Opiate Abuse in Young Adults Essay

The opioid epidemic is a widespread issue throughout the United States. The epidemic first began through large pharmaceutical companies convincing doctors that they were non-addictive, combined with pressure from the federal government for hospitals to focus on pain relief to meet accreditation standards. Opiates were then being prescribed at alarming rates, with pharmaceutical companies and doctors raking in large profits. However, the nation began to become addicted to these medications, and incidents of overdose began to rise rapidly. Several legislative policies and laws have been enacted to fight this epidemic. Young adults are the age group most at-risk for abusing opiates. They are also the segment of the population that sees the most fatalities due to opiate overdose. The ecosystems theory of social work can be an effective lens with which to view this epidemic to truly understand the scope of the problem.

Opiate abuse is a widespread problem affecting many different race, genders, and socioeconomic classes. One group that is particularly impacted is the young adult age range, ages 18 to 25. There have been policies and legislation implemented in attempts to combat the opiate epidemic in the United States, however much work needs to be done on this issue.

The opiate epidemic in the United States dates back to the 1980’s. The New England Journal of Medicine published one paragraph about a study that reported that oxycodone provided non-addictive relief for pain. The paragraph failed to mention that the study was done on just a small number of closely supervised patients in hospitals (Quinones, 2015).

Big pharmaceutical companies, such as Purdue Pharma, launched aggressive marketing campaigns, including hosting physicians at conferences held at fancy resorts to tell them the benefits of OxyContin (Quinones, 2015). Purdue Pharma also applied for FDA approval, asserting that the addiction rate was a mere one percent. The company did not disclose, however, that the initial data came from that small sample of patients being supervised in a hospital setting. The FDA believed Purdue’s claims and licensed OxyContin in late 1995 and soon many doctors began prescribing it routinely (Quinones, 2015).

In the late 1990’s, pharmaceutical companies were assuring physicians that patients would not become addicted to these substances, so they began to prescribe at increasingly higher rates (United States Department of Health and Human Services, 2018). Additionally, in this same timeframe, pain management began to become a focus in healthcare settings. Pain became known as the “fifth vital sign” and physicals were encouraged to aggressively address pain. The federal government began to rate hospitals from one to five smiley faces based on how they handled pain. Physicians were pressured to prescribe opiates as the standard of care. The criteria for accreditation and patient satisfaction rested on if a patient’s pain was resolved by the doctor (Sonick, 2017). As Solnik stated, “Much of the opiate epidemic, in other words, came out of not a war on drugs, but a war on pain” (2017).

Doctors began opening “pill mills” where a mere three-minute appointment could get patients prescriptions for OxyContin. Doctors made significant amount of money in this way. Additionally, senior citizens, who had limited income, began to supplement their income by selling extra OxyContin for a dollar a milligram (Quinones, 2015).

As the death toll increased and the cost to the government increased through Medicaid and Medicare spending, pharmaceutical companies came under fire (Solnik, 2017). Further research was eventually released that showed that opiates were in fact highly addictive. By then, prescribing had already increased at alarming rates. Both big pharmacy and physicians were making high profits. Patients were becoming increasingly dependent on opiates and business was booming. In 2012, there were 259 million prescriptions written for opiates, the amount equivalent to the entire adult population of the United States (Brady, McCauley, and Back, 2016).

By the early 2000’s, the opiate epidemic was in full swing. Data from the 2012 National Survey on Drug Use and Health indicated that 12.5 million Americans reported abusing prescription opioids, increased from 4.9 million in 1992 (Substance Abuse and Mental Health Services Administration, 2013). Rates of unintentional opiate overdose increased almost fourfold between the years of 2000 and 2010. They now accounted for more than half of all overdose deaths (Brady, McCauley, and Back, 2016).

The Social and Economic Justice Implications of Opiate Abuse

The impact of opiate abuse is widespread. In addition to the nearly 150 deaths per day, millions of more people are impacted through direct and indirect injuries, emotional distress, social issues, and loss of productivity (Hodge, Wetter, and Noe, 2017). People who abuse opiates report significant diminishment in quality of life, including relationships, finances, and health. Abuse of opiates is associated with higher risks of contracting diseases, such as HIV and Hepatitis, as well as premature death (Morse and MacMaster, 2015).

The public health impact is also huge. There are increased emergency department visits and increased need for substance abuse treatment (Mackesy-Amiti, Donenberg, and Ouellet, 2015). In 2007, it was estimated that the cost to society of opioid abuse, including health care consumption, lost productivity, and criminal justice costs, were estimated at 55.7 billion (Morse and MacMaster, 2015).

On a local level, across North Carolina in 2017, nearly 530 million opiates were dispensed, which is an average of 78.3 opiate pills prescribed per person per year, based on the total number of residents per capita (Carter, 2018).

Current Policies and Legislation Regarding Opiate Abuse

The federal government has recognized the seriousness of this epidemic and has begun to devote policies, legislation, research, and funding to the cause. The Drug Enforcement Agency (DEA) and Federal Drug Administration (FDA) are the two primary federal agencies that are in charge of overseeing opioid misuse prevention efforts. The DEA imposes penalties when they find physicians that are inappropriate prescribing, to include jail time, fines, and revocation of licensure. The FDA requires drug manufactures to complete Risk Evaluation Mitigation Strategies (Brady, McCauley, and Back, 2016).

The Office of National Drug Control Policy has worked to expand the National Drug Control Strategy. It now includes four specific recommendations regarding the enhancement of efforts to prevent opioid abuse. These recommendations include education of patients and providers about risks, enhancing the prescription monitoring program utility, increasing proper disposal of prescriptions, and assisting law enforcement addressing key sources of diversion. These include cracking down on doctor shopping and pill mills (Brady, McCauley, and Back, 2016).

The Affordable Care Act, introduced during President Obama’s tenure, provides great access to Substance Use Disorder treatment through major coverage expansions and changes to the regulatory requirements of coverage for Substance Use Disorder treatment in existing insurance plans (American Journal of Public Health, 2017). This enabled a broader range of access to treatment than was previously available. The Affordable Care act enables states to address the opioid epidemic through four primary mechanisms. These include expansion of insurance coverage, regulatory reforms of insurance that require the inclusion of Substance Use Disorder treatments, enhanced parity, and opportunities to integrate treatment into mainstream healthcare (American Journal of Public Health, 2017).

President Trump, though initially resistant, declared the opiate crisis a national emergency in 2017, thereby authorizing for additional funding to be used on prevention and treatment of this public health crisis (Hodge, Wetter, and Noe, 2017). His office announced an aggressive new initiative aimed at cutting nationwide opioid prescriptions by one third in three years (Hodge, Wetter, and Noe, 2017).

In 2016, Congress passed the Compressive Addiction and Recovery Act. This act supports greater access to naloxone, a life-saving emergency treatment for opiate overdose. The act also improved treatment of prisoners and pregnant woman and funded task forces on drug trafficking and illegal prescribing practices (Hodge, Wetter, and Noe, 2017). Several months later, the 21st Century Cures Act designated $1 billion in state grants for opioid prevention (Hodge, Wetter, and Noe, 2017).

In February 2018, Centers for Medicare and Medicaid Services proposed restrictions on the amount of opioids that Medicare beneficiaries could receive. This was in an attempt to reduce oversupply of opiates in the community. Several additional bills have been proposed in 2018, to include HR 4275 which is geared toward requiring DEA to aid pharmacists in better detecting of fraudulent prescriptions and HR 5401, designed to increase safe disposal of unused medications. HR 2063 would require continued education for people who prescribe opioids (Hodge, Wetter, and Noe, 2017).

In addition, federal efforts, much of the legislative efforts has been at the state government level, which means that it varies greatly from state to state (Brady, McCauley, and Back, 2016). Both state and federal level governments are shifting away from criminalization of illicit drug use and instead focusing on prevention, treatment, and rehabilitation. Nearly all states have enacted Good Samaritan statues, which shield medical professionals from liability in prescribing, dispensing, or administering naloxone (Hodge, Wetter, and Noe, 2017).

In August of 2017, the state of South Carolina sued Purdue Pharma, makers of OxyContin. They, along with several other states, have accused Purdue of unfair and deceptive marketing tactics. South Carolina has alleged in the lawsuit that Purdue fueled the opioid crisis by “downplaying the addictive nature of prescription opioids and overstating their benefits” (Hodge, Wetter, and Noe, 2017).

Young Adults and Opiate Abuse

While all ages, races, and socioeconomic classes are impacted by opiate abuse, one specific population is particularly at risk. Studies show that the young adult population, ages 18-25 years of age, is at the highest risk of opiate abuse. Studies show that this age group comprises the largest number of opioid abusers, as well as abusers of prescription stimulants and antianxiety drugs (National Institute on Drug Abuse, 2016). The National Institute on Drug Abuse (2016) reports that 12% of young adults age 18 to 25 reported using prescription drugs nonmedically within the past year. In 2011, the rate of substance abuse among young adults age 18 to 25 was 18.6%, higher than young (6.9%) and adults aged 26 and older (6.3%) (Substance Abuse and Mental Health Services Administration, 2012).

Cross-section studies have found that there are certain factors associated with increased risk of opioid abuse. These include age 18-25 years old, male gender, psychiatric disorders, exposure to violence or sexual assault, and a personal or family history of illicit drug use (Brady, McCauley, and Back, 2016).

In 2014, there were more than 1700 young adults who died due to prescription drug overdose, primarily opioids. This is more overdose fatalities than any other drug combined. Additionally, many more young adults required emergency medical services due to opioid abuse (National Institute on Drug Abuse, 2016). The number of young adult deaths in 2014 has increased nearly fourfold from the number in 1999, which constitutes an average of five young adults dying of prescription drug overdose every day (National Institute on Drug Abuse, 2016).

A study by Guarino, Mateu-Gelabert, Teubl, and Goodbody (2018) examined young adult opioid use trajectory, with specific research on the progression of opioid abuse to heroin, then injection, then treatment outcomes, and overdose. Their results suggested that” there is a predictable and ordered pathway by which opioid users tend to progress” (Guarino, Mateu-Gelabert, Teubl, and Goodbody, 2018). In their study, the young adults reported first nonprescribed use of opiates at the average age of 16.8. Most of their subjects progressed to heroin use (83%) and heroin injection (64%) within four years. The researchers found that participants did not typically access drug treatment until after they had already progressed to heroin use and that their first overdose typically occurred less than a year after their first use of heroin (Guarino, Mateu-Gelabert, Teubl, & Goodbody, 2018).

The National Institute on Drug Abuse (2016) reports that 12% of young adults age 18 to 25 reported using prescription drugs nonmedically within the past year. Additionally, young adults tend to enter treatment with higher levels of substance abuse and more anti-social behaviors, such as more illegal activities, more serious family problems, more difficulty controlling their violent behavior, and increased likelihood of pending legal action (Morse and MacMaster, 2015).

Theoretical Framework as Lens to View Intersectionality of Opiate Abuse and Young Adult Population

The intersectionality of opiate abuse and young adults naturally lends itself to the ecological and systems theory. These two theories combine to the ecosystems framework. In viewing the situation through this lens, one can examine not just the individual, but the family impact, and the larger system impact. The social worker could more accurate address the scope of the impact that opiate abuse has on not just the young adult themselves, but on all of the many ecosystems with which they are connected.

Ecological theory has a focus on inter-relational transactions between systems. Due to the interconnectedness of all of the systems impacted by this crisis, it is imperative that it be examined through this lens. Families have been impacted, school communities, medical communities, public health, substance abuse treatment facilities, pharmaceutical companies and physicians. There are so many various implications to not just how this opioid epidemic came to be, but what the best solution would be. The financial, political, interpersonal, cultural, and societal impacts of this epidemic must all be examined.

Systems theory, therefore, naturally lends itself to this as well. Systems theory examines the parts that make up the whole. This is an effective lens to view this epidemic, as there are many different stakeholders to this epidemic, and may people have been affected by it. Additionally, a solution will only be effective if the needs of all impacted systems are addressed.

The opioid epidemic is a crisis within the United States that first began nearly forty years ago. The implications of this epidemic have been widespread. The young adult population is particularly affected by this epidemic, as research shows they are the group most at risk for use and with the highest reported usage and overdose fatalities. It is imperative that this issue be examined through several theoretical frameworks so that one can develop an in-depth and well-rounded idea of the scope of this epidemic.

References

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