Growing up in Alcoholics Anonymous meetings, I was always hyperaware of staying away from substances due to the fear of addiction. My family and I joined my father in his AA meetings as he struggled with nicotine addiction and alcoholism. When my sister turned 21, my father would always warn her not to drink excessively. I wasn’t even aware that prescription medication could be abused until the media introduced me to this issue. I watched “House M.D.” and the main character was addicted to morphine. Some years later, an artist named Macklemore released two songs titled “Kevin” and “Drug Dealer,” which brought opioid addiction to light for me. I learned very quickly that there was a negative connotation that followed pharmaceutical companies and painkillers. I became angry to hear of the increase in deaths in the nation due to opioids, and this spurred my decision to research what the United States could do to address and solve this epidemic.
To begin my research, I needed to understand how opioids affect someone’s brain and lead to addiction. I began reading an article in the academic magazine Clinician Reviews titled, “Pain Management: What’s Appropriate, What’s Safe?” written by Deborah Salani et al. This article taught me that the brain has receptors which include mu, kappa, and delta lateral lines. The main sensory systems linked with pain are mu and kappa receptors. Most opioids prescribed clinically bind to mu structures which provide analgesia, or the inability to feel pain. Moreover, Salani writes, “Because mu receptors are located mainly in the brain and spinal cord (as well as the gastrointestinal tract), opioids also produce a feeling of euphoria that can lead to dependence.” I was pleased to learn and understand the effect opioids have on one’s brain. By presenting the answer to this question in my report, my audience comprised of unaware teenagers, young adults, adults who use opioids, addicts, and members of self-help groups will learn the scientific facts that show why people become addicted to opioids. This will allow those in my target audience to realize they are not weak or crazy for having a dependence on drugs, but it is important for them to find ways to get treatment and rid themselves of their addictions. Now that I knew the explanation behind opioid dependence, I wanted to focus on prescription drugs and the heavy influence they have on addicts.
To continue my research, I wanted to see if there was a relation between prescription sales and drug overdose deaths. I found a research report titled, “Mental Illness and Opioid Epidemic in the United States,” worked on by Dr. Evelio Velis et al, the current director of the Master of Science in Health Services Administration at Barry University. I learned that major depressive disorders have a strong relation with state level drug overdose deaths. I also learned that opioid overdose deaths surpass motor vehicle and gun related deaths.
Data from the Centers for Disease Control and Prevention (CDC) showed that northeastern states, such as West Virginia, New Hampshire, Ohio, Pennsylvania, and Kentucky, have the highest rates of deaths due to drug overdoses. Furthermore, most of these states, “have about 25% of their population in manual labor, which could lead that area to have more need for opioids to deal with on-the-job related injuries.” The CDC declared a “prescription drug epidemic” in 2011 and said, “prescription opioid painkillers and psychotherapeutic drugs being prescribed more widely by physicians,” was the overall issue that caused the epidemic. Moreover, while reading this report I was surprised to find an answer to another one of my questions from my research proposal. I wondered if addicts should be seen as criminals or sick people that need treatment and found that national surveys showed 75% of patients with mental illness struggle with drug and alcohol dependency. During the reports’ investigation, it was determined that, “PTSD [Post-Traumatic Stress Disorder] may also increase the risk of developing a substance use disorder (SUD) because individuals may use substances in an attempt to relieve symptoms of PTSD.” This report intrigued me as it was able to answer some of my questions and therefore inform my audience on the facts revolving this situation. Prescription sales and mental illness clearly play major roles in opioid related dependencies and deaths. Not only does this show that treatment is needed to help those suffering with opioid addiction, but this also shows that it’s not just “street junkies” troubled with this epidemic. Among the affected addicts are post-war veterans struggling with PTSD. This brings into question what we can do to accommodate post-war soldiers and regular civilians suffering from past traumas that still haunt them. Reading this report helped me realize that there is another group of victims added to my audience and that treatment for this epidemic is urgently needed.
In addition, while researching the other methods of medication to combat opioid addictions, I came upon another article that connected with my treatment question. I found an academic journal titled, “Intranasal Naloxone Administration for Treatment of Opioid Overdose,” by Amanda Robinson a Pharma. D student, and Daniel P. Wermeling a professor of Pharmacy at the University of Kentucky. While I could not find any form of medication to help reverse addiction, this article introduced Naloxone – a pure opioid antagonist – and the protocol treatment for suspected opioid overdoses. I was informed that naloxone spray is used by emergency medical service personnel as a pretreatment plan before patients arrive at the hospital. I also learned that Naloxone does not produce a physical dependency, therefore having no potential to become addicting. To continue, studies have been done to test the effectiveness of Naloxone, not only through a nasal sprays, but through I.V. fluids, muscle injections, and oral intake. Treatment has so far been successful; the article shows that, “in 2006, the Boston Public Health Commission (BPHC) started an overdose prevention program to distribute intranasal naloxone kits to “potential bystanders…” Training on the use of the kits was provided to 385 potential bystanders, and there were reports of 74 successful naloxone overdose reversals.” I was pleased to learn there is some form of overdose death preventative medication, and while this data is a bit outdated, the article says a delivery system for naloxone was being reviewed by the FDA (Food and Drugs Administration). This led me to research the FDA and the policies it has.
To finish off my research I had one final question that needed to be answered: Is the FDA too lenient on its regulations towards the pharmaceutical industry? I came across another article titled, “Renovations Needed: The FDA’s Floor/Ceiling Framework, Preemption, and the Opioid Epidemic,” by Michael R. Abrams an executive notes editor for Michigan Law Review. I learned that multiplying Japan’s daily opioid consumption 5 times over still puts it in second place behind the United States. I also found that the FDA has regulations in place that, “impose an elaborate system,” requiring pre-market approval, a rigorous labeling-approval process, and testing. However, “in 2006, without prior warning, the FDA slipped a preemptive statement into the preamble of its rulemaking on the format of prescription drug labels.” This resulted in the FDA relying on state common law to monitor post-approved drugs on the market. A string of Supreme Court cases ensued where the court held state tort laws preempted by federal administrative standards. This means any grounds for lawsuits evaporated as preemption does not allow the replacing of state remedies with federal remedies, leaving harmed victims with no ability to be compensated while providing legal immunity to companies that do harm. I was disappointed to read that although the FDA has exceptional regulatory procedures, its liability factors are where they fall short. Instead of taking the downfall on its revenues or having less manufacturers for distribution, the Food and Drugs Administration used preemption as a way to have immunity against liability. As manufacturers are also protected due to state laws, it becomes clear that federal regulations are needed to combat against this loophole and compensate victims of the epidemic.
In conclusion, I am intrigued and determined to continue researching this opioid epidemic. I am curious as to what the federal government has done aside from calling a national security. While I was able to find answers to most of my questions, I still have not found an article that describes other medications that help combat addiction – despite finding one that reverses overdoses. When I started researching this topic, I was furious. I was angry at big pharmaceutical companies and physicians for supplying potential addicts with opioids, but now I am worried. I am restlessly concerned for the wellbeing of the people in our nation and believe that what we need is a stable and well-rounded treatment plan for those affected by this epidemic.
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