Prevention Interventions to Address the Opioid Crisis
In the discussion, one selected California population. The purpose of the discussion is to identify the opioid crisis at the national and local level, identify prevention using evidence-based practice to address the practice problem of opioids, and the stakeholders addressing the issue (Chamberlain College of Nursing, 2019).
In the late 1990s, there was a change in government policies on pain control. Pain was identified as the fifth vital sign, leading to the government reducing the restriction on the prescription of opioids and the number of opioid prescriptions in response to the change. Data shows that chronic pain and injury are rampant in the rural areas, and these rural areas have a high rate of opioid prescription nationally. The opioid epidemic became a reality due to the relaxed regulation on prescribing opioids. People turn to illicit drugs to satisfy their misuse of opioids due to fewer providers’ opioids prescriptions (Ostling et al., 2018).
Comparison of the Opioid-Related Overdose Death Rates of the Selected Population to National Opioid-Related Overdose Death Rates.
California Opioid-Related Overdose Death Rate
One selected population is the state of California. In 2018, an estimated 45 percent of death was due to overdose, including opioid, leading to 2,400 tragedies (rate of 5.8). Opioid-related deaths, synthetic opioids other than methadone (mostly fentanyl and fentanyl analogs) cause over 60 percent increase in the death rate from 536 in 2017 to 865 in 2018 in California. In 2018, deaths due to heroin were constantly on the rise; 778 cases in 2018. Deaths due to prescription drugs are continually declining, a total of 1,0884 in 2018. California providers wrote an average of 35.1 prescriptions for an opioid for every 100 patients: less than the nation’s average providers’ prescription rate, 51.4 prescriptions. California is one of the lowest prescribing rates in the country (National Institute on Drug Abuse {NIDA}, 2021).
California Population
- Opioid-Related Overdose Death Rates (per 100,000 people) (2016): 13.30
- Opioid Pain Reliever Prescriptions (per 100 persons) (2015): 83.00
(Chamberlain College of Nursing, 2019).
National Opioid-Related Overdose Death Rate
The prevalence of the opioid crisis at the national level has increased for the past 15 years; an estimated 21.6 million age 12 and over reported substance dependence or abuse during the prior year. In 2014, an estimated 28 648 deaths from opioids nationally. In 2018, the nation reported 67,367 drug overdose death, and there were 4.1 percent fewer deaths than in 2017. There was a decline of about 4.6 percent to 20.7 per 100,000 standard population from the age-adjusted rate. The reduction was due to an increasing rate from 6.1 in 1999 to 21.7 in 2017. The number of deaths involving synthetic opioids outside methadone (combining fentanyl and fentanyl analogs) is still on the rise, with over 28,400 (rate of 9.9) death from overdose. Deaths from prescription opioids reduced to 14,975 (rate of 4.6) in 2018, and the deaths from heroin reduced to 14,996 (rate of 4.7). The danger of opioid dependence has disproportionately affected vulnerable and a low-income group of the population with declined access to healthcare, especially in rural areas (National Institute on Drug Abuse {NIDA}, 2021).
Identification of One Primary, One Secondary, and One Tertiary Prevention Intervention to Reduce the Misuse of Opioids in the Selected Population
Primary Prevention
Primary prevention involves an intervention instituted before any evidence of disease occurs. For example, primary prevention to reduce misuse of opioids in California involves avoiding initial and quick exposure to opioid prescription. In addition, primary prevention includes educating patients and using risk stratification to reduce opioid dose, the quantity, and the duration of use. Education also involved school-based prevention programs, community-based youth prevention programs, and reducing stigma (Kolodny et al., 2015).
Secondary Prevention
Secondary prevention targets the individual or population with identifiable risk factors for a disorder or the presence of early signs of a problem. Using prescription drug monitoring programs CURES, by setting a limit on opioid dosage, and duration. Proper referral to behavioral health services and treatment of mental illness mitigates complications from substance use. Using prescription drug monitoring programs and putting limitations on the number of pills issued and the duration used help prevent individuals from forming opioid misuse behavior (Kolodny et al., 2015).
Tertiary Prevention
Tertiary prevention seeks to reduce complications and harm once the disorder already present. Tertiary prevention includes implementing medication-assisted treatment (MAT) in primary care, making naloxone available, and providing treatment coverage for inpatient and residential treatment programs to mitigate the danger from overdoses and death (Gold & Wong, 2018).
The study also shows that promoting awareness, training, and education on naloxone distribution programs has decreased opioid abuse and encouraged the individual to seek treatment. Using naloxone, an opioid antagonist that reverses the result of opioid overdose for eliminating the opioid from the receptors in the brain, enhances opioids reverting addiction. Naloxone blocks the effects of the opioid on the brain by reversing respiratory depression caused by opioids, which decreases the likelihood of overdose and death. Expanding naloxone is crucial, especially in rural areas with reduced access to care and a high poverty rate. Tertiary prevention should also involve implementing policies to train and allow first responders to administer naloxone (Koenig, 2018).
Description of One Evidence-Based Strategy to Address Provider Opioid Prescription Rates.
Opioid overdose is a considerable contribution to the mortality rate among the population. The multidimensional management of pain is crucial to reducing the opioid crisis by identifying new cases, pre-existing incidence, and effective addiction treatment to reduce morbidity and mortality rate. Opioid prescription is a big part of opioid addiction, overdose, and death (Koenig, 2018).
Evidence-based strategy to address provider opioid prescription rate is the initiation of prescribing practices and prescription-monitoring programs. There is the requirement to check the database (CURES in California) for the previous prescription by providers before issuing a new one. Pharmacy is the last health professional patients encounter before taking their medication. Pharmacies can identify and screen for involved opioids used. The pharmacy should be involved in decreasing the opioid crisis. Reviewing medicines for safety and appropriateness is the role of pharmacies (Bach, 2019). The tight restriction has led to a reduction in opioid prescription, but the related death is still rising as people are now turning to illicit drugs (Koenig, 2018; Ostling et al., 2018).
Identification of the Stakeholders Charged with Addressing the Opioid Crisis in One’s Community.
There are over 446 000 lives lost to the opioid epidemic in the United States (U.S) every year. There is no indication that conflict of interest and the role of stakeholders is contributing to the opioid crisis. Evidence indicated that misalignment contributes to the opioid crisis, health cost, quality, and access to care is a factor (Boloori et al., 2020). The opioid crisis has impacted many communities in the U.S., including Californian communities, with approximately 2,000 deaths from opioid overdose in 2016 (Public Health Institute, 2017).
In one’s community, the pharmacists’ roles as stakeholders are preventing the opioid crisis. Pharmacists are one of the accessible healthcare interprofessional. Therefore, pharmacists have a crucial role in the community in preventing and reducing opioid-related morbidity and mortality. Strategies to reduce the mortality rate should include involving the pharmacist in monitoring problematic opioid users by identifying a potential individual for naloxone treatment. In addition, the pharmacist can carry out the distribution of naloxone and needle exchange programs to enhance harm reduction (Bach, 2019).
The providers have a crucial role in addressing the opioid crisis in one’s community—safe prescribing by providers. Using tools and educational resources such as CURES to check the pattern of opioid prescriptions before issuing the prescription will save lives from having too many pills in possession. In addition, avoiding prolonged use of opioids for pain and substituting opioids for non-opioid for both acute and chronic pain. Intervention in decreasing the opioid crisis includes increasing awareness and training providers in medication-assisted treatment (MAT). Prevention of opioids also includes making available naloxone to revert opioid overdose (Public Health Institute, 2017).
First responders, law enforcement, jails, and correctional facilities have a crucial role through the availability of naloxone to reduce the mortality from the opioid mortality rate. In addition, mental health, addiction treatment services, hospitals, providers, clinics, and healthcare have an essential role in reducing morbidity and mortality through early identification, treatment, referral, and educating the community to minimize harm (Public Health Institute, 2017).
Substance Abuse and Mental Health Services Administration (SAMHSA) is a leading agency in providing awareness to opioid addiction both at the national, local levels, and one’s community. In addition, SAMHSA promotes awareness, coalition-based, education and resources to families (Public Health Institute, 2017).
One’s Professional Experience Related to the Topic.
Even though patients have difficulty getting prescription opioids, this has led them to seek illicit synthetic opioids such as fentanyl. Synthetic fentanyl is easier to obtain and cheaper but much deadly. Using a controlled substance utilization review and evaluation system (CURES) has helped reduce the number of opioid and other control substances misused in California. Even though the state of California recommended checking the CURES every four months, I have identified a quick change in patients’ prescription patterns. Some patients combine a controlled substance such as opioids with benzodiazepine, hypnotics, sedatives, and stimulants. I have a policy of not prescribing the combination. I also do not give more than thirty pills at a time and no refill. Monitoring the patients every month and randomly doing urine drug checks has helped me combat this furnishing crisis. I make sure I use the medication in a short time. For those patients coming to me as new and are already on the medication, I work out a plan on gradually weaning them off for six months to one year to reduce more complications from withdrawal symptoms.
In conclusion, the United States has been dramatically affected by the burden of opioid crisis-related morbidity and mortality. The hope that reducing opioid prescription and dispersing with other measures will reduce the population’s exposure to opioids and other drugs and reduce misused incidence. For now, awareness on mental health and drug use should be promoted and increase access to mental health services and specialists to fight the opioid crisis (Ostling et al., 2018).
References
Bach, P. (2019, September). Leveraging the role of the community pharmacists in the prevention, surveillance, and treatment of opioid use disorders. Addiction Science & Clinical Practice, 14(1), 30.
https://doi.org/10.1186/s13722-019-0158-0 (Links to an external site.)
Boloori, A., Arnetz, B.B., Viens, F., Maiti, T., & Arnetz, J.E. (2020, October). Misalignment of stakeholder incentives in the opioid crisis. International Journal of Environmental Research and Public Health, 17(20).
Chamberlain College of Nursing, (2019). NR-704 week four: Prevention interventions to address the opioid crisis. [Online lesson]. Downers Grove, IL: Adtalem.
Gold, S., & Wong, S. (2018). Preventing opioid addiction. The role of integrated behavioral health. 2.
Koenig, K.L. (2018, May). The opioid crisis in America: Too much, too little, too late. West J. Emerg Med, 19(3), 557-558. https://10.5811/westjem.2018.2.38087 (Links to an external site.)
Kolodny, A., Courtright, D.T., Hwang, C.S., Kreiner, P., Eadie, J.L., Clark, T.W. & Alexander, C.G. (2015, January). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574. https://doi.org/10.1146/annurev-publhealth-031914-122957 (Links to an external site.)
National Institute on Drug Abuse {NIDA}, 2021, May). California: Opioid-involved deaths and related harms. Retrieved from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state (Links to an external site.)/california-opioid -involved-deaths-related-harms
Ostling, P.S., Davidson, K.S., Anyama, B.O., Helander, E.M., Wyche, M.Q., & Kaye, A.D. (2018, May). America’s opioid epidemic: A comprehensive review and look into the rising crisis. Current Pain and Headache Reports, 22(5). https://doi.org/10.1007/s11916-018-0685-5 (Links to an external site.)
Public Health Institute, (2017). Tackling an epidemic. An assessment of the California opioid safety coalition network. Retrieved from https://www.phi.org
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