other identifiers, though the research exists for all of those areas. Again, this points to the emphasis being placed on making opioid addiction the major problem area of America. The problem is broken down by the state a person resides in.
For the state of Tennessee, the focal area of this paper, the issue with opioid addiction takes on an interesting approach. There were 1186 opioid deaths in Tennessee alone in 2016, which is a rate of 18 deaths per 100,000 persons (NIH website, 2018). In 2017, this number is reported to be 1268 which is an increase of 82 persons (TN.gov website, 2018). The daily average amounts to roughly 3 people per day dying as a result of their addiction to opioids (TN Together website, 2018). Pointing again to opioid addiction being everyone’s problem, the Tennessean ran a story in August of 2018 on the opioid crisis hitting the streets of Williamson County. The story reported that from the year 2012 to 2016 there has been 10 deaths from opioid addiction per 100,000 people. That is in one county in Tennessee alone. Those who reside in Tennessee or have any knowledge of the area, know Williamson County to be one of the richest in the state. Even with all the wealth, it is not immune to the damages of Opioid addiction. Again, opioid addiction has reached everyone.
Prescribing the Problem
Within the state of Tennessee, the issue of opioid abuse takes another dark turn. The National Institute on Drug Abuse reports that the national rate of opioids prescribed runs about 70 prescriptions per 100 persons. For the state of Tennessee, the National Institute on Drug Abuse reports a rate of 118 prescriptions per 100 persons. See the problem? Not only are the opioid rates reported to be higher in Tennessee than else where in the United States, but the state is also topping the list of supplying the demand of the very problem plaguing the state. To remedy this, one would assume you could just lower the amount of prescriptions being written. However, Pitt et al (2018) points out that this may lead to both positive and negative responses. The positive outcomes could be simply limiting the supply, but you risk the negative of a rise in synthetic street versions to offset the limited access to the real thing. Pitt et al (2018) also point out that while some may be motivated to seek treatment for their addiction if their supply is cut off, others may transition to harsher drugs such as heroin. All of this should be considered when addressing public policy.
Assessing Public Policy
Pitt et al (2018) suggests using what they call modeling to determine the short-term and long-term responses to the opioid epidemic. Looking at a 5-year and 10-year model, the team of researchers sought to determine how various solutions and policies to reduce the opioid addiction epidemic affected the population. What the team found was that programs and policies targeting the expansion of treatment programs were immediately beneficial with little ramification of increasing the number of overdoses or addiction related deaths (Pitt et al, 2018). Policies that focus primarily on reducing the number of prescriptions were found to have a negative impact on addiction related deaths since those who were opioid dependent may, as mentioned prior, turn to other drugs like heroin. This led Pitt et all (2018) to conclude that policymakers must weigh the ethical outcomes of their decisions.
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The state of Tennessee answered the call to weigh the ethical decisions by developing “TN Together”, which is an initiative to end the opioid crisis. From the tn.gov website, this program seeks to address the issue by attacking it from three angles. First, this program seeks to work in the area of prevention. Next, it focuses in on treatment. The last installment is on Law Enforcement. Let us examine each of these areas further.
The prevention piece focuses primarily on limiting the amount of opioid prescriptions written by handing down prescribing limits such as supply guidelines and dosage boundaries. Going back to the research by Pitt et al (2018), while this approach is well meaning, there is not much mention of the consideration needed to offset the potential growth in the demand for other drugs like heroin. It is easy to assume this category also includes more patient education on the dangers associated with taking opioids, even as prescribed. However, again, there is no clear understanding of this in the brief description provided under the TN Together section on the tn.gov website. The greater breakdown of the actual legislation shows that preventative measures are not limited to simply educating the public but also those in the medical field.
The same can be said for the other two focal areas. Both, the area of treatment and law enforcement, are broken down further into tangible objectives than disclosed on the initial website. They boast a strong focus on meeting the immediate need of the opioid epidemic, but neither focus on the potential effects of the crackdown on this problem. Again, this supports the claim made by Pitt et al (2018) that ethical considerations should be made by policymakers. Law enforcement and treatment are great initiatives, but one must question will this be enough?
While it is great to meet the immediate need, you have to look at the possible long-term results. Opioid addiction has proven to be a huge need for the American population, including the state of Tennessee. Opioid addiction has proven to be America’s Problem, not being centralized to one specific area or location. Across the United States of America, initiatives are being drafted and passed to combat the problem. A great law enforcement and treatment effort have gone out to combat the problem. Problem is we have seen this play out before in the past. Looking at the policies on this issue moving forward, the focus will be on what can be done differently to actual reduce and remove the addiction, not just transpose it over into another, potentially more lethal form.
- TN.gov. 2018. https://www.tn.gov/opioids/about-tn-together.html
- Pitt, A. L., Humphreys, K., & Brandeau, M. L. (2018). Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. American Journal of Public Health, 108(10), 1394-1400. doi:10.2105/ajph.2018.304590
- Cicero, T. J., & Ellis, M. S. (2017). The prescription opioid epidemic: a review of qualitative studies on the progression from initial use to abuse. Dialogues in Clinical Neuroscience, (3), 259. Retrieved from https://ezproxy.mtsu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN613122290&site=eds-live&scope=site
- Sauber, Elaina. (2018). The Opioid Crisis Has Hit Williamson County. Why Aren’t More People Talking About It? The Tennessean. http://tennessean.com/story/news/local/williamson/2018/08/16/opioid-crisis-williamson-county-tn/
- NIH. (2017). National Institute on Drug Abuse. https://www.drugabuse.gov
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