Opioid Epidemic in the United States

Introduction of the Issue/Problem

The opioid epidemic is taking over the United States like a wild fire and is what I would say, a national emergency that needs to be stopped. "Opiates affect the central nervous system and produce feelings of tranquility, drowsiness, or euphoria" (Zastrow, 2014, p. 267"One of the biggest reasons for the opioid epidemic is the over prescription of the drugs themselves to patients. The sales of prescribed opioids raised four times the amount between the years of 1999 to 2008 and this ultimately resulted in four times the amount of deaths due to opioids in the same amount of item (Theisen, Jacobs, Macleod, & Davies, 2018, p. 754). The United States prescribes more than 50 times the opioids that all of the other countries in the world added prescribe, together (Theisen, 2018, p. 754). Furthermore, approximately 6% of the population within the United States that were between the ages of 15 and 64 said that they abused opioid drugs in 2015 (Theisen, 2018, p.754). There are other studies that show that between 12 and 24 percent of people who are prescribed opioids for pain will abuse their prescription and one time or another (Kirsh, Peppin, & Coleman, 2012).

According to Kirsh et al. (2012), the amount of people who visited the ER due to prescribed opioids had gone from 198,114 in 2004 to 477,936 in 2009. The epidemic is only getting worse, and these numbers of people who have to go to the ER due to prescribed opioids have probably gone up tremendously since this journal was written. Jones, Christensen, and Gladden (2017) discussed how there was a major spike in the amount of prescription opioid abuse that was not oral (p. 93). The most increased way of administering prescription opioids according to the study was through injection in which 11.7% admissions claimed injection as their way of administering prescribed opioids in 2004 compared to 18.1% in 2013, which was in a 55% overall increase (Jones, Christensen, & Gladden, 2017, p. 93).

A 50 percent increase is an extremely large number, but the fact that it occurred within nine years is even more alarming. Data further shows that the amount of accidental drug overdoses that resulted in death in the USA increased five times since 1990 (Kirsh, 2012). Ultimately, overdosing on drugs has resulted in causing the most deaths by injury in the United states since 2015 (Theisen, 2018, p.754). The spike in the abuse of prescription opioids in extremely alarming, along with the fact that it is resulting in the use of other dangerous opioids, such as heroin, as substitutes since they are a cheaper fix. Not only is the amount of abuse rising according to the articles, but the number of deaths resulting from this abuse is rising significantly. The rest of the paper will further elaborate on this issue and a resource in Oklahoma that is one of many places that help with opioid addiction.

Impact of the Issue on a Population or Subset of Population

I picked a broad topic in the opioid abuse epidemic that has been plaguing the United States for years now. Ultimately I did not pick a specific target group due to the seriousness of the epidemic itself on all people. There was a wide variety of information on the topic of opioid abuse, but not as much on specific subjects from specific regions that were scholarly sources, in my opinion. Along with this, I am interested in the overall numbers of opioid abuse on all populations anyways. Therefore, I am focusing on anyone that is affected by the opioid epidemic that is ravishing through this country, the statistics that show this increase, and ways in which to help this issue. There are many ways in which opioid addiction affects not only addicts, but their families, communities, and states. First, approximately 59.5% of prescribed opioids go unused by patients in the United States (Theisen, 2018, p.755). This number represents the what is making people either sober or opioid addicts. This large quantity of over prescribed opioids gives people more chances to get their hands on the drugs and to become addicted, ultimately changing their lives forever in one way or another. Overprescribing gives adolescents the ability to go into their parents cabinet and stealing opioids along with giving the patient themselves the ability to going back to taking the medication at any time they want. Overprescribing opioids is what ultimately leads to many of peoples addictions to these drugs, later resulting in the possible use of more dangerous opioids such as heroin.

Secondly, addicts are changing from orally taking opioids to other, non-oral, means of taking the drugs (Jones, Christensen, & Gladden, 2017 p. 89). "Non-oral routes of abuse provide faster drug delivery and onset compared to oral use, thereby intensifying the delivery and onset compared to oral use, thereby intensifying the reinforcing, euphoric effects of opioids and increasing vulnerability to addiction" (Jones, Christensen, & Gladden, 2017, p. 89). This switch to taking opioids by other means is causing there to be even more of an epidemic occurring within the United States. These other means of taking opioids results in the addiction being more severe and there is also a higher chance of overdose (Jones, Christensen, & Gladden, 2017, p. 89).

The process of taking drugs by means of needles would also raise the risk of catching diseases such as HIV (Jones, Christensen, & Gladden, 2017, p. 90). This means that the drug addicts are using ways to get stronger highs, running the risk of overdosing or catching a disease due to the increase in the non-oral administering of opioids. Lastly, prescription opioid addicts are turning to more dangerous opioids such as heroin due to the difference in price and availability. The U.S. Department of Human Services (2015) describes how there was a 39% spike between 2012 to 2013 in just heroin related deaths alone. "A Centers for Disease Control and Prevention (CDC) analysis of 28 states from 2010 to 2012 shows heroin overdose death rates in 2012 highest among: adults aged 25-34 years old; White, non-Hispanic people; Men; and people living in the Northeast and Midwest" (U.S. Department of Human Services, 2015). These facts are significant in the understanding of opioid abuse and it further drives my theory about young people getting into unused prescribed opioids. I believe young men are most susceptible to opioid addiction due to either experimentation or by being prescribed opioids due to some form of pain because of manual labor. Eventually prescription opioids become expensive, hard to find, or tolerance is formed, therefore, making addicts turn to other drugs such as heroin. Heroin is becoming such a dangerous drug due to what drug dealers are cutting the heroin with, ultimately spiking overdoses and ruining more families lives.

Current Prevention & Intervention Efforts

The agency I chose to talk about is Rolling Hills hospital which is located in Ada, Oklahoma. The agency first starts off rehabilitation by medical detoxification in which the agency states they pay attention to safely having patients withdraw from opioids while also receiving an established clinical treatment (Mental Health & Drug Addiction Treatment Center | Ada, Ok | Rolling Hills Hospital, n.d.). Patients at Rolling Hills see the facility's psychiatrist a at least three times a week to evaluate the patients and to treat any mental health issues, along with giving medicine out occasionally to help with withdraws. Each patient goes to a form of individual therapy on a weekly basis, adolescents go for at least two hours a week, while the website states that the rest of the patients simply attend weekly (Mental Health & Drug Addiction Treatment Center | Ada, Ok | Rolling Hills Hospital, n.d.). This therapy can help the patients at Rolling Hills better understand why they started their abusing medication. Not only is there individual therapy on a weekly basis, there is also group therapy specific to different things such as for anger and coping, along with topics for people recovering from substance abuse (Mental Health & Drug Addiction Treatment Center | Ada, Ok | Rolling Hills Hospital, n.d.). Family therapy is an important aspect to the treatment process at Rolling Hills and occurs on a weekly basis for all of the members. Adolescents have to have a licensed therapist present during their family therapy (Mental Health & Drug Addiction Treatment Center | Ada, Ok | Rolling Hills Hospital, n.d.).

I got in contact with a lady from Rolling Hills hospital who gave me some additional information. She said that the agencies official name is Avenues Recovery Center of Oklahoma, something I did not see on the website. She stated that Rolling Hills provides residential care in which clients receive group therapy, individual therapy, family therapy, equine therapy, art therapy, rehabilitation services, educational lectures, medical assistance and mental health services as well. Clients find Rolling Hills through several different ways such as web search, word of mouth, detox centers, emergency room staff, or AA/NA meetings. She stated that Rolling Hills accepts private pay and private insurance. The fee for Rolling Hills is $12,000 a month and she did not say whether they have any form of financial assistance that patients can receive for this treatment facility. Lastly, she stated that the facility consisted of a Psychiatrist, a nurse practitioner, LADC, PHD, LPC, LMFT, LCSW, and a LMSW. There are many ways to find educational information about opioid addiction such as on YouTube and websites in general over the topic. Social Work's Impact on the Issue The NASW has had a hand in helping with the substance abuse epidemic with federal drug policies along with behavioral health and in the justice system (Wilson, p. 11).

Not only is substance abuse in Oklahoma a major issue, but so is rehabilitation and incarceration rates of offenses related to substances. "Over the years, NASW has continued to support drug-related legislation such as the Fair Sentencing Act which led to parity on sentences for convictions for crack-cocaine as compared to powder cocaine" (Wilson, p. 11). That is one of the main issues with Oklahoma is the fact that drug offense sentences generally are much longer than they should be and while incarcerated, the perpetrator does not get any kind of rehabilitation to help them. The NASW is so focused on helping with the opioid epidemic that they joined the Coalition to Stop Opioid Overdose and this speaks heavily on how the NASW is trying to make changes in society related to this topic. I listened to a podcast over opioids on the NASW website by a recovering addict who has been sober since 2009 in which he describes the organization he started, the reality of substance abuse, and some ways to fix substance abuse. Many people try to state that addiction is not a disease, but David describes how even the American Medical Association stated that addiction was a disease (Stoecker, 2018).

This is not only an opioid epidemic but a pandemic in general for all drugs due to the fact of rising substance abusers. He drove the concept of showing the values of empathy, unconditional positive regard, and compassion to help form solutions for the opioid epidemic (Stoecker, 2018). Harm reduction & recovery supports need more attention spent on them in order also to help with the fight on addiction (Stoecker, 2018). In several classes I have been in while in the social work program, students have discussed issues with the drug epidemic and that addiction is a disease. There is even an organization at the University of Oklahoma known as Students in Recovery (SIR) that was organized to help students who are in recovery. The support SIR has received further shows the support for recovery from students in the social work program. When searching the CSWE website, there are many articles over substance abuse.

I did not find anything particular on the website though that discussed the perspective that CSWE has, it simply showed different articles related to the subject from the browser on the website. The state has addressed the opioid abuse epidemic in several ways here recently. The state of Oklahoma passed Bill 1446 that would change the limit of opioids that are allowed to be prescribed to patients in the state starting November 1st, 2018 (Burkes, 2018). This law will make it to where doctors can only prescribe enough opioids to last a client for 7 days and before a prescription can be written the doctor has to do a re-evaluation (Burkes, 2018). The state of Oklahoma also has a program called the Screening, Brief Intervention, and Referral to Treatment (SBIRT). "SBIRT is a public health evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and drugs" (Oklahoma Department of Mental Health and Substance Abuse Services - Prevention in Practice, n.d.). SBIRT is a great intervention tool for identifying the amount of risk that there is to substance abuse finding an intervention for it Oklahoma Department of Mental Health and Substance Abuse Services - Prevention in Practice. (n.d.). Both of these state programs are great tools to help to try and slow down the amount of substance abuse on prescription opioids in Oklahoma.

There are three values I would like to discuss in this part of the paper, which are social justice, dignity and worth of the person, and integrity. Social justice has to do with the social change for people who are in either vulnerable or helpless peoples (NASW, 2017). This value could involve advocating for funding and programs to help with the opioid epidemic. Dignity and worth of the person deals with the way in which social workers treat individuals in the field in a caring, respectful way (NASW, 2017). This value would involve the social workers making sure the people affected by opioid abuse are heard and that there is treatment for all peoples affected by the epidemic. Lastly, integrity is the last value and deals with the understanding of a social worker's job and the values and ethical principles that they have to abide by (NASW, 2017). It is a social workers job to do everything in their power to work for the subjects at hand, while still staying within the values and ethics set for them by the NASW.

Summary/Conclusion

Many different Acts and programs have fell short or completely failed when it came to trying to help with the lowering of substance abuse both nationally and at a federal level. As stated earlier by David Stoecker (2018), the war on drugs miserably failed. As it is known throughout history such as when the alcohol prohibition happen in the 1920's, there was an increase in alcohol consumption. Ultimately, the prohibition was stopped due to the fact that it made things worse instead of making anything, and I feel as if the war on drugs did the exact same thing in the United States. When things are taken away from people it makes it more tempting to do risky behavior when it comes to what was taken away.

I like the Bill I discussed earlier that was passed in Oklahoma to limit the amount of opioids being prescribed and made there be evaluations before each prescription. However, I feel that many people can still work the system and receive opioids weekly simply by lying to the physician who is prescribing them. I feel that there may need to be more testing done on patients by the means of x-rays and physicals to see who has actual structural chronic pain to receive opioids. The people who do not have chronic pain with an identifiable source would then receive medication but it would not be strong opioids such as hydrocodone. I think a system like this could very well work, but there are people with chronic pain and there is no way for a doctor to see it, therefore, the patient would be in pain without the stronger opioids. Therefore, I am not sure how to fix this bill completely but I feel as if this is a start by having the doctors running more extensive tests on patients before prescribing opioids. Social workers have the capability of making a big impact in the opioid epidemic in the United States.

Social workers can advocate for change at the Oklahoma capitol, demanding more funds for programs to help people who are affected by opioids and substance abuse in general. Social workers have the ability also to be the counselor to a person in recovery and potentially change their life for the better. Social workers can help reform the criminal justice system in which there is a lowering in severity of sentences for drug offenders and also offering these offenders rehabilitation while incarcerated. It is the social worker's job to make change in society and the everyday life of the citizens they serve, therefore, they can make tremendous changes if they stand together and fight for what is right.

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